28 November 2023

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Pulpotomies of permanent teeth performed with bioactive materials: Evaluation of success

Lara Figini

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Recent literature studies have shown that vital pulp treatments (VPT) can be effective both in deciduous teeth but also in mature permanent teeth with irreversible pulpitis (Lin et al., 2020). One type of VPT is pulpotomy, which involves removal of only the coronal pulp with the aim of protecting the root pulp tissue. This procedure is used in cases of pulp exposure caused by trauma or deep decay, where the exposed pulp is still viable, inflamed but capable of healing (Lin et al., 2020). Once the coronal pulp has been partially or completely removed, the remaining pulp tissue is covered with a material suitable to promote healing, a biocompatible material, which can promote the formation of hard dental tissue and carry out antimicrobial activity without being toxic to the residual pulp tissues (Chen et al., 2019). These materials include bioactive cements, such as pastes based on calcium hydroxide, or enriched with calcium mixtures (CEM), mineral trioxide aggregates (MTA) and other cements based on calcium silicate, also called bioceramics . The International Association of Dental Traumatology (2020) recommends calcium hydroxide paste and MTA as the best materials for pulpotomy in permanent teeth with pulp exposure due to trauma.

Materials and methods

In a recent systematic review, published in International Endodontic Journal, the authors evaluated the success rate of pulpotomies on permanent teeth, performed with ProRoot MTA compared to those performed with calcium hydroxide and other bioceramic materials. A comprehensive search was conducted through several electronic databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase and Science Direct up to December 2022. The search was guided by the PICOS criteria and included only clinical trials randomized trials (RCTs) that evaluated the success rate of pulpotomy treatments in permanent teeth using ProRoot MTA compared to calcium hydroxide and other bioceramic materials. The quality of included studies was assessed using the RoB-2 for risk of bias and relevant data were extracted and analyzed using RevMan 5.3 software. The GRADE tool was used to determine the overall quality of the evidence.

Results

Of the 1,072 studies initially identified, 16 studies were included in the final systematic review, of which 10 were considered to be at high risk of bias. Pulpotomy overall showed an average success rate of 92% after 1 year. The meta-analysis indicated significantly higher success for pulpotomies performed with MTA compared to calcium hydroxide, while no significant difference was observed between MTA and calcium-enriched materials (CEM) or Biodentine. The GRADE assessment revealed an overall low level.

Conclusions

From the data of this review, which must be confirmed in other similar studies and reviews, it can be concluded that pulpotomy is a highly effective treatment for the management of permanent teeth. The results indicate that the success rate of pulpotomy using the ProRoot MTA is significantly higher than that of pulpotomy with calcium hydroxide.

Info: Success rate of permanent teeth pulpotomy using bioactive materials: A systematic review and meta-analysis of randomized clinical trials. Emmanuel J. N. L. Silva, Karem P. Pinto, Felipe G. Belladonna, Claudio M. A. Ferreira, Marco A. Versiani, Gustavo De-Deus. Int Endod J. September 2023;56