Matoug-Elwerfelli Manal, ElSheshtawy Ahmed S, Duggal Monty, Tong Huei Jinn, Nazzal Hani
College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt.
Int Endod J. 2022 Jun;55(6):613-629. doi: 10.1111/iej.13741. Epub 2022 Apr 10.
Traumatic dental injuries involving the pulp are quite common and there is a need to evaluate the quality of evidence on the success of vital pulp treatment (VPT) interventions in traumatised permanent teeth.
The aim of this systematic review was to assess the success of VPT in the management of traumatised human vital permanent teeth diagnosed with complicated crown or crown-root fractures.
An electronic search of the following databases: Web of Science, Scopus, PubMed, MEDLINE, EMBASE, LILACS, Clinical Trial Registries and the grey literature was performed until 25 /8/2021. Controlled clinical trials, cohort studies, case-control studies, case series with at least five cases and a minimum of 12-months follow-up were included. Non-English language literature was excluded. Two independent assessors performed study selection, data extraction and quality assessment using the National Institutes of Health's quality assessment tool. Disagreements were resolved through consensus/with a third assessor.
A total of 14-studies (2-controlled clinical trials, 1-case-control, and 11-case series) published between 1978-2020, with a total of 1081 permanent teeth and an age range between 6-42 years-old were included. Bias analysis ranged considerably from 'good' to 'poor'. Meta-analysis was not performed due to data heterogeneity, unclear reporting, and limited number of controlled clinical studies. Partial pulpotomy was the main reported clinical procedure with an overall success rate between 82.9-100%. Complete pulpotomy and direct pulp capping were associated with lower success rates of 79.4-85.7% and 19.5%, respectively. Calcium hydroxide was the main pulp capping material with favourable clinical and radiographic success (79.4-100%). Biodentine , mineral trioxide aggregate and IRoot BP were also associated with a high clinical and radiographic success, 80-91%, 80-100%, and 90-100%, respectively, albeit in fewer studies.
Although a high success rate has been reported when using VPT in managing pulpally involved traumatised teeth, the results of this systematic review clearly highlighted a paucity and low quality of the available evidence.
Overall high success of VPT in the management of traumatised vital permanent teeth were reported, although based on limited evidence of well-conducted clinical studies.
PROSPERO database (CRD42020205213).
涉及牙髓的创伤性牙损伤相当常见，有必要评估在创伤恒牙中进行活髓治疗（VPT）干预措施成功的证据质量。
本系统评价的目的是评估VPT在治疗诊断为复杂冠折或冠根折的创伤性人类活髓恒牙中的成功率。
截至2021年8月25日，对以下数据库进行电子检索：科学网、Scopus、PubMed、MEDLINE、EMBASE、LILACS、临床试验注册库和灰色文献。纳入对照临床试验、队列研究、病例对照研究、至少5例且随访至少12个月的病例系列。排除非英语语言文献。两名独立评估者使用美国国立卫生研究院的质量评估工具进行研究选择、数据提取和质量评估。分歧通过共识/与第三位评估者解决。
共纳入1978年至2020年间发表的14项研究（2项对照临床试验、1项病例对照研究和11项病例系列），共计1081颗恒牙，年龄范围在6至42岁之间。偏倚分析范围从“良好”到“较差”差异很大。由于数据异质性、报告不明确以及对照临床研究数量有限，未进行荟萃分析。部分牙髓切断术是主要报告的临床操作，总体成功率在82.9%至100%之间。完全牙髓切断术和直接盖髓术的成功率较低，分别为79.4%至85.7%和19.5%。氢氧化钙是主要的盖髓材料，临床和影像学成功率良好（79.4%至100%）。尽管研究较少，但生物陶瓷、矿物三氧化物凝聚体和IRoot BP也具有较高的临床和影像学成功率，分别为80%至91%、80%至100%和90%至100%。
尽管在使用VPT治疗牙髓受累的创伤性牙齿时报告了较高的成功率，但本系统评价的结果清楚地突出了现有证据的匮乏和低质量。
尽管基于开展良好的临床研究的证据有限，但报告显示VPT在治疗创伤性活髓恒牙方面总体成功率较高。
PROSPERO数据库（CRD42020205213）
