Non-Cochrane · intervention · PM38968236
Efficacy of pulpotomy for permanent teeth with carious pulp exposure: A systematic review and meta-analysis of randomized controlled trials.
Li Wenjun, Yang Bo, Shi Jing · PloS one · 2024 · PubMed · doi:10.1371/journal.pone.0305218
Oral HealthDental cariesEndodontics and dental traumaAMSTAR 2: Low / Critically Low (extractors disagree)
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
39
current version
GRADE rated
3
No studies
0
Included studies
25
linked below
No studies 0 · 0%Ungraded 36 · 92.3%Very low 1 · 2.6%Low 2 · 5.1%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 | Permanent teeth with carious pulp exposure treated with pulpotomy | Permanent teeth with carious pulp exposure; 2085 teeth (2012 evaluable) across 25 RCTs (n=25) |
| Intervention | Pulpotomy (full or partial) with a bioactive pulp capping/dressing material | Pulpotomy - full and partial; capping materials MTA, Biodentine, CH, CEM, PRF, TotalFill BC and others (n=25) |
| Comparison | A different capping material, or full pulpotomy vs partial pulpotomy | Head-to-head capping-material comparisons and full vs partial pulpotomy (n=25) |
| Outcomes | Overall success (composite of clinical and radiographic success) at >=12 months follow-up | Pooled overall success proportion (86.7%) and odds-ratio material comparisons (n=25) |
| Study designs | Randomized controlled trials | Randomized controlled trials, 24 parallel and 1 split-mouth (n=25) |
| Timing | >=12 months follow-up | 12 months (n=14), 18 months (n=2), 24 months (n=7), >24 months (n=2) |
Search date: 2023-08-31. Databases: PubMed; EMBASE; Scopus; Web of Science; Clinicaltrial.gov; Cochrane Library; Google Scholar (grey literature)
Questions and results
Pulpotomy (full or partial) vs None (single-arm success proportion)
Population: Permanent teeth with carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall success (composite of clinical and radiographic success) >=12 months · Hemostasis <=6 min Hemostasis within 6 min gave the highest success (90.4%), but the difference across hemostasis-time groups was not significant (ungraded). Source: Results 'Overall success rate of pulpotomy' (S4 Fig) · same question in other reviews | Proportion 0.904 | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months · Hemostasis >=10 min Hemostasis of 10 min or more gave a success rate of 86.2% (difference across groups not significant; ungraded). Source: Results 'Overall success rate of pulpotomy' (S4 Fig) · same question in other reviews | Proportion 0.862 | NR | Ungraded |
Overall success (composite of clinical and radiographic success) 12 months · 12-month follow-up Success at 12 months (85.6%) did not differ significantly from 24 months (ungraded). Source: Results 'Overall success rate of pulpotomy' (S3 Fig) · same question in other reviews | Proportion 0.856 | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months · Hemostasis unknown Trials with unknown hemostasis time had a success rate of 80.2% (difference across groups not significant; ungraded). Source: Results 'Overall success rate of pulpotomy' (S4 Fig) · same question in other reviews | Proportion 0.802 | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months · Irreversible pulpitis Teeth with irreversible pulpitis had a significantly lower success rate (82.4%) than teeth with normal/reversible pulpitis (92.0%) (ungraded). Source: Results 'Overall success rate of pulpotomy'; Fig 5 · same question in other reviews | Proportion 0.824 [0.746, 0.890] | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months · Normal pulp/reversible pulpitis Teeth with normal pulp or reversible pulpitis had a high success rate (92.0%), significantly higher than irreversible pulpitis (ungraded). Source: Results 'Overall success rate of pulpotomy'; Fig 5 · same question in other reviews | Proportion 0.920 [0.879, 0.954] | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months · Unspecified/mixed diagnosis Teeth with unspecified or mixed pulpal diagnosis had a success rate of 90.9% (ungraded). Source: Results 'Overall success rate of pulpotomy'; Fig 5 · same question in other reviews | Proportion 0.909 [0.833, 0.965] | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months · Partial pulpotomy Partial-pulpotomy trials showed a success rate (88.2%) similar to full-pulpotomy trials (ungraded). Source: Results 'Overall success rate of pulpotomy' (S2 Fig) · same question in other reviews | Proportion 0.882 | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months Pulpotomy achieves a high overall success rate (86.7%) in permanent teeth with carious pulp exposure (very low certainty). Source: Abstract; Results 'Overall success rate of pulpotomy'; Fig 4; Table 2 (GRADE) · same question in other reviews | Proportion 0.867 [0.820, 0.907] | 25 studies · 2012 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Overall success (composite of clinical and radiographic success) 24 months · 24-month follow-up Success at 24 months (90.2%) did not differ significantly from 12 months (ungraded). Source: Results 'Overall success rate of pulpotomy' (S3 Fig) · same question in other reviews | Proportion 0.902 | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months · Mature teeth Success in mature teeth (83.8%) did not differ significantly from immature teeth (ungraded). Source: Results 'Overall success rate of pulpotomy' (S1 Fig) · same question in other reviews | Proportion 0.838 [0.759, 0.904] | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months · Immature teeth Success in immature teeth (87.2%) did not differ significantly from mature teeth (ungraded). Source: Results 'Overall success rate of pulpotomy' (S1 Fig) · same question in other reviews | Proportion 0.872 [0.803, 0.929] | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months · Full pulpotomy Full-pulpotomy trials showed a success rate (85.9%) similar to partial-pulpotomy trials (ungraded). Source: Results 'Overall success rate of pulpotomy' (S2 Fig) · same question in other reviews | Proportion 0.859 | NR | Ungraded |
Mineral trioxide aggregate (MTA) vs Calcium hydroxide (CH)
Population: Permanent teeth with carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall success (composite of clinical and radiographic success) >=12 months · Partial pulpotomy In partial pulpotomy, MTA had significantly higher success than calcium hydroxide (OR 2.81; ungraded). Source: Results 'Direct comparison of capping materials'; S3 Table · same question in other reviews | OR 2.81 [1.38, 5.74] | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months MTA increases pulpotomy success compared with calcium hydroxide (OR 2.41; low certainty). Source: Results 'Direct comparison of capping materials'; Fig 6; Table 2 (GRADE) · same question in other reviews | OR 2.41 [1.28, 4.51] | 7 studies · 377 participants | Low Downgraded: risk of bias, imprecision |
Overall success (composite of clinical and radiographic success) >=12 months · Mature teeth In mature teeth, MTA had significantly higher success than calcium hydroxide (OR 2.63; ungraded). Source: Results 'Direct comparison of capping materials'; S3 Table · same question in other reviews | OR 2.63 [1.14, 6.03] | NR | Ungraded |
Overall success (composite of clinical and radiographic success) >=12 months · Irreversible pulpitis In teeth with irreversible pulpitis, MTA had significantly higher success than calcium hydroxide (OR 3.17; ungraded). Source: Results 'Direct comparison of capping materials'; S3 Table · same question in other reviews | OR 3.17 [1.25, 7.99] | NR | Ungraded |
Mineral trioxide aggregate (MTA) vs Biodentine
Population: Permanent teeth with carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall success (composite of clinical and radiographic success) >=12 months MTA and Biodentine have similar pulpotomy success (OR 0.89, not significant; low certainty). Source: Results 'Direct comparison of capping materials'; Fig 6; Table 2 (GRADE) · same question in other reviews | OR 0.89 [0.47, 1.69] | 6 studies · 348 participants | Low Downgraded: risk of bias, imprecision |
Mineral trioxide aggregate (MTA) vs Calcium-enriched mixture (CEM)
Population: Permanent teeth with carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall success (composite of clinical and radiographic success) >=12 months MTA and calcium-enriched mixture had comparable pulpotomy success (ungraded). Source: Results 'Direct comparison of capping materials'; Fig 6 · same question in other reviews | OR 0.78 [0.46, 1.34] | 4 studies · 611 participants | Ungraded |
Mineral trioxide aggregate (MTA) vs Platelet-rich fibrin (PRF)
Population: Permanent teeth with carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall success (composite of clinical and radiographic success) >=12 months MTA and platelet-rich fibrin had comparable pulpotomy success (ungraded). Source: Results 'Direct comparison of capping materials'; Fig 6 · same question in other reviews | OR 1.02 [0.43, 2.43] | 3 studies · 109 participants | Ungraded |
Mineral trioxide aggregate (MTA) vs TotalFill BC
Population: Permanent teeth with carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall success (composite of clinical and radiographic success) >=12 months MTA and TotalFill BC had comparable pulpotomy success (ungraded). Source: Results 'Direct comparison of capping materials'; Fig 6 · same question in other reviews | OR 1.44 [0.65, 3.19] | 2 studies · 248 participants | Ungraded |
Biodentine vs Calcium hydroxide (CH)
Population: Permanent teeth with carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall success (composite of clinical and radiographic success) >=12 months Biodentine may increase pulpotomy success versus calcium hydroxide at marginal significance (ungraded). Source: Results 'Direct comparison of capping materials'; S5 Fig · same question in other reviews | OR 6.03 [0.97, 37.6] | 2 studies | Ungraded |
Platelet-rich fibrin (PRF) vs Calcium hydroxide (CH)
Population: Mature permanent teeth with irreversible pulpitis and carious pulp exposure (treated with full pulpotomy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall success (composite of clinical and radiographic success) >=12 months Platelet-rich fibrin and calcium hydroxide showed no significant difference in success (ungraded; effect size not reported). Source: Results 'Direct comparison of capping materials'; S6 Fig · same question in other reviews | OR 1.67 [0.59, 4.72] | 2 studies · 70 participants | Ungraded |
Full pulpotomy vs Partial pulpotomy
Population: Mature permanent teeth with symptomatic irreversible pulpitis and carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall success (composite of clinical and radiographic success) >=12 months Full pulpotomy showed a non-significant trend toward higher success than partial pulpotomy in mature teeth with irreversible pulpitis (ungraded). Source: Results 'Direct comparison of full vs partial pulpotomy'; S7 Fig · same question in other reviews | OR 2.16 [0.92, 5.07] | 3 studies | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall success (composite of clinical and radiographic success) Immature teeth, unspecified/mixed diagnosis | Proportion 0.888 [0.816, 0.945] | 6 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Partial pulpotomy, normal pulp/reversible pulpitis | Proportion 0.920 [0.879, 0.954] | 4 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Partial pulpotomy, mature teeth | Proportion 0.842 [0.745, 0.921] | 6 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Mature teeth, partial pulpotomy, irreversible pulpitis | Proportion 0.808 [0.723, 0.881] | 5 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Full pulpotomy, irreversible pulpitis | Proportion 0.837 [0.741, 0.916] | 12 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Immature teeth, normal pulp/reversible pulpitis | Proportion 0.892 [0.834, 0.940] | 2 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Partial pulpotomy, immature teeth | Proportion 0.924 [0.851, 0.976] | 3 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Full pulpotomy, immature teeth | Proportion 0.844 [0.748, 0.921] | 7 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Mature teeth, irreversible pulpitis | Proportion 0.798 [0.712, 0.873] | 10 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Immature teeth, irreversible pulpitis | Proportion 0.790 [0.667, 0.892] | 2 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Full pulpotomy, mature teeth | Proportion 0.846 [0.739, 0.930] | 9 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Full pulpotomy, unspecified/mixed diagnosis | Proportion 0.903 [0.801, 0.973] | 5 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Mature teeth, full pulpotomy, irreversible pulpitis | Proportion 0.817 [0.702, 0.909] | 8 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Partial pulpotomy, irreversible pulpitis | Proportion 0.826 [0.754, 0.889] | 6 studies | Ungraded |
Overall success (composite of clinical and radiographic success) Mixed root maturation (both mature and immature teeth) | Proportion 0.950 [0.859, 0.998] | 3 studies | 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 | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Yes | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | No | no |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Critically Low | no |
Included primary studies 25
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Baranwal, 2022 Outcome of partial pulpotomy verses full pulpotomy using biodentine in vital mature permanent molar with clinical symptoms indicative of… PMID:35836550 | 1 other review | not stated | not extracted yet | not extracted yet |
| Eppa, 2018 Comparative Evaluation of Three Different Materials: Mineral Trioxide Aggregate, Triple Antibiotic Paste, and Abscess Remedy on Apical… PMID:29875553 | 1 other review | not stated | not extracted yet | not extracted yet |
| Keswani, 2014 Comparative evaluation of platelet-rich fibrin and mineral trioxide aggregate as pulpotomy agents in permanent teeth with incomplete root… PMID:24767550 | 1 other review | not stated | 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 | not stated | not extracted yet | not extracted yet |
| Nosrat, 2012 Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized… PMID:22309243 | 1 other review | not stated | not extracted yet | not extracted yet |
| Ozgur, 2017 Partial Pulpotomy in Immature Permanent Molars After Carious Exposures Using Different Hemorrhage Control and Capping Materials. PMID:29070158 | 1 other review | not stated | not extracted yet | not extracted yet |
| Abuelniel, 2021 Evaluation of Mineral Trioxide Aggregate and Biodentine as pulpotomy agents in immature first permanent molars with carious pulp exposure:… PMID:33719478 | this review only | not stated | not extracted yet | not extracted yet |
| Ahmed, 2021 Clinical and Radiographic Assessments of Potassium Nitrate in Polycarboxylate Versus Mineral Trioxide Aggregate as Pulpotomy Biomaterials… PMID:34478788 | this review only | not stated | not extracted yet | not extracted yet |
| Alawwad, 2020 A Randomised Clinical Radiological Study using Platelet Rich Fibrin and MTA in Pulpotomy of First Permanent Immature Molars DOI:10.7860/jcdr/2020/45877.14178 | this review only | not stated | not extracted yet | not extracted yet |
| Alnassar, 2022 Evaluation of Bioceramic Putty in Pulpotomy of Immature Permanent Molars With Symptoms of Irreversible Pulpitis. PMID:36579231 | this review only | not stated | not extracted yet | not extracted yet |
| Asgary, 2013 Treatment outcomes of pulpotomy in permanent molars with irreversible pulpitis using biomaterials: a multi-center randomized controlled… PMID:22339289 | this review only | not stated | not extracted yet | not extracted yet |
| Asgary, 2022 Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: a randomized controlled trial. PMID:34854987 | this review only | not stated | not extracted yet | not extracted yet |
| Chailertvanitkul, 2014 Randomized control trial comparing calcium hydroxide and mineral trioxide aggregate for partial pulpotomies in cariously exposed pulps of… PMID:24299006 | this review only | not stated | not extracted yet | not extracted yet |
| Doranala, 2021 Comparative assessment of titanium-prepared platelet-rich fibrin, EndoSequence root repair material, and calcium hydroxide as pulpotomy… PMID:35558675 | this review only | not stated | not extracted yet | not extracted yet |
| Jassal, 2023 Outcome of partial and full pulpotomy in cariously exposed mature molars with symptoms indicative of irreversible pulpitis: A randomized… PMID:36403208 | this review only | not stated | not extracted yet | not extracted yet |
| Qudeimat, 2007 Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries. PMID:17555692 | this review only | not stated | not extracted yet | not extracted yet |
| Ramani, 2022 Comparative evaluation of complete and partial pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis: A randomized… PMID:35226769 | this review only | not stated | not extracted yet | not extracted yet |
| Sharaan, 2022 Mineral Trioxide Aggregate vs Calcium-Enriched Mixture Pulpotomy in Young Permanent Molars with a Diagnosis of Irreversible Pulpitis: A… PMID:36704084 | this review only | not stated | not extracted yet | not extracted yet |
| Singh, 2023 Comparative evaluation of treatment outcome of partial pulpotomy using different agents in permanent teeth-a randomized controlled trial. PMID:37460903 | this review only | not stated | not extracted yet | not extracted yet |
| Singla, 2023 Comparative assessment of the outcome of complete pulpotomy using mineral trioxide aggregate and Biodentine in mature permanent mandibular… PMID:37705539 | this review only | not stated | 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. PMID:28673494 | this review only | not stated | not extracted yet | not extracted yet |
| Taha, 2022 Outcome of full pulpotomy in mature permanent molars using 3 calcium silicate-based materials: A parallel, double blind, randomized… PMID:35152464 | this review only | not stated | not extracted yet | not extracted yet |
| Tzanetakis, 2023 Treatment outcome of partial pulpotomy using two different calcium silicate materials in mature permanent teeth with symptoms of… PMID:37452640 | this review only | not stated | 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… PMID:30638262 | this review only | not stated | not extracted yet | not extracted yet |
| Uyar, 2021 Evaluation of partial pulpotomy treatment in cariously exposed immature permanent molars: Randomized controlled trial. PMID:34657018 | this review only | not stated | 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).