Non-Cochrane · intervention · PM36385132
Outcome of pulpotomy in permanent teeth with irreversible pulpitis: a systematic review and meta-analysis.
Ather Amber, Patel Biraj, Gelfond Jonathan A L, et al. · Scientific reports · 2022 · PubMed · doi:10.1038/s41598-022-20918-w
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
14
current version
GRADE rated
3
No studies
0
Included studies
11
linked below
No studies 0 · 0%Ungraded 11 · 78.6%Very low 3 · 21.4%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Human permanent teeth with irreversible pulpitis (symptomatic or asymptomatic) as a result of carious pulp exposure; English-language clinical studies with >=6-month follow-up | Permanent teeth with irreversible pulpitis from carious exposure across 11 studies |
| Intervention | Pulpotomy (partial or full coronal) | Pulpotomy (mostly full coronal, some partial) with various capping materials (11 studies) |
| Comparison | None for the primary single-arm success proportion; planned predictor comparisons by symptom status, root apex development, and pulp capping material | Single-arm pooled proportions; indirect between-material and between-subgroup comparisons |
| Outcomes | Success rate by clinical and radiographic criteria (clinical: no pain on percussion/palpation or spontaneous pain and no need for root canal treatment; radiographic: normal or healing periapical tissues) | Pooled clinical/radiographic success rate 86% (95% CI 0.76-0.92; I2=81.9%; 11 studies) |
| Study designs | Original clinical data: clinical trials, prospective and retrospective observational studies (case reports/series, reviews, deciduous teeth, trauma, laser pulpotomy, and other vital pulp therapy procedures excluded) | 5 randomized controlled trials, 5 prospective studies, 1 retrospective study (n=11) |
| Timing | Minimum 6-month follow-up | Follow-up 6 to 73.6 months (varied; not analyzed by specific interval) |
Search date: January 2021 (articles from January 1960 to January 2021). Databases: PubMed, Scopus, CENTRAL, Web of Science
Questions and results
Pulpotomy (partial or full) vs None (single-arm pooled success proportion)
Population: Human permanent teeth with irreversible pulpitis (symptomatic and asymptomatic) due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Trim-and-fill adjusted for publication bias Adjusting for publication bias (trim-and-fill), the pooled pulpotomy success estimate was 78.6% (95% CI 66-87%). Source: Results (pulp capping materials paragraph; publication bias / trim-and-fill) · same question in other reviews | Proportion 0.786 [0.66, 0.87] | 15 (11 observed + 4 imputed) studies | Ungraded |
Clinical and radiographic success rate (>=6 months) >=6 months · Randomized trials (GRADE evidence profile) Among 5 randomized trials, pooled pulpotomy success was 74.3 per 100 (95% CI 0.56-0.86), very low certainty. Source: Table 2 (GRADE evidence profile, randomized trials row) · same question in other reviews | Proportion 0.743 [0.56, 0.86] 74.3 [56, 86] successes per 100 | 5 studies · 488 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Clinical and radiographic success rate (>=6 months) >=6 months · Observational studies (GRADE evidence profile) Among 6 observational studies, pooled pulpotomy success was 92.6 per 100 (95% CI 0.86-0.96), very low certainty. Source: Table 2 (GRADE evidence profile, observational studies row) · same question in other reviews | Proportion 0.926 [0.86, 0.96] 92.6 [86, 96] successes per 100 | 6 studies · 177 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Clinical and radiographic success rate (>=6 months) >=6 months (follow-up 6 to 73.6 months) Pulpotomy in permanent teeth with irreversible pulpitis had a pooled success rate of 86% (95% CI 76-92%), graded very low certainty. Source: Abstract; Results (Pooled success rate of pulpotomy in IP); Fig. 2; Table 2 (GRADE) · same question in other reviews | Proportion 0.86 [0.76, 0.92] | 11 studies | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Pulpotomy (partial or full) vs None (single-arm pooled success proportion)
Population: Human permanent teeth with symptomatic irreversible pulpitis due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Symptomatic irreversible pulpitis In symptomatic irreversible pulpitis, pooled pulpotomy success was 84% (95% CI 72-92%); not significantly different from asymptomatic (z=-1.34, p=0.18); ungraded. Source: Abstract; Results (symptomatic vs asymptomatic); Fig. 3 · same question in other reviews | Proportion 0.84 [0.72, 0.92] | 9 studies | Ungraded |
Pulpotomy (partial or full) vs None (single-arm pooled success proportion)
Population: Human permanent teeth with asymptomatic irreversible pulpitis due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Asymptomatic irreversible pulpitis In asymptomatic irreversible pulpitis, pooled pulpotomy success was 91.3% (95% CI 80-96.5%); ungraded. Source: Abstract; Results (symptomatic vs asymptomatic); Fig. 4 · same question in other reviews | Proportion 0.913 [0.80, 0.965] | 3 studies | Ungraded |
Pulpotomy (partial or full) vs None (single-arm pooled success proportion)
Population: Human permanent teeth with irreversible pulpitis and closed (mature) root apex due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Closed (mature) root apex In closed-apex teeth, pooled pulpotomy success was 83% (95% CI 69-91%); significantly lower than open apex (z=2.33, p=0.02); ungraded. Source: Results (closed vs open apex); Fig. 5 · same question in other reviews | Proportion 0.83 [0.69, 0.91] | 8 studies | Ungraded |
Pulpotomy (partial or full) vs None (single-arm pooled success proportion)
Population: Human permanent teeth with irreversible pulpitis and open (immature) root apex due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Open (immature) root apex In open-apex teeth, pooled pulpotomy success was 95.8% (95% CI 81-99%); significantly higher than closed apex (z=2.33, p=0.02); ungraded. Source: Abstract; Results (closed vs open apex); Fig. 6 · same question in other reviews | Proportion 0.958 [0.81, 0.99] | 3 studies | Ungraded |
Pulpotomy with Biodentine vs Pulpotomy with mineral trioxide aggregate (MTA)
Population: Human permanent teeth with irreversible pulpitis due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Pulp capping material: Biodentine vs MTA Biodentine had a significantly higher pulpotomy success rate than MTA (indirect comparison; numeric estimate not available); ungraded. Source: Results (pulp capping materials); Supplementary Table S5 (not available) · same question in other reviews | Biodentine demonstrated a statistically significantly higher success rate than MTA (indirect comparison; numeric estimate in Supplementary Table S5, not available). | NR | Ungraded |
Pulpotomy with Biodentine vs Pulpotomy with Calcium Enriched Mixture (CEM)
Population: Human permanent teeth with irreversible pulpitis due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Pulp capping material: Biodentine vs CEM Biodentine had a significantly higher pulpotomy success rate than CEM (indirect comparison; numeric estimate not available); ungraded. Source: Results (pulp capping materials); Supplementary Table S5 (not available) · same question in other reviews | Biodentine demonstrated a statistically significantly higher success rate than CEM (indirect comparison; Supplementary Table S5, not available). | NR | Ungraded |
Pulpotomy with Biodentine vs Pulpotomy with calcium hydroxide (Ca(OH)2)
Population: Human permanent teeth with irreversible pulpitis due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Pulp capping material: Biodentine vs calcium hydroxide Biodentine had a significantly higher pulpotomy success rate than calcium hydroxide (indirect comparison; numeric estimate not available); ungraded. Source: Results (pulp capping materials); Supplementary Table S5 (not available) · same question in other reviews | Biodentine demonstrated a statistically significantly higher success rate than calcium hydroxide (indirect comparison; Supplementary Table S5, not available). | NR | Ungraded |
Pulpotomy with mineral trioxide aggregate (MTA) vs Pulpotomy with calcium hydroxide (Ca(OH)2)
Population: Human permanent teeth with irreversible pulpitis due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Pulp capping material: MTA vs calcium hydroxide MTA had a significantly higher pulpotomy success rate than calcium hydroxide (indirect comparison; numeric estimate not available); ungraded. Source: Results (pulp capping materials); Supplementary Table S5 (not available) · same question in other reviews | MTA yielded a statistically significantly higher success rate than calcium hydroxide (indirect comparison; Supplementary Table S5, not available). | NR | Ungraded |
Pulpotomy with mineral trioxide aggregate (MTA) vs Pulpotomy with Calcium Enriched Mixture (CEM)
Population: Human permanent teeth with irreversible pulpitis due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Pulp capping material: MTA vs CEM MTA and CEM did not differ significantly in pulpotomy success (indirect comparison); ungraded. Source: Results (pulp capping materials); Supplementary Table S5 (not available) · same question in other reviews | MTA was not significantly superior to CEM (no significant difference; Supplementary Table S5, not available). | NR | Ungraded |
Pulpotomy with Calcium Enriched Mixture (CEM) vs Pulpotomy with calcium hydroxide (Ca(OH)2)
Population: Human permanent teeth with irreversible pulpitis due to carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate (>=6 months) >=6 months · Pulp capping material: CEM vs calcium hydroxide CEM and calcium hydroxide did not differ significantly in pulpotomy success (indirect comparison); ungraded. Source: Results (pulp capping materials); Supplementary Table S5 (not available) · same question in other reviews | No significant difference was observed between CEM and calcium hydroxide (indirect comparison; Supplementary Table S5, not available). | NR | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Partial Yes | NR | no |
| 2Protocol established before the reviewcritical | No | NR | no |
| 3Choice of study designs explained | No | NR | no |
| 4Comprehensive literature searchcritical | Partial Yes | NR | no |
| 5Study selection in duplicate | Yes | NR | no |
| 6Data extraction in duplicate | Yes | NR | no |
| 7List of excluded studies with reasonscritical | Yes | NR | no |
| 8Included studies described in detail | Yes | NR | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NR | no |
| 10Funding of included studies reported | No | NR | no |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: Yes | NR | no |
| 12Impact of risk of bias on the pooled results | No | NR | no |
| 13Risk of bias accounted for in interpretationcritical | Yes | NR | no |
| 14Heterogeneity explained | Yes | NR | no |
| 15Publication bias investigatedcritical | Yes | NR | no |
| 16Conflicts of interest reported | Yes | NR | no |
| Overall | Low | NR | no |
Included primary studies 11
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Asgary, 2017 matched by author and year (probable) | 1 other review | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
| Kumar, 2016 Comparative evaluation of platelet-rich fibrin, mineral trioxide aggregate, and calcium hydroxide as pulpotomy agents in permanent molars… PMID:27994420 | 1 other review | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
| Taha, 2017 Partial Pulpotomy in Mature Permanent Teeth with Clinical Signs Indicative of Irreversible Pulpitis: A Randomized Clinical Trial DOI:10.1016/j.joen.2017.03.033 | 1 other review | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
| Caliskan, 1993 Success of pulpotomy in the management of hyperplastic pulpitis DOI:10.1111/j.1365-2591.1993.tb00557.x | this review only | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
| Caliskan, 1995 Pulpotomy of carious vital teeth with periapical involvement DOI:10.1111/j.1365-2591.1995.tb00293.x | this review only | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
| Linsuwanont, 2017 Treatment Outcomes of Mineral Trioxide Aggregate Pulpotomy in Vital Permanent Teeth with Carious Pulp Exposure: The Retrospective Study DOI:10.1016/j.joen.2016.10.027 | this review only | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
| Nosrat, 2013 Pulpotomy in caries‐exposed immature permanent molars using calcium‐enriched mixture cement or mineral trioxide aggregate: a randomized… DOI:10.1111/j.1365-263x.2012.01224.x | this review only | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
| Qudeimat, 2017 Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: a preliminary study DOI:10.1111/iej.12614 | this review only | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
| Taha, 2018 (Int Endod J) Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis DOI:10.1111/iej.12903 | this review only | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
| Taha, 2018 (J Endod) Full Pulpotomy with Biodentine in Symptomatic Young Permanent Teeth with Carious Exposure DOI:10.1016/j.joen.2018.03.003 | this review only | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
| Uesrichai, 2019 Partial pulpotomy with two bioactive cements in permanent teeth of 6‐ to 18‐year‐old patients with signs and symptoms indicative of… DOI:10.1111/iej.13071 | this review only | Clinical and radiographic success rate (>=6 months) | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).