Pulpotomy for irreversible pulpitis in mature permanent teeth: An overview of systematic reviews of randomized controlled trials.

BackgroundPulpotomy is widely used in primary and immature permanent teeth, but its effectiveness in mature permanent teeth with irreversible pulpitis remains controversial.ObjectiveTo identify and evaluate the existing systematic reviews of randomized controlled trials (RCTs) assessing pulpotomy as a treatment for irreversible pulpitis in mature permanent teeth.MethodsA protocol-guided search was conducted across PubMed, ProQuest, EMBASE, and Cochrane up to March 2024, targeting systematic reviews based on RCTs. Eligibility, selection, data extraction, and risk of bias assessment were performed independently by two reviewers. Quality was assessed using the AMSTAR 2 tool.ResultsOf the 52 articles retrieved, only one systematic review met inclusion criteria. The review included four RCTs involving 874 patients. Reported clinical success rates ranged from 81.2% to 98.19%, and radiographic success ranged from 38.4% to 95%, with the highest outcomes observed for calcium-enriched mixture and mineral trioxide aggregate. The AMSTAR 2 assessment rated the systematic review as critically low quality.ConclusionCurrent evidence from systematic reviews is insufficient to definitively recommend pulpotomy for irreversible pulpitis in mature permanent teeth. However, favorable clinical outcomes and the minimally invasive, cost-effective nature of the procedure suggest that pulpotomy may serve as a practical alternative to root canal treatment in select cases. High-quality RCTs and systematic reviews are urgently needed to strengthen the evidence base.