School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland.
Int Endod J. 2021 Apr;54(4):556-571. doi: 10.1111/iej.13449. Epub 2020 Dec 28.
The outcome of vital pulp treatment after carious pulp exposure is multifactorial and related to the procedure, biomaterial and pre-operative pulpal diagnosis.
To conduct a systematic review and meta-analysis determining the outcome of direct pulp capping (DPC) in mature permanent teeth with a cariously exposed pulp and a clinical diagnosis of reversible pulpitis, and ascertain whether the capping material influences the outcome.
Sources: MEDLINE Ovid-SP, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Embase and Web of Science until April 2020. Inclusion: Prospective, retrospective cohort studies and randomized trials investigating DPC outcome or comparing different capping materials after carious pulp exposure. Exclusion: Primary teeth, mechanical, traumatic or not specified pulp exposure, teeth with irreversible pulpitis or no pulpal diagnosis. Risk of bias assessed using Cochrane and modified Downs and Black quality assessment checklist. Meta-analysis on combined clinical/radiographic outcome was performed using a random effect model. Success was defined as absence of signs and symptoms of irreversible pulpitis, apical periodontitis or loss of pulp vitality.
Quality assessment highlighted four non-randomized studies to be of fair and five of poor quality. Four randomized trials had a high risk of bias. The pooled success rate differed based on material and follow-up. Calcium hydroxide success rate was 74% at 6-months, 65% at 1-year, 59% at 2-3 years and 56% at 4-5 years. Mineral trioxide aggregate (MTA) success was 91%, 86%, 84% and 81% at the same time points. Biodentine success was 96% at 6-months, 86% at 1 year and 86% at 2-3 years. The meta-analysis revealed MTA had better success than calcium hydroxide at 1-year (OR 2.66, 95% CI; 1.46- 4.84, P = 0.001) and 2- to 3-year follow-up (OR 2.21, 95% CI; 1.42-3.44, P = 0.0004). There was no difference between MTA and Biodentine.
These results were based on poor methodological quality studies. The effect size for of MTA vs Ca(OH)2, although modest, was consistent with narrow CI.
Low-quality evidence suggests a high success rate for direct pulp capping in teeth with cariously exposed pulps with better long-term outcomes for MTA and Biodentine compared with calcium hydroxide.
暴露于龋坏牙髓后的活髓治疗结果是多因素的，与治疗过程、生物材料和术前牙髓诊断有关。
进行系统评价和荟萃分析，以确定在临床诊断为可逆性牙髓炎的成熟恒牙中，直接盖髓（DPC）治疗暴露于龋坏牙髓后的结果，并确定盖髓材料是否会影响结果。
资料来源：MEDLINE Ovid-SP、Cochrane 对照试验中心注册库（CENTRAL）、国际临床试验注册平台（ICTRP）、ClinicalTrials.gov、Embase 和 Web of Science，检索时间截至 2020 年 4 月。纳入标准：前瞻性、回顾性队列研究和随机试验，调查 DPC 结果或比较不同的盖髓材料在龋坏牙髓暴露后的情况。排除标准：乳恒牙、机械性、外伤性或未指定的牙髓暴露、不可复性牙髓炎或无牙髓诊断的牙齿。使用 Cochrane 和改良 Downs 和 Black 质量评估清单评估偏倚风险。使用随机效应模型对联合临床/放射学结果进行荟萃分析。成功定义为无不可逆性牙髓炎、根尖周炎或牙髓活力丧失的迹象和症状。
质量评估强调了四项非随机研究为中等质量，五项为低质量。四项随机试验存在高度偏倚风险。根据材料和随访时间的不同，汇总成功率也有所不同。氢氧化钙的成功率在 6 个月时为 74%，在 1 年时为 65%，在 2-3 年时为 59%，在 4-5 年时为 56%。三氧化矿物聚合体（MTA）的成功率在相同时间点分别为 91%、86%、84%和 81%。Biodentine 的成功率在 6 个月时为 96%，在 1 年时为 86%，在 2-3 年时为 86%。荟萃分析显示，MTA 在 1 年（OR 2.66，95%CI；1.46-4.84，P=0.001）和 2 至 3 年随访（OR 2.21，95%CI；1.42-3.44，P=0.0004）时的成功率优于氢氧化钙。MTA 和 Biodentine 之间没有差异。
这些结果基于方法学质量较差的研究。MTA 与 Ca(OH)2 的效应大小虽然较小，但与狭窄的置信区间一致。
低质量证据表明，在临床诊断为可逆性牙髓炎的成熟恒牙中，直接盖髓治疗成功率较高，MTA 和 Biodentine 的长期结果优于氢氧化钙。
