Prognosis of vital pulp therapy on permanent dentition: a systematic review and meta-analysis of randomized controlled trials

 Published:August 31, 2021DOI:https://doi.org/10.1016/j.joen.2021.08.008

Abstract:

Introduction

The aim of this systematic review was to evaluate the existing randomized controlled trials (RCT) on the safety and efficacy of vital pulp therapy (VPT) and to analyze the outcomes of VPT performed with a variety of pulp capping materials and techniques.

Methods

Medline (PubMed), Embase, Cochrane Library, and grey literature were searched (January 2000 to March 2021). Study selection and data extraction were performed in duplicate. Eligible RCTs were critically appraised for risk of bias and quality of evidence and were meta-analyzed to estimate the treatment effects.

Results

14 studies were included. The pooled success rate of VPT using contemporary capping materials such as mineral trioxide aggregate (MTA) or calcium silicate–based materials (CSM) was 93.2% (95% confidence intervals [CI] 91.6-94.9%). The multiple subgroup analyses by different of etiologies, procedure types, developmental stages of teeth, and pre-operative diagnoses were performed. Analyses presented low certainty of evidence. No significant difference was noted between MTA and CSM at 12 months or longer follow-up (Risk Ratio [RR] = 0.99, 95% CI 0.95-1.03) with low certainty of evidence. Laser-assisted VPT failed to show significantly better outcomes than conventional VPT (RR = 1.19, 95% CI 0.99-1.49) with very low certainty of evidence.

Conclusions

When MTA or CSM was used as a capping material, VPT was 93% successful. The techniques, etiologies, developmental stages of teeth, or preoperative diagnosis had no significant influence on treatment outcomes. No major adverse effects (except discoloration associated with the use of MTA) were identified. The overall quality of evidence was low.