Vital pulp therapy in carious pulp–exposed permanent teeth: an umbrella review

Objective There has been increasing evidence indicating rather high success rates of vital pulp therapies. This umbrella review aimed to provide an overview of existing systematic reviews regarding the outcomes of vital pulp therapy, specifically direct pulp capping, partial pulpotomy and full pulpotomy, in carious pulp–exposed permanent human teeth. Materials and methods The specific PICO questions were as follows: Population - permanent human teeth with carious pulp exposure; Intervention - direct pulp capping with pulp capping materials; Comparators - partial pulpotomy and full pulpotomy; Outcomes - success rate and prognostic factors. PubMed, Ovid and Cochrane databases were searched in conjunction with hand searching. Grey literature was searched too. Study selection, data extraction and study appraisal were performed independently by two authors. A consensus was reached through discussion when disagreements arose. Results Six articles fulfilled the inclusion criteria. Higher and more predictable success rates of ≥ 2 years were observed for partial pulpotomy and full pulpotomy in carious pulp–exposed permanent human teeth as compared to direct pulp capping. Possible prognostic factors (pre-operative pulp status, pulp capping material and apex closure) yielded conflicting results. Restorative material, periapical status at baseline, final irrigation solution, age and study type did not seem to affect the treatment outcome. Conclusions Vital pulp therapy is a reliable treatment option for permanent teeth with carious pulp exposure. However, more high-quality studies are required to corroborate this finding. Clinical relevance Vital pulp therapy could be considered as an alternative for root canal treatment for carious pulp–exposed permanent teeth.