Non-Cochrane · intervention · PM41339865
Partial pulpotomy for carious pulp exposure in adult mature permanent teeth: a systematic review and meta-analysis.
Abdelkhader Sakha, Koller Garrit, Kang Jing, et al. · BMC oral health · 2025 · PubMed · doi:10.1186/s12903-025-07408-x
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
18
current version
GRADE rated
0
No studies
0
Included studies
11
linked below
No studies 0 · 0%Ungraded 18 · 100%Very low 0 · 0%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 | Adult patients aged 18 years or older with mature permanent teeth and deep carious pulp exposure (including irreversible pulpitis) | Adults (18-85 y) with mature permanent teeth and carious pulp exposure (irreversible pulpitis or normal/reversible); 42,320 records screened, 12,752 after de-duplication, 49 full-text assessed (n=9 studies in 11 records; per-study samples 50-106) |
| Intervention | Partial pulpotomy (PP) | Partial pulpotomy (restricted or extended lateral extent) (n=9 studies) |
| Comparison | PP with different capping materials (MTA, calcium hydroxide, Biodentine); and PP versus other vital pulp therapies (direct pulp capping, full pulpotomy) | Capping materials calcium hydroxide (3 records), MTA (6), Biodentine (3); comparators full pulpotomy (3 RCTs), direct pulp capping (1 RCT), restricted vs extended PP (1 RCT) |
| Outcomes | Success rate (clinical and radiographic) after at least one year | Clinical/radiographic success: calcium hydroxide 34.3% (95% CI 24.93-43.67) vs tri-calcium silicate 86.8% (95% CI 83.78-89.82); PP vs FP pooled effect -0.77 (95% CI -1.62 to 0.09) |
| Study designs | Randomized controlled trials and observational studies published 2000-2025; no language restriction | 6 RCTs, 2 prospective, 1 retrospective (n=9 studies) |
| Timing | Minimum follow-up of 1 year | Follow-up 1 year (8 studies), 2 years (1), 3.1 years (1), 5 years (3) |
Search date: September 2025. Databases: PubMed (NCBI); ScienceDirect (Elsevier); Embase (Elsevier); Cochrane Library; Web of Science; Open Grey (grey literature); hand search (Journal of Endodontics, International Endodontic Journal)
Questions and results
Partial pulpotomy with calcium hydroxide vs No comparator
Population: Adults aged 18 years or older with mature permanent teeth and carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate At least 1 year · Calcium hydroxide Partial pulpotomy with calcium hydroxide had a pooled success rate of 34.3%. Source: Results: Characteristics of included studies, meta-analysis and meta-regression · same question in other reviews | Success rate (%) 34.3 [24.93, 43.67] | NR | Ungraded |
Clinical and radiographic success rate >=1 year (subgroups at 1, 2, 5 years) · Capping material (tri-calcium silicate vs calcium hydroxide) Population: Adults (>=18 y) with mature permanent teeth and carious pulp exposure (irreversible pulpitis or normal/reversible) Partial pulpotomy with tri-calcium silicate cements (MTA/Biodentine) has a much higher success rate than with calcium hydroxide in adults (86.8% vs 34.3%; ungraded). Source: Abstract; Results 'PP success rate' and Table 2; Discussion 'Factors affecting success rate' · same question in other reviews | MD 52.5 52.5 percentage points (success rate) | NR | Ungraded |
Partial pulpotomy with tri-calcium silicate material (MTA or Biodentine) vs No comparator
Population: Adults aged 18 years or older with mature permanent teeth and carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate At least 1 year · MTA or Biodentine Partial pulpotomy with MTA or Biodentine had a pooled success rate of 86.8%. Source: Results: Characteristics of included studies, meta-analysis and meta-regression · same question in other reviews | Success rate (%) 86.8 [83.78, 89.82] | NR | Ungraded |
Clinical and radiographic success rate >=1 year · Timing of permanent restoration: immediate vs >14 days Population: Adults (>=18 y) with mature permanent teeth and deep carious pulp exposure Immediate permanent restoration after partial pulpotomy is associated with much higher success than delayed restoration (89.9% immediate vs 23.2% beyond 14 days; ungraded). Source: Abstract; Results 'Reporting Success rate based on the timing of restoration' and Fig. 3B; Conclusion · same question in other reviews | MD 66.7 66.7 percentage points (success rate) | NR | Ungraded |
Partial pulpotomy with immediate permanent restoration vs No comparator
Population: Adults aged 18 years or older with mature permanent teeth and carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate Immediate restoration Immediate permanent restoration was associated with a pooled success rate of 89.9%. Source: Results: Characteristics of included studies, meta-analysis and meta-regression · same question in other reviews | Success rate (%) 89.9 [78.5, 99.8] | NR | Ungraded |
Partial pulpotomy with permanent restoration after 7-14 days vs No comparator
Population: Adults aged 18 years or older with mature permanent teeth and carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate Permanent restoration after 7-14 days Permanent restoration after 7-14 days was associated with a pooled success rate of 73.6%. Source: Results: Characteristics of included studies, meta-analysis and meta-regression · same question in other reviews | Success rate (%) 73.6 [66.5, 80.7] | NR | Ungraded |
Clinical and radiographic success rate 1 year Population: Adults (>=18 y) with mature permanent teeth, carious exposure and normal/reversibly inflamed pulp At 1 year, partial pulpotomy and direct pulp capping (both calcium hydroxide) gave similarly low success in reversibly inflamed pulps (34.5% vs 31.8%; ungraded, single trial). Source: Results 'DPC' and Table 3 · same question in other reviews | Success rate (%) 34.5 vs 31.8 31.8 vs 34.5 | 1 study · 51 participants | Ungraded |
Clinical and radiographic success rate 5 years Population: Adults (>=18 y) with mature permanent teeth, carious exposure and normal/reversibly inflamed pulp At 5 years, both partial pulpotomy and direct pulp capping with calcium hydroxide had very low success (11.1% vs 5.9%; ungraded, single trial). Source: Results 'DPC' and Table 3 · same question in other reviews | Success rate (%) 11.1 vs 5.9 5.9 vs 11.1 | 1 study · 44 participants | Ungraded |
Restricted partial pulpotomy (pulp removal 2-3 mm from exposure site only) vs Extended partial pulpotomy (pulp removal 2-3 mm from entire pulp chamber with complete deroofing)
Population: Adults (18-45 y) with mature permanent molars, carious exposure and symptomatic irreversible pulpitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate 1 year · Lateral extent of pulp amputation Restricting the lateral extent of partial pulpotomy gives success equivalent to more extensive amputation (97.6% vs 97.5%, p>0.05; ungraded, single trial). Source: Discussion 'Factors affecting success rate' (Ramani 2024 [40]) · same question in other reviews | Success rate (%) 97.6 vs 97.5 97.5 vs 97.6 | 1 study · 96 participants | Ungraded |
Clinical and radiographic success rate Permanent restoration after more than 14 days Population: Adults aged 18 years or older with mature permanent teeth and carious pulp exposure Permanent restoration after more than 14 days was associated with a pooled success rate of 23.2%. Source: Results: Characteristics of included studies, meta-analysis and meta-regression · same question in other reviews | Success rate (%) 23.2 [13.4, 33.0] | NR | Ungraded |
Postoperative pain and analgesic intake Postoperative days 1-2 · Lateral extent of pulp amputation Restricted partial pulpotomy causes less early postoperative pain and analgesic use than extended amputation (p<0.05; ungraded, single trial). Source: Discussion 'Factors affecting success rate' (Ramani 2024 [40]) · same question in other reviews | Same RCT (Ramani 2024): restricted PP had significantly lower postoperative pain scores on days 1 and 2 (p<0.05) and required significantly less analgesic intake (p<0.05) than extended PP. | 1 study · 96 participants | Ungraded |
Partial pulpotomy with sodium hypochlorite (NaOCl) hemostatic agent vs Partial pulpotomy without NaOCl / alternative hemostatic agent
Population: Adults (>=18 y) with mature permanent teeth and deep carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate >=1 year · Hemostatic agent (NaOCl use and concentration) Using NaOCl during partial pulpotomy is associated with borderline-higher success, independent of concentration (ungraded, exploratory). Source: Results Fig. 3C-D; Discussion 'Factors affecting success rate' · same question in other reviews | Meta-regression across included studies: NaOCl concentration did not significantly affect success when a tri-calcium silicate capping material was used; the use of NaOCl itself showed borderline significance (higher… | NR | Ungraded |
Clinical and radiographic success rate Meta-regression Population: Adults aged 18 years or older with mature permanent teeth and carious pulp exposure Tri-calcium silicate use was associated with a 37% increase in partial-pulpotomy success in meta-regression. Source: Results: Characteristics of included studies, meta-analysis and meta-regression · same question in other reviews | Meta-regression effect (%) 37 | NR | Ungraded |
Partial pulpotomy with one additional day before permanent restoration vs Partial pulpotomy with one fewer day before permanent restoration
Population: Adults aged 18 years or older with mature permanent teeth and carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate Per day of restoration delay · Meta-regression Each additional day before permanent restoration was associated with a 0.088% decrease in success in meta-regression. Source: Results: Characteristics of included studies, meta-analysis and meta-regression · same question in other reviews | Meta-regression coefficient (per day, proportion scale) -0.088 | NR | Ungraded |
Full pulpotomy vs Partial pulpotomy
Population: Adults aged 18 years or older with mature permanent teeth and carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate 1 year · Irreversible pulpitis The three-study meta-analysis found no significant difference between full and partial pulpotomy after 1 year. Source: Results: Comparing PP success rate with other approaches, FP; Fig. 4 caption · same question in other reviews | Log odds ratio (LogOR) -0.77 [-1.62, 0.09] | 3 studies · 204 participants | Ungraded |
Partial pulpotomy with one-unit longer follow-up vs Partial pulpotomy with one-unit shorter follow-up
Population: Adults aged 18 years or older with mature permanent teeth and carious pulp exposure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate Per unit increase in follow-up time · Sensitivity analysis excluding studies with high risk of bias In the high-risk-study-excluded sensitivity meta-regression, longer follow-up was associated with lower success. Source: Results: Characteristics of included studies, meta-analysis and meta-regression · same question in other reviews | Meta-regression coefficient -0.36 | NR | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success rate Full meta-regression: preoperative diagnosis | Meta-regression No significant association | NR | Ungraded |
Clinical and radiographic success rate Full meta-regression: follow-up duration | Meta-regression No significant association | 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 | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Yes | Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: No · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: Yes | NRSI: No · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | 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 | No | no |
| Overall | Low | Critically Low | no |
Included primary studies 11
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 | Clinical and radiographic success rate | 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… DOI:10.1111/iej.13872 | 1 other review | Clinical and radiographic success rate | 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… DOI:10.1111/iej.13714 | 1 other review | Clinical and radiographic success rate | 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 | not extracted yet | not extracted yet |
| Aldeen 2023 The Influence of Carious Lesion and Bleeding Time on the Success of Partial Pulpotomy in Permanent Molars with Irreversible Pulpitis: A… PMID:37370631 | this review only | not stated | not extracted yet | not extracted yet |
| Bjorndal 2010 Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp… DOI:10.1111/j.1600-0722.2010.00731.x | this review only | Clinical and radiographic success rate | not extracted yet | not extracted yet |
| Bjorndal 2017 Randomized Clinical Trials on Deep Carious Lesions: 5-Year Follow-up DOI:10.1177/0022034517702620 | this review only | Clinical and radiographic success rate | not extracted yet | not extracted yet |
| Eggmann 2022 Partial pulpotomy without age restriction: a retrospective assessment of permanent teeth with carious pulp exposure. PMID:34076771 | this review only | not stated | not extracted yet | not extracted yet |
| Ramani 2024 Effect of lateral extent of pulp tissue removal on the outcome of partial pulpotomy for managing cariously exposed mature permanent molars… DOI:10.1111/iej.14152 | this review only | Clinical and radiographic success rate | not extracted yet | not extracted yet |
| Ramani 2025 Outcome Following Complete and Partial Pulpotomy in Managing Cariously Exposed Mature Permanent Molars With Symptomatic Irreversible… DOI:10.1111/iej.70028 | this review only | not stated | not extracted yet | not extracted yet |
| Tan 2020 Long-term Pulpal and Restorative Outcomes of Pulpotomy in Mature Permanent Teeth DOI:10.1016/j.joen.2019.11.009 | 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).