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Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-analysis.

James A Coll1, N Sue Seale2, Kaaren Vargas3

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|March 16, 2017
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Summary
This summary is machine-generated.

Indirect pulp therapy (IPT) and pulpotomy using mineral trioxide aggregate (MTA) or formocresol (FC) show the highest success rates for primary teeth with deep caries. Direct pulp capping (DPC) also has similar outcomes but with lower quality evidence.

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Area of Science:

  • Pediatric Dentistry
  • Endodontics
  • Dental Materials Science

Background:

  • Vital pulp therapy (VPT) aims to preserve the vitality of inflamed or exposed pulp in primary teeth.
  • Common VPT options include indirect pulp therapy (IPT), direct pulp capping (DPC), and pulpotomy.
  • Determining the superior VPT for primary teeth with deep caries is crucial for long-term dental health.

Purpose of the Study:

  • To systematically review and meta-analyze the outcomes of IPT, DPC, and pulpotomy in primary teeth.
  • To compare the success rates of different vital pulp therapies after a minimum of 12 months.
  • To identify if any specific vital pulp therapy (VPT) demonstrates superior efficacy for deep caries in primary teeth.

Main Methods:

  • A comprehensive search of multiple databases (MEDLINE, EMBASE, CENTRAL, etc.) was conducted from 1960 to September 2016.
  • Included were parallel and split-mouth randomized controlled trials (RCTs) of at least 12 months duration.
  • Primary outcome was overall success (clinical and radiographic); meta-analysis and GRADE approach were used for evidence quality assessment.

Main Results:

  • Forty-one articles were included in the meta-analysis.
  • Twenty-four-month success rates: IPT (94.4%), DPC (88.8%), and pulpotomy (82.6%).
  • Mineral trioxide aggregate (MTA) and formocresol (FC) pulpotomy showed high success rates (89.6% and 85.0%) with high-quality evidence, superior to calcium hydroxide (CH).

Conclusions:

  • Indirect pulp therapy (IPT) and pulpotomy using MTA or FC are supported by the highest success rates and quality of evidence for deep caries in primary teeth.
  • Direct pulp capping (DPC) demonstrated comparable success rates to IPT and MTA/FC pulpotomy, but with lower quality evidence.
  • These findings guide clinical decisions in vital pulp therapy for pediatric patients.