Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review

Objectives: Management of carious teeth with signs and symptoms indicative of irreversible pulpitis is traditionally invasive, but emerging evidence suggests successful treatment outcomes with less invasive vital pulp treatment such as coronal pulpotomy. The objective of this systematic review is to determine whether coronal pulpotomy is clinically effective in treating carious teeth with signs and symptoms indicative of irreversible pulpitis. Sources: MEDLINE; PubMed; Embase, Web of Science, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform and ClinicalTrials.gov were searched until December 2018. Study selection: Prospective, retrospective and randomised clinical trials investigating coronal pulpotomy or comparing pulpotomy to root canal treatment in permanent mature carious teeth with signs and symptoms indicative of irreversible pulpitis were included. Studies were independently assessed for risk of bias using Cochrane Systematic Reviews of intervention criteria and modified Downs and Black quality assessment checklist. Data: Eight articles were selected for analysis. The average success rate for coronal pulpotomy was 97.4% clinical and 95.4% radiographic at 12 month follow-up. This was reduced to 93.97% clinical and 88.39% radiographic success at 36 months follow-up. Results from the only comparative clinical trial showed pulpotomy to have comparable success to root canal treatment at 12, 24 and 60 month follow-up. Conclusions: The evidence suggests high success for pulpotomy for teeth with signs and symptoms of irreversible pulpitis, however, results are based on heterogeneous studies with high risk of bias. Well-designed, adequately powered randomised controlled trials are required for evidence to change clinical practice. Clinical significance: Management of carious teeth with irreversible pulpitis is traditionally invasive, but emerging evidence suggests potentially successful treatment outcomes with less invasive therapies such as coronal pulpotomy