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1728 4250 1 PB
1728 4250 1 PB
Review Article
ABSTRACT
Vital pulp therapy (VPT) is a biologic and conservative treatment modality to preserve the
vitality and function of the coronal or remaining radicular pulp tissue in vital permanent teeth.
A search was conducted via the Cochrane database, PubMed, MEDLINE, and Ovid for any
articles with the criteria for pulp-capping, or pulp-capping materials and VPT outcomes
from 1978 to mid 2014. All articles were evaluated and the valid papers were selected. The
outcomes of various VPT techniques, including indirect pulp treatment, direct pulp treatment,
partial pulpotomy, and complete pulpotomy in vital permanent teeth were extracted. Although
various studies have different research approach, most studies noted a favorable treatment
outcome. Mineral trioxide aggregate (MTA) appears to be more effective than calcium
hydroxide (Ca(OH)2) for maintaining long-term pulp vitality after indirect and direct pulpcapping. However, it seems that the success rate for partial pulpotomy and pulpotomy with
Ca(OH)2 is similar to MTA.
Key Words: Dental cements, calcium hydroxide, permanent dentition, mineral trioxide
aggregate, root canal therapies
INTRODUCTION
Website: www.drj.ir
www.drjjournal.net
www.ncbi.nlm.nih.gov/pmc/journals/1480
406
Year
Observation period
Sample size
1983
1998
2008
2010
2010
2010
6 months
6 months
3 months
Over 1-year
3 years
1-year
Maltz et al.[17]
2011
2012
Petrou et al.[19]
2014
1.5 year
3 years
5-year
10-year
3 months MTA
6 months MTA
3 months Ca(OH)2
6 months Ca(OH)2
6 months
38
94
52
154
66
Stepwise excavation (n=143)
Direct complete excavation (n=149)
32
94.1
94.6
97.8
92-94
93
74.1
62.4
97
90
82
63
93
89.6
73
73
86.9
90.5
94.5
60
31
29
26
Type of material
Ca(OH)2
Ca(OH)2
Ca(OH)2
Ca(OH)2
Ca(OH)2
Ca(OH)2
Ca(OH)2
MTA
Ca(OH)2
(Dycal())
Ca(OH)2
Portland cement
MTA
407
Year
Observation period
Sample size
Beetke et al.[20]
Fitzgerald and Heys[21]
Matsuo et al.[22]
1990
1991
1996
Santucci[23]
1999
106
18
25
10
18
Barthel et al.[9]
2000
Al-Hiyasat et al.[24]
Farsi et al.[25]
2006
2006
Bogen et al.[10]
2008
Orhan et al.[13]
Dammaschke et al.[6]
2008
2010
1-year
>6 months to 1-year
>6 months to 1-year
>1-2 years
6 months
4.5 years
>5-year
10-year
3-5 years
>6 months to 1-year
>1-2 years
>6 months to 1-year
>1-2 years
>2-3 years
>3 years
3 months
0.4-16.6 years
204
30
28
49
49
12
17
52
248
93.4
75
80
100
76
43.6
37.0
13.0
59.3
93.3
100
100
100
100
98
74.4
76.3 after 13.3 years
Bjrndal et al.[16]
Orhan et al.[14]
2010
2010
1-year
Over 1-year
22
154
Mente et al.[26]
2010
6.5 year
122
Miles et al.[27]
2010
51
Naito[28]
2010
1-year
2-year
5-year
Willershausen et al.[29]
2011
Hilton et al.[30]
2013
1-year
5-year
9 years
2 years
Nowicka et al.[31]
2013
6 weeks
Mente et al.[32]
2014
Over 10-year
195
181
11
11
229
Asgary et al.[33]
2014
13.4 months
28
123
69
53
1075
Type of material
Type of exposure
Ca(OH)2
Ca(OH)2
Ca(OH)2
Artificial exposure
Caries exposure
Caries exposure
Ca(OH)2
Caries exposure
Ca(OH)2
Caries exposure
Ca(OH)2
MTA
Caries exposure
Caries exposure
MTA
Caries exposure
Ca(OH)2
Ca(OH)2
Caries exposure
Caries exposure
31.8
78
Ca(OH)2
Ca(OH)2
Caries exposure
Caries exposure
78
60
67.7
56.2
78.17
69.5
80.1
68.0
58.7
80.3
68.5
100
100
80.5
59
96.4
MTA
Ca(OH)2
MTA
Caries exposure
MTA
Ca(OH)2
Ca(OH)2
Caries exposure
MTA
Ca(OH)2
MTA
Biodentine
MTA
Ca(OH)2
CEM cement
Caries exposure
Caries exposure
Caries exposure
Mechanically
exposed
Caries exposure
Caries exposure
Year
Observation period
Sample size
Type of material
Type of exposure
Zilberman et al.[34]
Mejre and Cvek[8]
1989
1993
Ca(OH)2
Caries exposure
1998
93.3
91.9
100
98.8
97.1
96.9
95.2
100
100
Caries exposure
Caries exposure
1995
15
37
33
17
35
32
21
6
6
Ca(OH)2
Ca(OH)2
Mass et al.[35]
Ca(OH)2
Caries exposure
Barrieshi-Nusair and
Qudeimat[37]
Qudeimat et al.[38]
2006
28
21
50
Caries exposure
Ca(OH)2, MTA
Caries exposure
Bjrndal et al.[16]
Caprioglio et al.[39]
Chailertvanitkul et al.[40]
2010
2014
2014
1-year
3 years
2 years
29
27
84
82.1
95.2
91
93
34.5
85
99.8
99.8
MTA
2007
1-8 years
>1-2 years
>2-3 years
>3 years
>6 months to 1-year
>1-2 years
>2-3 years
>3 years
>6 months to 1-year
>1-2 years
>6 months to 1-year
>1-2 years
3 years
Ca(OH)2
MTA
MTA
Ca(OH)2: Dycal
Caries exposure
Trauma exposure
Caries exposure
408
Year
Observation period Sample size Success rate (%) Type of material Type of exposure
Caliskan[41]
1995
Waly[42]
1995
Teixeira et al.[43]
DeRosa[44]
2001
2006
Witherspoon et al.[45]
2006
2006
24
8
6
6
20
20
19
18
41
26
24
21
13
13
10
30
Nosrat et al.[47]
2013
12 months
49
Barngkgei et al.[48]
2013
24-42 months
11
91.7
100
100
100
100
95
94.7
100
82.9
92.3
87.5
90.5
97.8
100
90
93.3
86.6
76.8
73.8
100
Ca(OH)2
Caries exposure
Ca(OH)2
Caries exposure
Ca(OH)2
Ca(OH)2
Caries exposure
Caries exposure
MTA
Ca(OH)2, MTA
CEM cement
MTA
MTA
Caries exposure
Caries exposure
Calcium hydroxide
Adhesive technique
412
Full pulpotomy
Partial pulpotomy
3.
5.
CONCLUSION
There is a controversy regarding the VPT procedures
outcomes, with many methodological variations
between the different studies. Although various studies
have different research approach, most studies noted
a favorable treatment outcome. The type of coronal
restoration and clinical status of the pulp tissue have a
significant influence on the results.
Mineral trioxide aggregate appears to be more
effective than Ca(OH)2 for maintaining long-term
pulp vitality after indirect and DPC. However, it
seems that the success rate for partial pulpotomy and
pulpotomy with Ca(OH)2 is similar to MTA.
ACKNOWLEDGMENTS
The authors wish to acknowledge Vise Chancellery
for Research (IUMS), the staff of Pediatric Dentistry
and Endodontic Department, Dental School of Isfahan
University of Medical Sciences (IUMS) for their supports.
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Conflicts of interest
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