Which procedures and materials could be applied for full pulpotomy in permanent mature teeth? A systematic review

Zanini, Marjorie; Hennequin, Martine; Cousson, Pierre-Yves

doi:10.1080/00016357.2019.1614217

Cited by 29 publications

(27 citation statements)

References 73 publications

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“…The recent literature reports that pulpotomy in teeth with partial irreversible pulpitis has a high success rate (Zanini et al . 2019) and the outcome is comparable to root canal treatment (Asgary et al . 2015, Galani et al .…”

Section: Discussionmentioning

confidence: 55%

Association between concentration of active MMP‐9 in pulpal blood and pulpotomy outcome in permanent mature teeth with irreversible pulpitis – a preliminary study

et al. 2020

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Aim To investigate the correlation between the concentration of active‐matrix metalloproteinases‐9 (aMMP‐9) in pulpal blood and the outcome of pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis (SIP). Methodology Forty permanent molar teeth with a clinical diagnosis of SIP and normal apical tissues with periapical index (PAI) score ≤ 2 and ten permanent teeth (8 molars and two premolars) with a diagnosis of normal pulp that required root canal treatment for prosthetic reasons from patients between the ages of 15–35 years were recruited. All clinical procedures were performed under local anaesthesia and rubber dam isolation. After access opening, the coronal pulp tissue was amputated up to the canal orifice. A 100 μL volume of the pulpal blood was collected using a micropipette and transported to the laboratory. Sodium hypochlorite (2.5 %) was used as a haemostatic agent, and mineral trioxide aggregate (MTA) was used as the pulp capping material. The tooth was restored with composite at the same visit. Teeth with normal pulps were treated with single‐visit root canal treatment. Patients with pulpotomy were recalled at 6 and 12 months. Outcome assessment of teeth with pulpotomy was carried out at 12 months and was categorized as success (asymptomatic patients with PAI score ≤ 2) or failure (symptomatic patients or PAI score ≥ 3). Quantification of aMMP‐9 in pulpal blood was achieved using a fluorometric assay. The following statistical analyses were performed to assess the data: t‐test, Fisher's exact test, kappa coefficient, non‐parametric test, Wilcoxon rank‐sum test, Spearman rank correlation test and receiver operating characteristic curve (ROC). Result The success rate of pulpotomy was 88 % at 12‐months. There was a significant difference between the median concentrations of aMMP‐9 in pulpal blood of teeth with normal pulps (52 (12–96) ng mL−1:) and SIP (193.3 (25.8–607.7) ng mL−1:) (P = 0.0003) and successful (132.3 (25.8–548.3) ng mL−1:) and failed cases (512.4 (334.8–607.7 ng mL−1:) (P = 0.0015) of MTA pulpotomy. A significant association was established between aMMP‐9 concentration and outcome of pulpotomy. The area under the receiver operating characteristics curve (0.9484, 95%CI) suggested excellent discriminatory power of aMMP‐9 concentration in pulpal blood to predict the pulpotomy outcome. Conclusion The pulpal blood concentration of aMMP‐9 was significantly associated with the outcome of pulpotomy in teeth with symptomatic irreversible pulpitis, where it may be used as a potential prognostic biomarker.

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Section: Discussionmentioning

confidence: 55%

Association between concentration of active MMP‐9 in pulpal blood and pulpotomy outcome in permanent mature teeth with irreversible pulpitis – a preliminary study

et al. 2020

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“…Despite the favorable outcomes of VPT in permanent mature teeth with irreversible pulpitis captured in this review and a previous one [39], universal goals, case selection and outcome criteria need to be established for VPT when considered as an alternative to NSRCT [45]. As well as this, because the outcome of VPT depends on several procedural factors, such as the anesthetics used, removal technique of carious tissue, strict disinfection and bleeding control [48], dressing materials [7], type of permanent restoration [47], and possibly the use of magnification [10], the reports from different geographical areas and clinical settings are required to validate the universal applicability of VPT for permanent mature teeth with symptomatic irreversible pulpitis.…”

Section: Discussionmentioning

confidence: 98%

“…The consideration of a mature permanent tooth as a candidate for VPT requires careful assessment of the extent of damage to the pulp tissue, using clinical and radiographic measures [47]. The pulp condition, routinely surmised pre-operatively from past and present signs and symptoms and responses to clinical tests, must be confirmed intraoperatively by the assessment of pulpal bleeding, tissue color and consistency [48]; if pulp exposure does not elicit bleeding, the coronal pulp may be infected and necrotic, contraindicating a VPT procedure [10].…”

Section: Discussionmentioning

confidence: 99%

“…Because the composition of the anesthetic used may impact hemostasis, it may directly influence the intra-operative assessment of the pulp condition. As well as this, the best protocol for hemostasis is yet to be established, with all of saline solution, different concentrations of sodium hypochlorite, hemostatic agents, chlorhexidine, corticosteroid paste, and compression with a dried cotton pellet reportedly used for this purpose [47].…”

Section: Discussionmentioning

confidence: 99%

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Vital Pulp Therapy in Permanent Mature Posterior Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review of Treatment Outcomes

et al. 2021

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Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed®, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle–Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as ‘high’ or ‘serious’, ‘fair’, and ‘low’ for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions: The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.

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“…Many studies recommended observing the pulpal bleeding and the ability to control it, rather than depending on the preoperative clinical signs/symptoms (4,26). However, the profuse bleeding which is difficult to control confirms severe pulp inflammation (27). The solution used for hemostasis in this study was 2.5% of NaOCl, as it aids in disinfecting and rapid control of bleeding of the access cavity, as recommended by many previous recent clinical trials (21,28).…”

Section: Discussionmentioning

confidence: 97%

Regenerative Pulpotomy as a Novel Technique for Treatment of Permanent Mature Molars Diagnosed with Irreversible Pulpitis Using Platelet-Rich Fibrin: A Case Series Study

Mobarak

Genena

et al. 2020

Alexandria Dental Journal

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Which procedures and materials could be applied for full pulpotomy in permanent mature teeth? A systematic review

Cited by 29 publications

References 73 publications

Association between concentration of active MMP‐9 in pulpal blood and pulpotomy outcome in permanent mature teeth with irreversible pulpitis – a preliminary study

Association between concentration of active MMP‐9 in pulpal blood and pulpotomy outcome in permanent mature teeth with irreversible pulpitis – a preliminary study

Vital Pulp Therapy in Permanent Mature Posterior Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review of Treatment Outcomes

Regenerative Pulpotomy as a Novel Technique for Treatment of Permanent Mature Molars Diagnosed with Irreversible Pulpitis Using Platelet-Rich Fibrin: A Case Series Study

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