What do systematic reviews say?

Partial pulpotomy with one-unit longer follow-up vs Partial pulpotomy with one-unit shorter follow-up

In the high-risk-study-excluded sensitivity meta-regression, longer follow-up was associated with lower success.

• Partial pulpotomy for carious pulp exposure in adult mature permanent teeth: a systematic review and meta-analysis. 2025 All outcomes

  Per unit increase in follow-up time · Sensitivity analysis excluding studies with high risk of bias
  Meta-regression coefficient -0.36
  Studies not reported
  GRADE not reported

Flowable bulk-fill composite resin vs Light-cured compomer (polyacid-modified composite resin)

No comparative effect estimate was reported; both arms had 0% failure.

• Clinical effectiveness of restorative materials for the restoration of carious primary teeth without pulp therapy: a… 2022 All outcomes

  1 year · Private dental practice · Class II
  Annual failure rate (%) compomer 0%; bulk-fill composite resin 0%
  1 study · 32 participants
  GRADE not reported

Indirect restorations (crowns, fixed partial dentures, inlays/onlays/veneers) vs Follow-up duration

The pooled incidence with > 5–10 years of follow-up was 5.53%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  > 5–10 years · > 5–10 years
  Proportion 5.53 [3.74, 7.64]
  2443 participants
  GRADE not reported

Indirect restorations (crowns, fixed partial dentures, inlays/onlays/veneers) vs Follow-up duration

The pooled incidence with > 5–10 years of follow-up was 3.88%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  > 5–10 years · > 5–10 years
  Proportion 3.88 [1.95, 6.45]
  1864 participants
  GRADE not reported

Indirect restorations (crowns, fixed partial dentures, inlays/onlays/veneers) vs None (single-group incidence)

Pulp necrosis incidence among treated by prosthodontists was 1.87% (subgroup analysis; not GRADE-rated).

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Follow-up ≤5 to >10 years · University clinics and dental practices, multiple countries · Treated by prosthodontists
  Proportion 1.87 [0.84, 3.31]
  3834 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Follow-up ≤5 to >10 years · University clinics and dental practices, multiple countries · PFM fabrication material
  Proportion 5.71 [0.12, 18.75]
  1980 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  >5-10 years · University clinics and dental practices, multiple countries · Follow-up >5-10 years
  Proportion 5.53 [3.74, 7.64]
  2443 participants
  GRADE not reported

Tooth location

One study reported a 7.1% incidence in mandibular posterior teeth.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Kontakiotis et al. 2015 mandibular posterior
  Proportion 7.1
  1 study
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Cheung et al. 2005 mandibular anterior
  Proportion 0
  1 study
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Cheung et al. 2005 mandibular posterior
  Proportion 6.1
  1 study
  GRADE not reported

Indirect restoration placement by undergraduate students vs None (single-group incidence)

The pooled incidence with undergraduate students was 5.68%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Undergraduate students
  Proportion 5.68 [3.17, 8.86]
  1604 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  General practitioners
  Proportion 4.44 [2.16, 7.49]
  2113 participants
  GRADE not reported

Pre-operative caries fillings or crowns vs Intact teeth

One study reported a 13% incidence in teeth with pre-operative caries fillings or crowns.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Pre-operative caries fillings or crowns
  Proportion 13
  1 study
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Intact teeth
  Proportion 5
  1 study
  GRADE not reported

Pre-operative bone level < 35% vs Pre-operative bone level ≥ 35%

One study reported a 1.4% incidence with bone level < 35%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Bone level < 35%
  Proportion 1.4
  1 study
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Bone level ≥ 35%
  Proportion 0
  1 study
  GRADE not reported

Eugenol-based temporary cement vs Eugenol-free temporary cement

The pooled incidence with eugenol-based temporary cement was 3.34%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Eugenol-based
  Proportion 3.34 [1.66, 5.58]
  7043 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Eugenol-free
  Proportion 5.77 [3.72, 8.24]
  639 participants
  GRADE not reported

Intervention not reported

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Reversible hydrocolloid impression material
  Proportion 1.19
  1 study
  GRADE not reported

Glass ionomer (GIC) permanent cement vs Glass ionomer cement or zinc phosphate cement

The pooled incidence with GIC permanent cement was 5.33%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  GIC
  Proportion 5.33 [2.56, 9.03]
  182 participants
  GRADE not reported

Indirect restorations (crowns, fixed partial dentures, inlays/onlays/veneers) vs None (single-group incidence)

Periapical pathosis incidence among follow-up >5-10 years was 3.88% (subgroup analysis; not GRADE-rated).

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  >5-10 years · University clinics and dental practices, multiple countries · Follow-up >5-10 years
  Proportion 3.88 [1.95, 6.45]
  1864 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  >10 years · University clinics and dental practices, multiple countries · Follow-up >10 years
  Proportion 4.05 [0.89, 9.36]
  2656 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Follow-up ≤5 to >10 years · University clinics and dental practices, multiple countries · Fixed partial dentures (FPD)
  Proportion 4.59 [2.28, 7.64]
  9 studies · 2435 participants
  GRADE not reported

Polyether impression material vs Polyvinyl siloxane impression material

The pooled incidence with polyether impression material was 4.02%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Polyether
  Proportion 4.02 [2.47, 5.92]
  2985 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Polyvinyl siloxane
  Proportion 3.17 [1.55, 5.34]
  636 participants
  GRADE not reported

Ceramic restoration material vs Porcelain-fused-to-metal restoration material

The pooled incidence with ceramic restorations was 5.59%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Ceramic
  Proportion 5.59 [2.89, 9.12]
  460 participants
  GRADE not reported

Pulp-status assessment method

The pooled incidence with radiographic assessment was 4.95%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Radiographic
  Proportion 4.95 [2.43, 8.29]
  5 studies · 1853 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Objective
  Proportion 5.66 [3.71, 7.99]
  24 studies · 6581 participants
  GRADE not reported

Zinc polycarboxylate cement

One study reported a 1.1% incidence with zinc polycarboxylate permanent cement.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Zinc polycarboxylate
  Proportion 1.1
  1 study
  GRADE not reported

Intervention not reported

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Compound impression material
  Proportion 3.27
  1 study
  GRADE not reported

Indirect restorations (crowns, fixed partial dentures, inlays/onlays/veneers) vs None (single-group incidence)

The pooled incidence with ≤ 5 years of follow-up was 3.53%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  ≤ 5 years · ≤ 5 years
  Proportion 3.53 [2.10, 5.31]
  5532 participants
  Low