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

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.