Title Vital Pulp Therapy using Bioceramic Materials Is a Treatment Option for Patients Presenting with Reversible or Irreversible Pulpitis
Clinical Question For patients presenting with reversible or irreversible pulpitis in mature teeth, do pulpotomies performed with bioceramic materials have long-term successful outcomes compared to nonsurgical root canal therapy (NS-RCT)?
Clinical Bottom Line For mature teeth (teeth with closed apices) diagnosed with reversible or irreversible pulpitis, there is sufficient evidence to support vital pulp therapy using bioceramic material as a long-term alternative to root canal therapy.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
31229496Cushley/2019431 teeth received treatment in 8 studiesSystematic review of randomized trials
Key resultsThe systematic review reported the success rate of pulpotomies on mature teeth with irreversible pulpitis at 12- and 36-month follow-up. At 12 months, the calculated clinical and radiographic success was >92%. At 36 months, the clinical and radiographic success was >84%. Subgroup analysis in 3 publications by Asgary et al. 2013, 2014, 2015 compared pulpotomy with NS-RCT in randomized controlled trial. 12-, 24-, and 60-month follow up showed comparable success rates between pulpotomy and NS-RCT with the success rate decreasing for both treatments as the follow-up time increased.
31515048Elmsmari/2019512 teeth treated/11 studiesMeta-Analysis
Key resultsSuccess rate of partial pulpotomy on carious pulp exposure in teeth with reversible and irreversible pulpitis at 6 months was 98%, at 1 year was 96%, and at 2 years was 92%. According to subgroup analysis, the 1-year success rate for teeth diagnosed with reversible pulpitis was 98%, and with irreversible pulpitis, 75%. Due to no significant changes in success rate after 6 months, it is considered an appropriate time period for evaluating success of partial pulpotomy treatment. In this systematic review, there is no difference in success rate between protocols using calcium hydroxide or the bioceramic mineral trioxide aggregate (MTA) as the capping material.
Evidence Search Subheading: therapy MeSH Terms: adult; dental pulp; therapeutics; Irreversible pulpitis; root canal therapy; vital pulp therapy; pulpotomy
Comments on
The Evidence
Validity: The Cushley/2019 systematic review included four prospective single-arm studies, one retrospective study and one randomized controlled trial with parallel arms (Asgary 2013, 2014, 2015). Meta-analysis could not be performed due to the heterogeneity in study design of the included studies. Among these studies, the Taha & Abdullkhader and Qudeimat et al. studies had small sample sizes with only 20 and 24 teeth respectfully. The Asgary study showed evidence of high bias including detection and performance bias. Three different bioceramic materials were used - MTA, biodentin and calcium-enriched mixture cement - suggesting varied protocols. In the Elmsmari/2019 study, the lower treatment success rate associated with irreversible pulpitis compared with reversible pulpitis may be attributed to the smaller sample size or the end-point of the partial pulpotomy procedure (remaining diseased tissue). Perspective: Based on the systematic reviews, pulpotomy using bioceramics is a valid treatment option for teeth with reversible or irreversible pulpitis and has a similar prognosis as conventional NS-RCT.
Applicability This information can benefit a practitioner when discussing different treatment options for a patient who has reversible or irreversible pulpitis. Vital pulp therapy is a good treatment alternative when a provisional therapy is needed for a reason such as insufficient treatment time or limited patient finances. Well-designed, better powered randomized controlled trials are needed for more evidence; however, these studies show that there is good long-term prognosis of vital pulp therapy in permanent teeth.
Specialty (Endodontics) (General Dentistry)
Keywords vital pulp therapy, pulpotomy, permanent teeth, adult, reversible/irreversible pulpitis, bioceramics
ID# 3417
Date of submission 12/16/2019
E-mail wangp1@livemail.uthscsa.edu
Author Pei Wang
Co-author(s) Alicia Casarez-Quintana, DDS
Co-author(s) e-mail casarezquint@uthscsa.edu
Faculty mentor Asma Khan, BDS, PhD
Faculty mentor e-mail KhanA2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available