Effectiveness of Pulpotomy in the Management of Symptomatic Irreversible Pulpitis in Mature Permanent Teeth: An Umbrella Review.

The objective of this umbrella review is to analyze the conclusions drawn from systematic reviews and meta-analyses on pulpotomy effectiveness in the treatment of irreversible pulpitis in mature permanent teeth, focusing on the impact of pulp capping materials and factors influencing treatment outcomes. A search of electronic databases (PubMed, Science Direct, Google Scholar, CINAHL, Cochrane Library) was conducted up to December 2022 using the keywords: Pulpotomy, Child, Permanent mature teeth, Irreversible pulpitis. The methodological quality of systematic reviews was assessed using the AMSTAR (A Measurement Tool to Assess Systematic Reviews) 2 tool. Of the 332 articles selected, 11 were chosen for data extraction, focusing on pulpotomy success in treating irreversible pulpitis in mature permanent teeth, and evaluating the influence of materials and techniques on outcomes. Applying AMSTAR 2 criteria, only one systematic review was rated "moderate" quality; most were rated as "low" to "very low" quality. This umbrella review reported a very high pulpotomy success rate, up to 100%, varying with materials and follow-up duration. Pulpotomy success rates range from 37% to 100%, depending on the material used, with Biodentine® (Septodont, Saint-Maur-des-Fossés, France), achieving the highest success rate. Short-term pulpotomy success rates ranged from 80% to 95%, exceeding root canal treatment, while long-term outcomes remain comparable. Pulpotomy success depends on pre- and perioperative conditions, hemostasis, and definitive coronal restoration. Analysis of systematic reviews indicates that pulpotomy is a promising alternative to conventional root therapy for managing irreversible pulpitis in mature permanent teeth. Available evidence remains limited, emphasizing the need for high-quality trials to confirm its effectiveness.