Duncan Henry F, El-Karim Ikhlas, Dummer Paul M H, Whitworth John, Nagendrababu Venkateshbabu
Division of Restorative Dentistry & Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland.
School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
Int Endod J. 2023 Mar;56 Suppl 2:62-81. doi: 10.1111/iej.13866. Epub 2022 Nov 22.
The promotion of minimally invasive treatments focussed on the maintenance of pulp vitality has become a priority area in Endodontics. These vital pulp treatments (VPT) include partial and full pulpotomy, during which diseased coronal pulp tissue is removed prior to placement of a capping biomaterial and restoration. Traditionally, pulpotomies were confined to the treatment of carious primary and traumatized permanent teeth. However, these treatments have now been proposed as definitive solutions for cariously exposed permanent teeth with mild symptoms or even symptoms indicative of irreversible disease. Until recently, it was recommended that carious exposure of mature permanent teeth be managed by root canal treatment. The promotion of pulpotomy as an alternative treatment has opened up a wave of laboratory and clinical research aimed at improving therapies or evaluating clinical outcomes. In modern evidence-based endodontics, it is imperative that the outcomes of both partial and full pulpotomy are considered and important prognostic factors identified, so that improvements can be made to aid clinical decision-making and to direct new research. In this narrative review, the outcomes of partial and full pulpotomy are discussed, before analysis of patient, intraoperative and postoperative factors that influence the outcome of the pulpotomy procedure. The review highlights that although partial and full pulpotomy for the treatment of even pulpal disease are highly successful procedures, this is based on low-quality evidence with a lack of prospective, comparative trials investigating potential prognostic factors. Based on current evidence, it appears that age, gender, tooth type, root development and intraoperative pulpal haemorrhage do not impact significantly on pulpotomy outcome, whilst others such as caries depth, inflammatory status of the pulp, capping material, level of inflammatory pulpal-biomarkers and the final restoration integrity do. Other factors, including the influence of exposure type, periodontal condition, pulpal lavage, magnification, operator experience, isolation of the operating field and type of pulpotomy, require further experimental investigation before definitive conclusions can be made relating to the success of the pulpotomy procedure. Finally, there is not only a need for future well-designed prospective research addressing these issues but also a widening of our understanding of outcome to include patient-reported as well as clinician-reported outcomes.
专注于维持牙髓活力的微创治疗的推广已成为牙髓病学的一个优先领域。这些牙髓活力治疗（VPT）包括部分和全部牙髓切断术，即在放置盖髓生物材料和修复之前，先去除病变的冠部牙髓组织。传统上，牙髓切断术仅限于治疗龋坏的乳牙和外伤的恒牙。然而，现在这些治疗方法已被提议作为有轻度症状甚至有不可逆疾病迹象的龋源性暴露恒牙的确定性解决方案。直到最近，仍建议对成熟恒牙的龋源性暴露采用根管治疗。牙髓切断术作为一种替代治疗方法的推广引发了一系列实验室和临床研究，旨在改进治疗方法或评估临床结果。在现代循证牙髓病学中，必须考虑部分和全部牙髓切断术的结果，并确定重要的预后因素，以便进行改进以辅助临床决策并指导新的研究。在这篇叙述性综述中，在分析影响牙髓切断术结果的患者、术中及术后因素之前，先讨论了部分和全部牙髓切断术的结果。该综述强调，尽管用于治疗牙髓疾病的部分和全部牙髓切断术是非常成功的手术，但这是基于低质量证据，缺乏对潜在预后因素进行调查的前瞻性、对比试验。根据目前的证据，年龄、性别、牙齿类型、牙根发育和术中牙髓出血似乎对牙髓切断术结果影响不大，而龋坏深度、牙髓炎症状态、盖髓材料、牙髓炎症生物标志物水平和最终修复体完整性等因素则有影响。其他因素，包括暴露类型、牙周状况、牙髓冲洗、放大倍数、术者经验、术野隔离和牙髓切断术类型的影响，在就牙髓切断术的成功得出明确结论之前，需要进一步的实验研究。最后，不仅需要未来设计良好的前瞻性研究来解决这些问题，还需要拓宽我们对结果的理解，将患者报告的结果以及临床医生报告的结果都包括在内。
