Chhabra Ajay, Prathap B Saravana, Kp Ramya, Yadav Priyanka, Parvathy Sona J, Chhabra Vandana
Department of Dentistry, AIIMS Kalyani, Kalyani, West Bengal, India.
Department of Conservative Dentistry and Endodontics, AIIMS Kalyani, Kalyani, West Bengal, India.
Sci Prog. 2025 Apr-Jun;108(2):368504251346677. doi: 10.1177/00368504251346677. Epub 2025 May 27.
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.
背景
牙髓切断术广泛应用于乳牙和年轻恒牙,但对于成熟恒牙不可逆性牙髓炎的治疗效果仍存在争议。
目的
识别和评估现有的关于评估牙髓切断术治疗成熟恒牙不可逆性牙髓炎的随机对照试验(RCT)的系统评价。
方法
截至2024年3月,在PubMed、ProQuest、EMBASE和Cochrane数据库中进行了方案指导检索,目标是基于RCT的系统评价。两名 reviewers 独立进行纳入标准、选择、数据提取和偏倚风险评估。使用AMSTAR 2工具评估质量。
结果
在检索到的52篇文章中,只有一项系统评价符合纳入标准。该评价纳入了四项涉及874例患者的RCT。报告的临床成功率为81.2%至98.19%,影像学成功率为38.4%至95%,富钙混合物和三氧化矿物凝聚体的治疗效果最佳。AMSTAR 2评估将该系统评价评为极低质量。
结论
目前系统评价的证据不足以明确推荐牙髓切断术用于治疗成熟恒牙的不可逆性牙髓炎。然而,良好的临床效果以及该手术的微创、经济有效的特点表明,在某些情况下,牙髓切断术可能是根管治疗的一种实用替代方法。迫切需要高质量的RCT和系统评价来加强证据基础。