Vital pulp treatment for traumatized permanent teeth: A systematic review

Area of Science:

• Endodontics
• Dental Traumatology
• Regenerative Dentistry

Background:

• Traumatic dental injuries frequently affect the pulp in permanent teeth.
• There is a need to assess the evidence quality for vital pulp treatment (VPT) success in traumatized teeth.

Purpose of the Study:

• To systematically review the success of vital pulp treatment (VPT) in managing traumatized human vital permanent teeth.
• Focus on teeth diagnosed with complicated crown or crown-root fractures.

Main Methods:

• Systematic review including controlled clinical trials, cohort studies, case-control studies, and case series (≥5 cases, ≥12-month follow-up).
• Searched multiple databases (Web of Science, Scopus, PubMed, etc.) up to August 2021.
• Assessed study quality using NIH tools; excluded non-English literature.

Main Results:

• Included 14 studies (2 RCTs, 1 case-control, 11 case series) involving 1081 teeth.
• Partial pulpotomy showed high success (82.9-100%); complete pulpotomy (79.4-85.7%) and direct pulp capping (19.5%) had lower rates.
• Calcium hydroxide, Biodentine®, MTA, and IRoot® BP demonstrated favorable success rates, though with limited supporting studies.

Conclusions:

• VPT demonstrates high reported success rates for pulpally involved traumatized teeth.
• A significant paucity and low quality of available evidence from well-conducted clinical studies were identified.
• Further high-quality research is needed to substantiate these findings.