Long-term outcomes of vital pulp therapy in teeth affected by dental caries or trauma: A systematic review
Ananya Kaul, Rajesh Shetty, Anil Pardeshi, Poonam Joshi, Ankita MathurAbstract
Background:
The utilization of vital pulp therapy (VPT) has significantly increased in immature and mature permanent teeth due to the advancement in calcium silicate-based biomaterials like Mineral Trioxide Aggregate (MTA), Biodentine, and other modern bioceramic formulations. However, long-term longevity and available evidence for treatment outcomes in different clinical conditions are still in a heterogeneous form. The study aimed to systematically assess the longevity, clinical success, and prognostic factors associated with VPT in teeth affected by Dental caries or traumatic pulp exposure.
Materials and Methods:
This systematic review was done by following the predetermined and structured screening process. The 1042 records were identified from Database searching. After removal of duplicate records and after eligibility assessment, a total of 13 studies were included in the study for final analysis. The narrative synthesis of available evidence was done based on VPT technique, used biomaterial, tooth maturity, follow-up duration, and predictors associated with treatment success or failure.
Results:
VPT has consistently shown the favorable clinical and radiographic outcomes in included studies. The reported success rates for Partial pulpotomy were 70% to 93%, while for complete/full pulpotomy it was 80% to 95%. The treatment success for mature permanent teeth was 70% to 100%, whereas more consistent treatment outcomes were observed in immature permanent teeth, in which success rates were 84.5% to 93.1%. The continued root development and apexogenesis were frequently reported. Bioceramic materials have shown significant favorable results than calcium hydroxide. 85% success rate was reported for MTA after 24 months in one randomized clinical trial, whereas it was 43% for calcium hydroxide. Biodentine has shown the favorable outcomes as like MTA, whereas new fast-setting calcium silicate cements have shown more than 90% success rates in selected studies. The treatment outcomes during short-term and medium-term follow-up had remained favorable with 85%–90% success after 24 months in many studies.
Conclusion:
The current evidence suggests that the VPT predictable and durable treatment method for teeth affected by carious or traumatic pulp exposures. Especially, the calcium silicate-based biomaterials like MTA and Biodentine have shown the high clinical success in different clinical conditions. The pulp vitality can be successfully preserved in immature and mature permanent teeth by using adequate biomaterials, restorative strategies, and case-selection criteria.