Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
J Endod. 2011 May;37(5):581-7. doi: 10.1016/j.joen.2010.12.004. Epub 2011 Mar 5.
This systematic review aims to illustrate the outcome of vital pulp therapy, namely direct pulp capping, partial pulpotomy, and full pulpotomy, in vital permanent teeth with cariously exposed pulp.
Electronic database MEDLINE via Ovid, PubMed, and Cochrane databases were searched. Hand searching was performed through reference lists of endodontic textbooks, endodontic-related journals, and relevant articles from electronic searching. The random effect method of weighted pooled success rate of each treatment and the 95% confidence interval were calculated by the DerSimonian-Laird method. The weighted pooled success rate of each treatment was estimated in 4 groups: >6 months-1 year, >1-2 years, >2-3 years, and >3 years. All statistics were performed by STATA version 10. The indirect comparison of success rates for 4 follow-up periods and the indirect comparison of clinical factors influencing the success rate of each treatment were performed by z test for proportion (P < .05).
Overall, the success rate was in the range of 72.9%-99.4%. The fluctuation of the success rate of direct pulp capping was observed (>6 months-1 year, 87.5%; >1-2 years, 95.4%; >2-3 years, 87.7%; and >3 years, 72.9%). Partial pulpotomy and full pulpotomy sustained a high success rate up to more than 3 years (partial pulpotomy: >6 months-1 year, 97.6%; >1-2 years, 97.5%; >2-3 years, 97.6%; and >3 years, 99.4%; full pulpotomy: >6 months-1 year, 94%; >1-2 years, 94.9%; >2-3 years, 96.9%; and >3 years, 99.3%).
Vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp therapy. Current best evidence provides inconclusive information regarding factors influencing treatment outcome, and this emphasizes the need for further observational studies of high quality.
本系统评价旨在说明活髓保存治疗（即直接盖髓术、部分活髓切除术和全活髓切除术）在龋性暴露牙髓的恒牙中的疗效。
通过 Ovid 电子数据库 MEDLINE、PubMed 和 Cochrane 数据库进行电子检索。通过牙髓学教科书、与牙髓学相关的期刊以及电子检索相关文章的参考文献进行手工检索。采用 DerSimonian-Laird 法计算每种治疗方法的加权汇总成功率及其 95%置信区间。将每种治疗方法的汇总成功率估计分为 4 组：>6 个月-1 年、>1-2 年、>2-3 年和>3 年。所有统计均采用 STATA 版本 10 进行。通过 z 检验（P<0.05）对 4 个随访时间段的成功率进行间接比较，对影响每种治疗方法成功率的临床因素进行间接比较。
总体而言，成功率在 72.9%-99.4%之间。直接盖髓术的成功率波动较大（>6 个月-1 年为 87.5%，>1-2 年为 95.4%，>2-3 年为 87.7%，>3 年为 72.9%）。部分活髓切除术和全活髓切除术在 3 年以上的成功率保持较高（部分活髓切除术：>6 个月-1 年为 97.6%，>1-2 年为 97.5%，>2-3 年为 97.6%，>3 年为 99.4%；全活髓切除术：>6 个月-1 年为 94%，>1-2 年为 94.9%，>2-3 年为 96.9%，>3 年为 99.3%）。
龋性暴露牙髓的恒牙可以通过活髓保存治疗成功治疗。目前最佳证据提供了关于影响治疗结果的因素的不确定信息，这强调了需要进一步进行高质量的观察性研究。
