Vital Pulp Therapy in Permanent Teeth: A Systematic Review and Meta-Analyses.

Purpose: To determine factors affecting permanent tooth vital pulp therapy (VPT) success from a systematic review (SR) and metaanalyses.

Methods

SRs of databases were completed through June 2024, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used for the certainty of evidence.

Results

The 24-month indirect pulp treatment (IPT), direct pulp capping (DPC), partial pulpotomy (PP), and full pulpotomy (FP) successes (91 to 97 percent) were not statistically different (P=0.19) in teeth diagnosed with normal pulp/reversible pulpitis (NP/RP). IPT (94 percent) versus DPC (87 percent) success at 36 months was not significantly different when calcium silicate cement (CS) was used for DPC in teeth diagnosed with NP/RP (P=0.10). PP success versus DPC was equal (96 percent) after 24 months in teeth diagnosed with NP/RP if CS was used for DPC. Teeth exhibiting symptomatic irreversible pulpitis (SIP) were defined as exhibiting spontaneous unprovoked pain, lingering thermal pain, or referred pain, and may have periapical pathosis/involvement or not. One study's data on the five-year success rate for FP in teeth with SIP was 78 percent, and teeth without PPI showed significantly increased success (P=0.04). PP/FP success (90 percent) in teeth with SIP was not significantly different versus PP/FP success (97 percent) in NP/RP teeth (P=0.054). Selective caries removal minimized pulp exposures in teeth with deep caries diagnosed with NP/RP. For teeth diagnosed with SIP or extremely deep caries, complete caries removal is recommended to expose the pulp. If pulpal bleeding is controlled, it is recommended to perform a full pulpotomy. Hemo- stasis within six minutes likely improves pulpotomy success. Mineral trioxide aggregate was found to discolor teeth significantly more (83 percent) than Biodentine (zero percent) containing no bismuth oxide (P<0.001) PP/FP were significantly more successful for traumatic pulp exposures than DPC (P ≤ 0.001). Root maturity did not affect PP/FP success for NP/RP teeth.

Conclusions

All vital pulp therapy methods are successful for teeth diagnosed with normal pulp/reversible pulpitis. Teeth diagnosed with symptomatic irreversible pulpitis can be treated successfully with a full pulpotomy.