Alqaderi Hend, Lee Chun-Teh, Borzangy Sary, Pagonis Tom C
Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA, USA.
J Dent. 2016 Jan;44:1-7. doi: 10.1016/j.jdent.2015.12.005. Epub 2015 Dec 10.
This systematic review was performed to evaluate the clinical outcome of coronal pulpotomy treatment to manage carious vital pulp exposure in permanent posterior teeth with closed root apices.
DATA/SOURCES: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. A search of articles published between 1960 January and 2015 July was conducted in PubMed, EMBASE, and CENTRAL databases.
Only studies that performed full coronal pulpotomy for carious vital pulp exposure of permanent posterior teeth and had clinical and radiographic assessments during at least one-year follow-up were qualified for data analyses. The weighted mean success rate (WSR) was the primary outcome and estimated using DerSimonian-Laird random effects model. Out of 299 articles, six studies were included for the analysis of one-year WSR, and five studies were included in the analysis of two-year WSR. The one-year and two-year WSR were 94% (95% confidence interval (CI): [90,99]) and 92% (CI: [84,100]) respectively. Differences in pulp capping and restoration materials did not significantly affect success rates (Two-year WSR in the MTA and MTA-like products group vs. the calcium hydroxide group: 92% (CI: [85,99]) vs. 88% (CI: [76,100]); the amalgam group vs. the composite group: 92% (CI: [81,100]) vs. 93% (CI: [81,100])).
Generally, full coronal pulpotomy had a favorable success rate in treating carious vital pulp exposure of permanent mature teeth with closed root apices. More studies with control group of root canal treated teeth and longer follow-up periods are needed.
Coronal pulpotomy treatment can be considered as an intermediate treatment option in managing carious vital pulp exposures of permanent teeth with closed root apices. This option may also serve as a substitute to extraction when root canal treatment cannot be performed for low income and uninsured patients or in underserved areas.
本系统评价旨在评估冠髓切断术治疗恒牙后牙龋源性露髓且根尖孔封闭的临床疗效。
数据/来源：采用PRISMA（系统评价与Meta分析优先报告项目）指南。检索了1960年1月至2015年7月发表在PubMed、EMBASE和CENTRAL数据库中的文章。
仅对恒牙后牙龋源性露髓进行全冠髓切断术且在至少一年随访期间有临床和影像学评估的研究才有资格进行数据分析。加权平均成功率（WSR）是主要结局，采用DerSimonian-Laird随机效应模型进行估计。在299篇文章中，6项研究纳入一年WSR分析，5项研究纳入两年WSR分析。一年和两年的WSR分别为94%（95%置信区间[CI]：[90,99]）和92%（CI：[84,100]）。盖髓剂和修复材料的差异对成功率没有显著影响（MTA及类MTA产品组与氢氧化钙组的两年WSR：92%（CI：[85,99]）对88%（CI：[76,100]）；汞合金组与复合树脂组：92%（CI：[81,100]）对93%（CI：[81,100]））。
总体而言，全冠髓切断术治疗恒牙成熟牙龋源性露髓且根尖孔封闭的成功率较高。需要更多以根管治疗牙齿为对照组且随访期更长的研究。
冠髓切断术可被视为治疗恒牙根尖孔封闭的龋源性露髓的一种中间治疗选择。当低收入和未参保患者或在服务不足地区无法进行根管治疗时，该选择也可作为拔牙的替代方法。
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