Partial pulpotomy for carious pulp exposure in adult mature permanent teeth: a systematic review and meta-analysis

Deep carious lesions often lead to pulp exposure, highlighting the need for effective pulp preservation strategies. While root canal treatment was the conventional approach, alternatives like partial pulpotomy (PP) showed high success rates in maintaining pulp vitality. This review aimed to assess the success rates of PP in vital, mature teeth with carious pulp exposure, particularly focusing on adults aged 18 and older, as recent research is limited.

This systematic review (PROSPERO ID: CRD42024494545) examines the success rate of partial pulpotomy in adult mature permanent teeth with carious pulp exposure after at least one year of follow-up. The PICO framework outlines the population (adults with mature teeth), intervention (partial pulpotomy), comparators (various capping materials and pulp therapies), and outcome (success rates). Databases used for research included PubMed, ScienceDirect, Cochrane Library, and Embase. Inclusion criteria focused on RCTs and observational studies from 2000 to 2025 involving adults with deep carious pulp exposure, while exclusion criteria eliminated animal studies, case reports, and studies on primary teeth. Quality assessment tools included the Cochrane RoB 2 tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Mesh terms used included ("pulpotomy" OR "pulp therapy") AND ( "mature" OR "adults") OR ("carious" OR "Pulp exposure").

The search yielded six randomized controlled trials reported in eight records and three observational studies from 42,320 records, highlighting significant success rate differences among capping materials. PP using Calcium hydroxide (CH) had a mean success rate of 34.3% (95% CI: [24.93%, 43.67%]), while tri-calcium silicate materials (MTA and Biodentine) achieved 86.8% (95% CI: [83.78%, 89.82%]), resulting in a 52.5% mean difference. Timing of restoration also influenced outcomes: immediate restorations had a success rate of 89.9%, whereas delays reduced rates significantly. Meta-regression indicated tri-calcium silicate use increased success by 37% (P = 0.0002), while each day of delay decreased success by 0.088 (P = 0.023). Further analysis found no significant difference between pulpotomy and full pulpotomy (pooled effect estimate: -0.77) CI: [-1.62 to 0.09].

Partial pulpotomy (PP) is an effective treatment for carious pulp exposure in adults, with success largely dependent on the material used; tri-calcium silicate cements are preferred over calcium hydroxide.

This systematic review, registered with PROSPERO (ID: CRD42024494545).

Although PP is a successful clinical treatment affected by material choice and restoration timing, it is crucial to report and study age-related considerations to enhance clinical decision-making among practitioners.