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Pulpotomy for treatment of complicated crown fractures in permanent teeth: A systematic review
Aisling Donnelly1, Federico Foschi1,2,3, Paul McCabe4
1Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.
Background:
Consensus on the treatment of choice for complicated crown fractures of teeth is limited. Recent guidance recommends vital-pulp-therapy; however, the preferred type is not specified. Higher success rates for pulpotomy compared to pulp-capping have been documented, which suggests pulpotomy may be a preferable option for complicated crown-fractures.
Objectives:
The purpose of this systematic review was to determine the success rate of pulpotomy (partial and complete) on teeth that suffered complicated crown fractures.
Participants:
patients who have suffered a complicated crown fracture to an anterior permanent tooth.
Intervention:
pulpotomy (partial or complete). Comparator: pulp-capping or root canal treatment.
Outcome:
combined clinical and radiographic success at or after 12 months.
Methods:
A systematic literature using key search terms was conducted using PubMed, Web of Science and Cochrane-Central-Register-of-Controlled-Trials (CENTRAL) as well as a grey literature search from inception to May 2021 and without language restricted to English. Strict inclusion criteria were applied. A standardized tool with defined criteria to assess the risk of bias in each study was used. For non-randomized comparative trials, the Robins-I tool was used while the Newcastle-Ottawa scale was used for non-comparative non-randomized studies.
Results:
Seven retrospective clinical studies were included. The studies reported high success rates for pulpotomy with overall success ranges for partial or complete pulpotomy ranging from 75% to 96%. One study compared the success rates of pulpotomy to an alternative treatment option pulp capping (90.9% vs. 67%, respectively). Due to the lack of homogeneity in the included studies, a meta-analysis was not possible.
Discussion:
This review highlights the limited evidence based for the current guidance on treatment of complicated crown fractures. The findings of the review indicate high success rates for pulpotomy; however, there is a moderate risk of bias and small sample sizes in the included studies with the result that the overall results should be interpreted with caution.
Conclusion:
Within the limitations of this review, the benefits and high success rates reported for partial pulpotomy suggest this procedure, rather than pulp-capping, should be considered as the treatment of choice for both immature and mature teeth that have suffered complicated crown-fractures.
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