Pulpotomy for treatment of complicated crown fractures in permanent teeth: A systematic review

Overall success rate of permanent teeth pulpotomy using ProRoot MTA: A systematic review and meta-analysis of randomized clinical trials

INTRODUCTION

This systematic review and meta-analysis aimed to evaluate the success rate of pulpotomy in permanent teeth using ProRoot MTA.

METHODS

An unrestricted search was carried out in 6 electronic databases, until August 2024. The selection of studies adhered to the PIOS criteria, encompassing only randomized clinical trials that assessed the success rate of pulpotomy in permanent teeth using ProRoot MTA through clinical and radiographic evaluations. Risk of bias was assessed using the RoB-2 tool, and meta-analyses were conducted through RevMan 5.3 and R software. To determine the quality of evidence, the GRADE tool was employed.

RESULTS

The initial search yielded 971 studies. After removing duplicates, 468 studies underwent initial screening, and 32 studies were considered for eligibility. In the final selection, 26 studies were included, and among these, 14 were categorized as having high risk of bias. The analysis of pulpotomy in permanent teeth using ProRoot MTA revealed an overall success rate of 96%, 90%, and 96% at 6-, 12-, and 24-month follow-up periods, respectively, and an annual failure rate of 8%. Meta-analyses indicated a significantly higher success rate for pulpotomies in teeth with open apex. Upon applying the GRADE assessment, an overall moderate level of evidence was observed.

CONCLUSION

Pulpotomy in permanent teeth using ProRoot MTA yields a success rate exceeding 90%, even up to a 24-month follow-up period. Nonetheless, the certainty of evidence supporting these outcomes is moderate, highlighting the requirement for well-designed randomized clinical trials with extended follow-up durations. Registration This systematic review was registered in the PROSPERO database (registration number CRD42023451466).

Management of crown fractures with different pulp treatments and Re-attachment technique: case series

BACKGROUND

Crown fracture is a type of traumatic injury that mostly affects the maxillary incisors. Depending on the involvement of the pulp, crown fracture may occur as complicated or uncomplicated and constitutes 26-76% of dental injuries in the permanent teeth. The effective treatment of crown fractures should aim to gain optimal aesthetics and function by preserving the vitality of the tooth. There have been case reports in the literature regarding pulpotomy and reattachment techniques in traumatized teeth. However, there has been no case series presenting different endodontic treatments performed with different current materials along with the reattachment technique. The aim of the current case series is to present treatment approaches of 3 crown fracture cases with different pulp treatments and re-attachment technique.

CASE PRESENTATION

In all cases the patients were 8 years old boys. In the first and third cases, complicated crown fractures involved upper central incisors. After endodontic treatment with Cvek pulpotomy, the teeth were restored using Biodentine in case 1 and MTA in case 3. In the second case, uncomplicated crown fracture of the lower central incisor was treated with indirect pulp capping. In all cases, the fractured crown parts were re-attached and the patients were scheduled for recall appointments.

CONCLUSIONS

Re-attachment technique offers aesthetic, functional and economic treatment option by long-term preserving the anatomic form, color and surface texture. The evaluation of the pulpal status before the reattachment technique and application of the proper pulpal treatment influences the prognosis of the tooth.

Promoting Dentin Bridge Formation Through N-Acetyl-L-Cysteine Application in Rat Molar Pulpotomy: An Experimental Study

Pulpotomy is performed when tooth decay reaches the dental pulp or when the crown is fractured due to trauma. Mineral trioxide aggregate (MTA) is commonly used in pulpotomy, but its prognosis can be variable. N-acetyl-L-cysteine (NAC), an antioxidant amino acid, has garnered attention due to its potential benefits. This study aimed to investigate the effects of MTA and NAC on pulpotomy outcomes. We used Sprague Dawley rat maxillary molars to perform pulpotomy and employed Superbond C&B, MTA, and MTA mixed with NAC (MTA-NAC) for pulp capping. We obtained tissue sections 3 and 7 days postpulpotomy, conducting histological analysis by examining the morphology of pulp tissue and assessing dentin sialophosphoprotein (DSPP) and osteopontin expression levels. At 3 days postpulpotomy, MTA and MTA-NAC reduced the inflammatory response. At 7 days postpulpotomy, dentin bridge formation was observed following MTA-NAC application, and although MTA resulted in DSPP- and osteopontin-positive areas, these areas were more extensive following MTA-NAC application. Given that adding NAC to MTA enhanced dentin bridge formation, MTA-NAC appears to be a superior option for pulp capping.

Vital Pulp Therapy: Evidence-Based Techniques and Outcomes

Vital pulp therapy (VPT) comprises a range of conservative treatment modalities aimed at preserving the vitality of the compromised dental pulp in primary and permanent teeth. This PubMed-based review comprehensively evaluates seven distinct VPT techniques; including their historical development, broad definitions, clinical protocols and treatment outcomes as evidenced by systematic reviews and meta-analyses. The VPT modalities covered in this review include stepwise excavation, indirect pulp capping, direct pulp capping, miniature pulpotomy, partial pulpotomy, full pulpotomy and partial pulpectomy. Stepwise excavation, as a minimally-invasive option, has demonstrated effectiveness in reducing the risk of pulp exposure, particularly in permanent teeth. Clinical outcomes of indirect and direct pulp capping are promising; specifically with the application of advanced calcium silicate cements. Miniature and partial pulpotomies emphasize the importance of precise definitions and standardised protocols due to their subtle differences. Full pulpotomy has emerged as a viable alternative to root canal treatment, achieving comparable success rates in managing irreversible pulpitis. While partial pulpectomy remains the most invasive approach, it has shown potential in managing complex cases, such as root resorption, through selective tissue preservation. Despite advancements in biomaterials and technique standardisation, challenges remain, including variability in clinical protocols, limited high-quality evidence, and the need for long-term studies to better evaluate anticipated outcomes. Nevertheless, emerging biotechnologies hold promise for enhancing the precision and predictability of VPT procedures in the future.

Two horizontal root fractures of a permanent central incisor tooth: A case report

Traditionally, teeth with horizontal root fractures resulting in pulp infections have been managed with conventional root canal therapy; however, this technique is associated with a limited success rate. This study presents an unusual case of multiple horizontal root fractures of the maxillary central incisor caused by a traumatic injury. The preservation of vital dental pulp is advantageous for healing root fractures. Therefore, we performed a pulpotomy to maintain vitality of the root pulp. The tooth exhibited no clinical symptoms and regained its normal color. In cases of traumatic root fractures, prompt treatment is important once pulpitis is confirmed. Pulpotomy is highly recommended as this procedure preserves the remaining vital root pulp, thereby enhancing the potential for improved healing. The purpose of this study was to emphasize the difficulty associated with diagnosing multiple root fractures and the value of preserving the biological tissue.

Single- versus multi-visit approach for fragment reattachment in complicated crown-root fractures: a cohort study

BACKGROUND

Complicated crown-root fractures are a type of tooth fracture that involves the enamel, dentin, and cementum and accompanied by pulp exposure. The treatment of a complicated crown-root fracture is always challenging due to the difficulties in achieving a hermetic seal and a stable restoration with a fracture level close to the crestale bone level. This study aimed to evaluate and compare the efficacy of single-visit and multi-visit approaches for fragment reattachment in complicated crown-root fractures of anterior teeth.

METHODS

Two cohort consist of 10 adolescent patients in each group at both genders, who suffered from permanent anterior tooth complicated crown-root fracture were included. Fragment reattachment with root canal treatment was performed with either single or multiple-visit approach. Single visit fragment attachement combined with root cannel therapy was conducted in single-visit approach group immediately after injury. Fragment attachment, root cananel therapy and post resoration were performed during three times ' clinical visit in multi-visit approach group.

RESULTS

All the patients in both groups achieved satisfactory aesthetic results one year after fragment reattachment. Patients who underwent a multi-visit approach had a significantly shorter operative duration, less intra-operative pain and fatigue, slightly better periodontal health at an early stage, and a decreased incidence of temporomandibular joint disorders compared to those who underwent a single-visit approach. However, multiple visits approach may increase the risk of fragment detachment postoperatively.

CONCLUSION

Fragment reattachment a reliable but temporary technique for adolescent patients who have suffered from complicated crown-root fractures. Multi-visit approach showed similar effecacy to single-visit approach but with slightly less complications. The choose of these two merhos should depend on the specific patient situation and patient compliance.

TRIAL REGISTRATION

This prospective cohort study was retrospectively registered in Chinese Clinical Trial Registry (ChiCTR2300076811) on 19/10/2023.

Total Pulpotomy Using a Newer Mineral Trioxide Aggregate for Managing Complicated Crown Fractures in Mature Permanent Incisors: A Case Report

Crown fractures with pulp exposure in mature permanent teeth present a challenging situation that requires immediate attention. Mineral trioxide aggregate (MTA) as a sealing material after pulpotomy has proven to be a reliable treatment in these cases compared to traditional root canal therapy. This case report emphasizes the importance of early diagnosis and careful treatment planning for complicated crown fractures and concussion injuries in a mature permanent incisor of a young child. Total pulpotomy using MTA has proven to be an effective treatment for fractures in young mature incisors with pulp exposure, as evidenced by a one-year follow-up in our case, which showed no discoloration.

Treatment outcomes of permanent teeth with uncomplicated and complicated crown fractures and factors associated with pulp survival: A retrospective study

BACKGROUND

Crown fracture is the most common injury in permanent teeth. This study aimed to evaluate the treatment outcomes of permanent teeth with uncomplicated and complicated crown fractures and to investigate potential factors.

MATERIALS AND METHODS

This retrospective study included patients who experienced crown fractures in permanent teeth from 2018 to 2021 with at least 12 months of follow-up. All complicated crown fractured teeth were treated with pulpotomy, while for teeth with uncomplicated crown fractures, three treatments (restoration, indirect pulp capping, or pulpotomy) were employed. The chi-square test was used to compare the prognosis of teeth with uncomplicated and complicated crown fractures. Potential factors associated with pulp survival including gender, interval, root development, enamel infraction, mobility, concomitant luxation injury, treatment, and coronal restoration were identified via Cox regression analysis.

RESULTS

A total of 307 teeth from 220 children (average age = 9.3 ± 1.4 years; age range, 6-14 years) with a median follow-up of 23 months were included, and 82.1% of all teeth had immature roots. Complicated crown fractured teeth (93.6%, 102/109) had a significantly higher success rate compared with uncomplicated crown fractured teeth (85.4%, 169/198) (p < .05). Pulpotomy (96.9%) had the highest success rate of all treatments for uncomplicated crown fractures, followed by only restoration (85.0%) and indirect pulp capping (76.9%). The success rate of teeth that received pulpotomy was significantly higher than those treated by indirect pulp capping (p < .05). In uncomplicated crown fractures, teeth with Class II mobility were more vulnerable to failure than teeth without abnormal mobility (HR = 34.83; 95% CI, 9.59-126.56; p < .05); teeth that received pulpotomy were less prone to failure than teeth that received indirect pulp capping (HR = 13.53; 95% CI, 1.58-115.72; p < .05).

CONCLUSION

Crown fractures treated with conservative pulp treatments had a relatively highly favorable prognosis. The prognosis of uncomplicated crown fractured teeth was impacted by the severity of periodontal injury and treatment strategies. Accurate diagnosis and identification of micro-exposures are important. Dentists should take multiple risk factors into account and select optimal treatment strategies.

Exploring vital pulp Therapies: A bibliometric analysis of the most cited articles

Aim

The aim of this study was to identify and analyze the most cited articles on vital pulp therapies.

Methodology

Bibliographical data related to the abstract, citations, keywords, and other relevant information was extracted using different combinations of keywords. Further evaluation and visualization of the selected data were performed with the help of various tools, including MS Excel, Microsoft Word, Google open refine, BibExcel, and VOS viewer. An initial search revealed 91 documents, of which 40 were chosen for further analysis. We used the Kolmogorov-Smirnov test and Spearman correlation coefficient test, and our adopted significance level was p < 0.05.

Results

In total, the articles received 1,905 citations, with six of them receiving at least 100 citations. Among the top 40 articles, the United States of America (10 articles) and Ireland (6 articles) were the countries with the highest number of cited articles. The journals "Journal of Endodontics" (14 articles; 650 citations) and "International Endodontic Journal" (13 articles; 577 citations) published most of the articles among the 50 most cited ones. Duncan H. was the author with the highest number of works cited (11 articles; 339 citations). Of the articles, systematic reviews accounted for 32%, literature reviews for 14%, in vitro experimental studies for 12%, clinical trials for 8%. Among the biomaterials used in vital pulp therapies, mineral trioxide aggregate (MTA) was discussed in 37 articles (74%), followed by calcium hydroxide, mentioned in 30 studies (60%). Interestingly, the publication year did not demonstrate a significant impact on citation count.

Conclusion

The present study provided a detailed list of the top 50 most cited and classic articles on vital pulp therapies. This will help researchers, students, and clinicians in the field of endodontics with an impressive source of information.

Pulpotomy of mature teeth: A systematic analysis of the failed cases

Pulp therapy aims to maintain the health and integrity of teeth and their supporting tissue and preserve the vitality of the tooth pulp affected by dentinal caries or severe traumatic injury. Thus, the best clinical practice provides pulpal health or pathosis diagnosis and various therapeutic interventions evidenced in both the deciduous and permanent dentition for endodontic treatment. The pulp health status determines the type of pulpal therapy used. Vital pulp therapies for primary teeth include protective liners, pulp capping, and pulpotomy for reversible pulpitis; for permanent teeth, pulpotomy can be considered for irreversible pulpitis. For reversible or irreversible pulpitis, invasive management of decayed teeth has traditionally been performed. However, at present, coronal pulpotomy-like vital pulp therapy has led to successful treatment outcomes that are less invasive. Compared to root canal treatments, coronal pulpotomy is cost-effective, less time-consuming, and less technically demanding. The success of a pulpotomy depends on the clinician's experience, appropriate clinical techniques, and materials used. This narrative review provides insights into the systematic analysis of pulpotomy failure, causes and signs of failure, and alternative endodontic interventions.

[Risk-oriented approach to predicting external inflammatory resorption in children with permanent teeth injuries]

THE AIM OF THE STUDY

Was to determine the risk factors for pulp necrosis and external inflammatory resorption in children with permanent teeth trauma.

MATERIALS AND METHODS

The study involved 68 pediatric patients aged 6 to 16 years (mean age 10.9±2.9 years) with a history of trauma to 152 permanent teeth. Of the 152 teeth, 55 had unformed roots, and 97 teeth had formed roots. Multiple trauma was observed in 43 teeth, and isolated trauma was observed in 109 teeth. All patients were assessed for the risks of pulp necrosis and external inflammatory root resorption in traumatized permanent teeth depending on a number of factors. The patients were observed clinically and radiographically from 6 months to 9 years.

RESULTS

The probability of external inflammatory resorption in case of pulp necrosis in permanent teeth with unformed roots is 2.3 times higher than in formed ones. Multiple trauma (30.9%) is more common in patients with unformed roots of permanent teeth, while combined trauma (87.6%) is more common in patients with formed roots. The probability of pulp necrosis in case of multiple trauma of a permanent tooth is higher (67.4%) than in case of isolated trauma (36.7%). Of all types of trauma, avulsion and impaction of a permanent tooth most often lead to pulp necrosis and development of external inflammatory root resorption.

CONCLUSION

Multiple trauma, which is more typical for permanent teeth with unformed roots, is a risk factor for pulp necrosis and, consequently, external inflammatory root resorption of a tooth. A risk-based approach can be an effective tool for a dentist in choosing the tactics of managing children with permanent tooth trauma. Evaluation of risk factors for pulp necrosis and external inflammatory resorption in a specific permanent tooth in a child will allow the dentist to provide a personalized way to prevent these complications, and therefore increase the likelihood of tooth survival after trauma.

Biomechanics of anterior endocrowns with different designs and depths: Study of finite elements

Background

To date, there is no clear consensus in the literature on which endocrown design and depth is the most effective treatment option for restoring endodontically treated maxillary central incisors. Aim: To determine the stress distribution of the anterior endocrowns by means of finite element analysis.

Material and Methods

Nine 3D finite element models (groups A - I) were made, each one representing a restoration system of endodontically treated upper central incisors. The models were endocrowns with and without ferrules at 0, 1, 3, and 5 mm depth and a post-core stump control group. A static load of 100N of force was applied to the palatal face at 45º from the long axis of the tooth. The Von Mise values and the maximum stress in the crown, dentin and resin cementum were evaluated separately.

Results

The maximum stress distribution was C < B < A < D < H < F < E < G < I and the Von Mises stresses were in the upper 1/3 of the retainer of endocrowns A, B, C and D. ; in the vestibular neck in endocrowns E and F; in the final 1/3 of the retainer in the endocrown G; in the middle 1/3 of the retainer in the H endocrown; and at the level of the vestibular neck of the crown in model I.

Conclusions

The smallest distribution of maximum and Von Mises stresses was observed in model C. Key words:Finite element analysis, Biomechanics, upper central incisor, endodontically treated teeth, dental restoration.

A Partial Pulpotomy in Traumatized Permanent Incisors With Pulp Exposure

A complicated crown fracture in a permanent incisor is one of the most difficult traumatic dental injuries to deal with. Treatment involves multiple visits and invasive intraoperative interventions and this is a very costly procedure. However, progress in vital pulp therapy and adhesive dentistry may allow practitioners to treat these injuries with a conservative method. Correct diagnosis of the pulp is important as it forms the basis for the establishment of an appropriate management strategy. A partial pulpotomy is indicated if the patient has significant pulp exposure or if it is reported after a considerable delay. It has been reported that partial pulpotomies after complicated crown fractures have a 96% success rate. Other studies have reported that partial pulpotomy is a treatment of choice after a complicated traumatic crown fracture, with a very high success record. Traditionally, calcium hydroxide has been applied as a dressing agent. However, research has recently focused on other calcium silicate cements (CSC), such as Biodentine (BD). This study aimed to illustrate the successful management of a vital permanent incisor with complicated crown fractures, which were treated by partial pulpotomy using Biodentine material and evaluated for healing clinically and radiographically. No radiographic signs of failure or clinical symptoms were detected over a one-year period.

Role of alpha smooth muscle actin in odontogenic differentiation of dental pulp stem cells

Pulpotomy is an effective treatment for retaining vital pulp after pulp exposure caused by caries removal and/or trauma. The expression of alpha smooth muscle actin (α-SMA) is increased during the wound-healing process, and α-SMA-positive fibroblasts accelerate tissue repair. However, it remains largely unknown whether α-SMA-positive fibroblasts influence pulpal repair. In this study, we established an experimental rat pulpotomy model and found that the expression of α-SMA was increased in dental pulp after pulpotomy relative to that in normal dental pulp. In vitro results showed that the expression of α-SMA was increased during the induction of odontogenic differentiation in dental pulp stem cells (DPSCs) compared with untreated DPSCs. Moreover, α-SMA overexpression promoted the odontogenic differentiation of DPSCs via increasing mitochondrial function. Mechanistically, α-SMA overexpression activated the mammalian target of rapamycin (mTOR) signaling pathway. Inhibition of the mTOR signaling pathway by rapamycin decreased the mitochondrial function in α-SMA-overexpressing DPSCs and suppressed the odontogenic differentiation of DPSCs. Furthermore, we found that α-SMA overexpression increased the secretion of transforming growth factor beta-1 (TGF-β1). In sum, our present study demonstrates a novel mechanism by which α-SMA promotes odontogenic differentiation of DPSCs by increasing mitochondrial respiratory activity via the mTOR signaling pathway.

Success rate of permanent teeth pulpotomy using bioactive materials: A systematic review and meta-analysis of randomized clinical trials

BACKGROUND

The results of vital pulp treatments in permanent teeth have been encouraging. Currently, pulpotomy treatment for permanent teeth primarily utilizes mineral trioxide aggregate (MTA) as the dressing material, followed by calcium hydroxide. While other calcium-silicate-based cements have been suggested for pulpotomy, there is a limited number of studies evaluating their long-term effectiveness.

OBJECTIVES

The objective of this systematic review and meta-analysis was to evaluate the success rate of pulpotomies performed on permanent teeth, comparing the use of ProRoot MTA with that of calcium hydroxide and other bioceramic materials.

METHODS

A comprehensive search was conducted in several electronic databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase and Science Direct until December 2022. The search was guided by PICOS criteria, including only randomized clinical trials (RCTs) that evaluated the success rate of pulpotomy treatments in permanent teeth using ProRoot MTA in comparison to calcium hydroxide and other bioceramic materials. The quality of the included studies was assessed using the RoB-2 tool to evaluate the risk of bias, and relevant data were extracted and analysed in RevMan software 5.3 using fixed-effect models. The GRADE tool was used to determine the overall quality of evidence.

RESULTS

The initial search retrieved 1072 studies and, after eliminating duplicates, 677 studies were screened and 28 studies were considered for eligibility. In the final selection process, 16 studies were included in the systematic review, with 10 being determined as having a high risk of bias. Pulpotomy showed an overall mean success rate of 92% after 1 year. The meta-analysis indicated a significantly higher success rate for pulpotomies utilizing MTA in comparison with calcium hydroxide, while no significant difference was seen between MTA and calcium-enriched mixture (CEM) or Biodentine. The GRADE assessment revealed an overall low level of evidence for the included studies.

DISCUSSION

Most randomized controlled trials exhibited a significant absence of control over confounding factors.

CONCLUSIONS

This systematic review and meta-analysis demonstrate that pulpotomy is a highly effective treatment for managing permanent teeth. The results indicate that the success rate of pulpotomy using ProRoot MTA is significantly higher than when using calcium hydroxide. However, the certainty of evidence supporting these findings is low, and there is a need for well-designed RCTs to assess the long-term outcomes of pulpotomy using newer bioceramic materials.

REGISTRATION

This systematic review was registered in the PROSPERO database (registration number CRD42023393970).

A New Biomaterial Derived from Aloe vera-Acemannan from Basic Studies to Clinical Application

Aloe vera is a kind of herb rich in polysaccharides. Acemannan (AC) is considered to be a natural polysaccharide with good biodegradability and biocompatibility extracted from Aloe vera and has a wide range of applications in the biomedical field due to excellent immunomodulatory, antiviral, antitumor, and tissue regeneration effects. In recent years, clinical case reports on the application of AC as a novel biomedical material in tissue regenerative medicine have emerged; it is mainly used in bone tissue engineering, pulp-dentin complex regeneration engineering, and soft tissue repair, among other operations. In addition, multiple studies have proved that the new composite products formed by the combination of AC and other compounds have excellent biological and physical properties and have broader research prospects. This paper introduces the preparation process, surface structure, and application forms of AC; summarizes the influence of acetyl functional group content in AC on its functions; and provides a detailed review of the functional properties, laboratory studies, clinical cutting-edge applications, and combined applications of AC. Finally, the current application status of AC from basic research to clinical treatment is analyzed and its prospects are discussed.

Mesenchymal condensation in tooth development and regeneration: a focus on translational aspects of organogenesis

The teeth are vertebrate-specific, highly specialized organs performing fundamental functions of mastication and speech, the maintenance of which is crucial for orofacial homeostasis and is further linked to systemic health and human psychosocial well-being. However, with limited ability for self-repair, the teeth can often be impaired by traumatic, inflammatory, and progressive insults, leading to high prevalence of tooth loss and defects worldwide. Regenerative medicine holds the promise to achieve physiological restoration of lost or damaged organs, and in particular an evolving framework of developmental engineering has pioneered functional tooth regeneration by harnessing the odontogenic program. As a key event of tooth morphogenesis, mesenchymal condensation dictates dental tissue formation and patterning through cellular self-organization and signaling interaction with the epithelium, which provides a representative to decipher organogenetic mechanisms and can be leveraged for regenerative purposes. In this review, we summarize how mesenchymal condensation spatiotemporally assembles from dental stem cells (DSCs) and sequentially mediates tooth development. We highlight condensation-mimetic engineering efforts and mechanisms based on ex vivo aggregation of DSCs, which have achieved functionally robust and physiologically relevant tooth regeneration after implantation in animals and in humans. The discussion of this aspect will add to the knowledge of development-inspired tissue engineering strategies and will offer benefits to propel clinical organ regeneration.

Factors that influence the outcome of pulpotomy in permanent teeth

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.

The Understanding of Vital Pulp Therapy in Permanent Teeth: A New Perspective

The indications of vital pulp therapy (VPT) are expanding, which cases are suitable for VPT, and how to improve the success rate of VPT is a problem that often bothers us. The main purpose of VPT is to eliminate pulpitis by promoting the formation of reparative dentin or calcium bridge, so that it can continue to perform various physiological functions, and finally achieve the purpose of preserving pulp vitality and long-term preservation of affected teeth. Pulp capping and pulpotomy are the most common methods for VPT. The research field of VPT has attracted the attention of many scholars, who have studied it from many aspects (such as indications, material selection, operation requirements, and long-term prognosis). This article reviews the recent advances in the techniques of VPT in permanent teeth.