Top

Published in:

01-04-2022 | Original Article

Is pulpotomy a promising modality in treating permanent teeth? An umbrella review

Authors: Galvin Sim Siang Lin, Yun Qing Yew, Hern Yue Lee, Ting Low, Manushantini Pillai Muralitharan Pillai, Thittikkon Suvanpratum Laer, Sharifah Wade’ah Wafa Syed Saadun Tarek Wafa

Published in: Odontology | Issue 2/2022

Abstract

Emerging evidence suggests the use of less invasive therapy such as pulpotomy in treating permanent teeth with pulp exposure and signs of pulpitis. Hence, this umbrella review aims to evaluate the available systematic reviews on pulpotomy treated permanent teeth. Articles published between January 1970 and May 2021 were searched in ten electronic databases and five textbooks. Only systematic reviews published in English that examined the use of pulpotomy on either carious or traumatic pulpal exposed in mature or immature permanent teeth with signs of pulpitis were selected. The Corrected Covered Areas (CCAs) were calculated to identify the overlap in primary studies, whereas the AMSTAR 2 assessment tool was used to analyze the risk of bias in each included review. Nine systematic reviews were chosen of which two systematic reviews focused solely on coronal pulpotomy, one on partial pulpotomy, and the remaining focused on both coronal and partial pulpotomies. Overall, only two reviews were rated as ‘High Quality’. Umbrella analyses showed that both coronal and partial pulpotomies revealed overall high success rates ranging from 88.5% to 90.6%. However, the currently available evidence on the effects of different pulpal medicaments and restorative materials on the success rate of pulpotomy were still inconclusive. Pulpotomy can be regarded as a promising modality in treating mature and immature permanent teeth with carious pulpal exposure or signs of pulpitis. Nonetheless, further high-quality clinical trials with long-term follow-up and better control of confounding factors are warranted in the future.

Cushley S, Duncan HF, Lappin MJ, Tomson PL, Lundy FT, Cooper P, et al. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: a systematic review. J Dent. 2019;88: 103158. https://doi.org/10.1016/j.jdent.2019.06.005.CrossRefPubMed

European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of endodontology. Int Endod J. 2006;39(12):921–30. https://doi.org/10.1111/j.1365-2591.2006.01180.x.CrossRef

Solomon RV, Faizuddin U, Karunakar P, Deepthi Sarvani G, Sree SS. Coronal pulpotomy technique analysis as an alternative to pulpectomy for preserving the tooth vitality, in the context of tissue regeneration: a correlated clinical study across 4 adult permanent molars. Case Rep Dent. 2015;2015: 916060. https://doi.org/10.1155/2015/916060.CrossRefPubMedPubMedCentral

Lin GSS, Hisham ARB, Cher CIY, Cheah KK, Ghani N, Noorani TY. Success rates of coronal and partial pulpotomies in mature permanent molars: a systematic review and single-arm meta-analysis. Quintessence Int. 2021;52(1):196–208. https://doi.org/10.3290/j.qi.b912685.CrossRef

Soni HK. Biodentine pulpotomy in mature permanent molar: a case report. J Clin Diagn Res. 2016;10(7):9–11. https://doi.org/10.7860/JCDR/2016/19420.8198.CrossRef

Namour M, Theys S. Pulp revascularization of immature permanent teeth: a review of the literature and a proposal of a new clinical protocol. ScientificWorldJournal. 2014;2014: 737503. https://doi.org/10.1155/2014/737503.CrossRefPubMedPubMedCentral

Lin GSS, Nik Abdul Ghani NR, Mokhtar K, Halim MS. Endodontic management of a mature mandibular first permanent molar that survived for 20 years after complete pulpotomy: a case report. Arch Orofac Sci. 2019;14(2):169–75. https://doi.org/10.21315/aos2019.14.2.372.CrossRef

Kang CM, Sun Y, Song JS, Pang NS, Roh BD, Lee CY, et al. A randomized controlled trial of various MTA materials for partial pulpotomy in permanent teeth. J Dent. 2017;60:8–13. https://doi.org/10.1016/j.jdent.2016.07.015.CrossRefPubMed

Asgary S, Eghbal MJ, Fazlyab M, Baghban AA, Ghoddusi J. Five-year results of vital pulp therapy in permanent molars with irreversible pulpitis: a non-inferiority multicenter randomized clinical trial. Clin Oral Investig. 2015;19(2):335–41. https://doi.org/10.1007/s00784-014-1244-z.CrossRefPubMed

10.

Alqaderi H, Lee CT, Borzangy S, Pagonis TC. Coronal pulpotomy for cariously exposed permanent posterior teeth with closed apices: a systematic review and meta-analysis. J Dent. 2016;44:1–7. https://doi.org/10.1016/j.jdent.2015.12.005.CrossRefPubMed

11.

Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132–40. https://doi.org/10.1097/XEB.0000000000000055.CrossRefPubMed

12.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71. https://doi.org/10.1136/bmj.n71.CrossRefPubMedPubMedCentral

13.

Cameron AC, Widmer RP. Handbook of pediatric dentistry. Philadelphia: Elsevier Health Sciences; 2008.

14.

Duggal M, Cameron A, Toumba J. Paediatric dentistry at a glance. Hoboken: Wiley; 2012.

15.

Koch G, Poulsen S. Pediatric dentistry: a clinical approach. Hoboken: Wiley; 2009.

16.

Srivastava VK. Modern pediatric dentistry. New Delhi: Jaypee Brothers Medical Publishers Pvt. Limited; 2011.CrossRef

17.

Welbury R, Duggal MS, Hosey MT. Paediatric Dentistry. Oxford: Oxford University Press; 2018.CrossRef

18.

Pieper D, Antoine SL, Mathes T, Neugebauer EA, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol. 2014;67(4):368–75. https://doi.org/10.1016/j.jclinepi.2013.11.007.CrossRefPubMed

19.

Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358: j4008. https://doi.org/10.1136/bmj.j4008.CrossRefPubMedPubMedCentral

20.

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. https://doi.org/10.1136/bmj.39489.470347.AD.CrossRefPubMedPubMedCentral

21.

Muhammad SZ, Ahmed A, Shahid I, Khalid A, Menezes RG, Sheikh MU, et al. Chest computed tomography findings in hospitalized COVID-19 patients: a systematic review and meta-analysis. Infez Med. 2020;28(3):295–301.PubMed

22.

Zafar K, Nazeer MR, Ghafoor R, Khan FR. Success of pulpotomy in mature permanent teeth with irreversible pulpitis: a systematic review. J Conserv Dent. 2020;23(2):121–5. https://doi.org/10.4103/JCD.JCD_179_19.CrossRefPubMedPubMedCentral

23.

Chen Y, Chen X, Zhang Y, Zhou F, Deng J, Zou J, et al. Materials for pulpotomy in immature permanent teeth: a systematic review and meta-analysis. BMC Oral Health. 2019;19(1):227. https://doi.org/10.1186/s12903-019-0917-z.CrossRefPubMedPubMedCentral

24.

Li Y, Sui B, Dahl C, Bergeron B, Shipman P, Niu L, et al. Pulpotomy for carious pulp exposures in permanent teeth: a systematic review and meta-analysis. J Dent. 2019;84:1–8. https://doi.org/10.1016/j.jdent.2019.03.010.CrossRefPubMed

25.

Taylor GD, Vernazza CR, Abdulmohsen B. Success of endodontic management of compromised first permanent molars in children: a systematic review. Int J Paediatr Dent. 2020;30(3):370–80. https://doi.org/10.1111/ipd.12599.CrossRefPubMed

26.

Elmsmari F, Ruiz XF, Miro Q, Feijoo-Pato N, Duran-Sindreu F, Olivieri JG. Outcome of partial pulpotomy in cariously exposed posterior permanent teeth: a systematic review and meta-analysis. J Endod. 2019;45(11):1296-306 e3. https://doi.org/10.1016/j.joen.2019.07.005.CrossRefPubMed

27.

Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. J Endod. 2011;37(5):581–7. https://doi.org/10.1016/j.joen.2010.12.004.CrossRefPubMed

28.

Ward J. Vital pulp therapy in cariously exposed permanent teeth and its limitations. Aust Endod J. 2002;28(1):29–37. https://doi.org/10.1111/j.1747-4477.2002.tb00364.x.CrossRefPubMed

29.

Asgary S, Nourzadeh M, Eghbal MJ. Miniature pulpotomy of symptomatic mature permanent teeth: a report of two cases. Iran Endod J. 2016;11(1):75–8. https://doi.org/10.7508/iej.2016.01.015.CrossRefPubMed

30.

Hennessy EA, Johnson BT. Examining overlap of included studies in meta-reviews: guidance for using the corrected covered area index. Res Synth Methods. 2020;11(1):134–45. https://doi.org/10.1002/jrsm.1390.CrossRefPubMed

31.

Arditi C, Burnand B, Peytremann-Bridevaux I. Adding non-randomised studies to a Cochrane review brings complementary information for healthcare stakeholders: an augmented systematic review and meta-analysis. BMC Health Serv Res. 2016;16(1):598. https://doi.org/10.1186/s12913-016-1816-5.CrossRefPubMedPubMedCentral

32.

Peinemann F, Tushabe DA, Kleijnen J. Using multiple types of studies in systematic reviews of health care interventions—a systematic review. PLoS ONE. 2013;8(12): e85035. https://doi.org/10.1371/journal.pone.0085035.CrossRefPubMedPubMedCentral

33.

Faggion CM Jr, Atieh M, Zanicotti DG. Reporting of sources of funding in systematic reviews in periodontology and implant dentistry. Br Dent J. 2014;216(3):109–12. https://doi.org/10.1038/sj.bdj.2014.47.CrossRefPubMed

34.

Drucker AM, Fleming P, Chan AW. Research techniques made simple: assessing risk of bias in systematic reviews. J Invest Dermatol. 2016;136(11):e109–14. https://doi.org/10.1016/j.jid.2016.08.021.CrossRefPubMed

35.

Higgins J, Thompson S, Deeks J, Altman D. Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice. J Health Serv Res Policy. 2002;7(1):51–61. https://doi.org/10.1258/1355819021927674.CrossRefPubMed

36.

Gentles SJ, Stacey D, Bennett C, Alshurafa M, Walter SD. Factors explaining the heterogeneity of effects of patient decision aids on knowledge of outcome probabilities: a systematic review sub-analysis. Syst Rev. 2013;2:95. https://doi.org/10.1186/2046-4053-2-95.CrossRefPubMedPubMedCentral

37.

Seifo N, Cassie H, Radford JR, Innes NPT. Silver diamine fluoride for managing carious lesions: an umbrella review. BMC Oral Health. 2019;19(1):145. https://doi.org/10.1186/s12903-019-0830-5.CrossRefPubMedPubMedCentral

38.

Ayorinde AA, Williams I, Mannion R, Song F, Skrybant M, Lilford RJ, et al. Assessment of publication bias and outcome reporting bias in systematic reviews of health services and delivery research: a meta-epidemiological study. PLoS ONE. 2020;15(1): e0227580. https://doi.org/10.1371/journal.pone.0227580.CrossRefPubMedPubMedCentral

39.

Stewart L, Moher D, Shekelle P. Why prospective registration of systematic reviews makes sense. Syst Rev. 2012;1:7. https://doi.org/10.1186/2046-4053-1-7.CrossRefPubMedPubMedCentral

40.

Egger M, Zellweger-Zähner T, Schneider M, Junker C, Lengeler C, Antes G. Language bias in randomised controlled trials published in English and German. Lancet. 1997;350(9074):326–9. https://doi.org/10.1016/s0140-6736(97)02419-7.CrossRefPubMed

41.

American Academy of Pediatric Dentistry. Guideline on pulp therapy for primary and immature permanent teeth. Pediatr Dent. 2016;38(6):280–8.

Title: Is pulpotomy a promising modality in treating permanent teeth? An umbrella review
Authors: Galvin Sim Siang Lin
Yun Qing Yew
Hern Yue Lee
Ting Low
Manushantini Pillai Muralitharan Pillai
Thittikkon Suvanpratum Laer
Sharifah Wade’ah Wafa Syed Saadun Tarek Wafa
Publication date: 01-04-2022
Publisher: Springer Singapore
Published in: Odontology / Issue 2/2022
Print ISSN: 1618-1247
Electronic ISSN: 1618-1255
DOI: https://doi.org/10.1007/s10266-021-00661-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is pulpotomy a promising modality in treating permanent teeth? An umbrella review

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2022

Microgap and microleakage of a hybrid connection platform-switched implant system in the absence or presence of a silicone-based sealing agent

Synergistic effect of thymoquinone and nystatin in the treatment of oral candidiasis; an in vitro study

Effects of phytosomal curcumin treatment on modulation of immunomodulatory and pulp regeneration genes in dental pulp mesenchymal stem cells

Occlusal problems, mental health issues and non-carious cervical lesions

Correction to: Evaluation of low-viscosity bulk-fill composites regarding marginal and internal adaptation

Association between root taper and root proximity of single-rooted teeth with periodontitis: a cone-beam computed tomography based study