Vital pulp treatment for traumatized permanent teeth: A systematic review

Background: Traumatic dental injuries involving the pulp are quite common and there is a need to evaluate the quality of evidence on the success of vital pulp treatment (VPT) interventions in traumatised permanent teeth. Objectives: The aim of this systematic review was to assess the success of VPT in the management of traumatised human vital permanent teeth diagnosed with complicated crown or crown-root fractures. Methods: An electronic search of the following databases: Web of Science, Scopus, PubMed, MEDLINE, EMBASE, LILACS, Clinical Trial Registries and the grey literature was performed until 25th/8/2021. Controlled clinical trials, cohort studies, case-control studies, case series with at least five cases and a minimum of 12-months follow-up were included. Non-English language literature was excluded. Two independent assessors performed study selection, data extraction and quality assessment using the National Institutes of Health's quality assessment tool. Disagreements were resolved through consensus/with a third assessor. Results: A total of 14-studies (2-controlled clinical trials, 1-case-control, and 11-case series) published between 1978-2020, with a total of 1081 permanent teeth and an age range between 6-42 years-old were included. Bias analysis ranged considerably from 'good' to 'poor'. Meta-analysis was not performed due to data heterogeneity, unclear reporting, and limited number of controlled clinical studies. Partial pulpotomy was the main reported clinical procedure with an overall success rate between 82.9-100%. Complete pulpotomy and direct pulp capping were associated with lower success rates of 79.4-85.7% and 19.5%, respectively. Calcium hydroxide was the main pulp capping material with favourable clinical and radiographic success (79.4-100%). Biodentine (R), mineral trioxide aggregate and IRoot (R) BP were also associated with a high clinical and radiographic success, 80-91%, 80-100%, and 90-100%, respectively, albeit in fewer studies. Discussion: Although a high success rate has been reported when using VPT in managing pulpally involved traumatised teeth, the results of this systematic review clearly highlighted a paucity and low quality of the available evidence. Conclusions: Overall high success of VPT in the management of traumatised vital permanent teeth were reported, although based on limited evidence of well-conducted clinical studies.