Vital pulp therapy of mature permanent teeth with irreversible pulpitis from the perspective of pulp biology

2019 ◽  
Vol 46 (1) ◽  
pp. 154-166 ◽  
Author(s):  
Louis M. Lin ◽  
Domenico Ricucci ◽  
Tarek M. Saoud ◽  
Asgeir Sigurdsson ◽  
Bill Kahler
Keyword(s):  
Permanent Teeth ◽  
Pulp Therapy ◽  
Vital Pulp Therapy ◽  
Pulp Biology ◽  
Irreversible Pulpitis

scholarly journals Vital Pulp Therapy in Permanent Teeth with Irreversible Pulpitis Caused by Caries: A Prospective Cohort Study

2021 ◽  
Vol 11 (11) ◽  
pp. 1125
Author(s):  
Xiaoxu Guan ◽  
Yi Zhou ◽  
Qingxia Yang ◽  
Tianer Zhu ◽  
Xuepeng Chen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Success Rate ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Permanent Teeth ◽  
Old Patients ◽  
Pulp Therapy ◽  
Vital Pulp Therapy ◽  
Significant Difference ◽  
Irreversible Pulpitis

Background: When a tooth is diagnosed with irreversible pulpitis, root canal therapy (RCT) is generally performed to completely remove pulp tissue, which might lead to a higher risk of loss of vascularity, and teeth being more prone to fracture. Vital pulp therapy (VPT) is a personalized method of treating irreversible pulpitis, which conforms to the trend of minimally invasive endodontics. The remaining vital pulp could promote the physiological development of the roots of young permanent teeth with incomplete apical foramen. However, clear guidelines for VPT indication are still missing. Objective: This prospective cohort study evaluated the outcomes of vital pulp therapy (VPT) using iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, BC, Canada) in permanent teeth of 6- to 20-year-old patients with irreversible pulpitis caused by caries and analyzed the preoperative factors affecting VPT prognosis. Methods: Fifty-nine permanent teeth in 59 patients with irreversible pulpitis caused by caries were treated with VPT using iRoot BP Plus. All patients received VPT under a standardized protocol. After informed consent, teeth were isolated with a dental dam, then operators performed VPT with iRoot BP Plus and restored the teeth with composite resin or stainless steel crown. Patients were postoperatively recalled after 3, 6 and 12 months and then recalled annually. Successful cases were defined as successful in both clinical and radiographic evaluations. A statistical analysis was performed using the Fisher exact test, and the level of significant difference was p < 0.05. Results: After 6–36 months of follow-up, a total of 57 teeth from 57 patients were accessible for evaluation. The mean age of subjects was 11.75 ± 3.81 years. The overall clinical and radiographic success rate of VPT was 91.2% (52/57). With an observation time of one year or more, the success rate was 90.5% (38/42). All the symptoms and physical examination findings showed no significant effect on VPT prognosis (p > 0.05) using a binary logistic regression model. Conclusions: Permanent teeth in 6- to 20-year-old patients diagnosed as irreversible pulpitis caused by caries can be successfully treated with VPT using iRoot BP Plus.

scholarly journals Vital Pulp Therapy in Permanent Mature Posterior Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review of Treatment Outcomes

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 573
Author(s):  
João Miguel Santos ◽  
Joana F. Pereira ◽  
Andréa Marques ◽  
Diana B. Sequeira ◽  
Shimon Friedman
Keyword(s):  
Systematic Review ◽  
Root Canal ◽  
Small Sample ◽  
Risk Of Bias ◽  
Root Canal Treatment ◽  
Cochrane Library ◽  
Posterior Teeth ◽  
Pulp Therapy ◽  
Vital Pulp Therapy ◽  
Irreversible Pulpitis

Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed®, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle–Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as ‘high’ or ‘serious’, ‘fair’, and ‘low’ for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions: The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.

Vital Pulp Therapy Current Trends and Future Perspectives

2021 ◽  
Author(s):  
Iris Slutzky-Goldberg
Keyword(s):  
Root Development ◽  
Future Perspectives ◽  
Direct Pulp Capping ◽  
Pulp Capping ◽  
Pulp Therapy ◽  
Immature Teeth ◽  
Current Trends ◽  
Vital Pulp Therapy ◽  
Irreversible Pulpitis

Vital pulp therapy (VPT), including direct pulp capping, partial and cervical Pulpotomy, was suggested for the treatment of young teeth, with reversible or irreversible pulpitis [1]. Maintaining the vitality of immature teeth enables continued root development, maturogenesis, and a better prognosis

scholarly journals A Prospective Analysis of the Correlation Between Postoperative Pain and Vital Pulp Therapy

2021 ◽  
Vol 2 ◽  
Author(s):  
Mark Shallal-Ayzin ◽  
Tam Trinh ◽  
William Yeung ◽  
Peter Z. Tawil ◽  
Carol L. Haggerty ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Permanent Teeth ◽  
Pulp Therapy ◽  
Standardized Protocol ◽  
Vital Pulp Therapy ◽  
Post Operative Pain ◽  
Experienced Pain ◽  
Functional Tooth ◽  
Poor Treatment ◽  
Poor Treatment Outcome

Vital pulp therapy (VPT) is a viable treatment option for carious teeth with exposed pulps. To our knowledge, no study has examined the correlation between postoperative pain and the outcome of VPT on asymptomatic permanent teeth. The aim of this study was to examine whether odontogenic pain experienced after VPT on asymptomatic teeth with a carious pulp exposures is correlated with the progression of pulpal disease into a more inflamed or necrotic state. Direct pulp caps or partial pulpotomies using a tricalcium silicate (MTA Angelus, Angelus, Londrina, Brazil) were performed on asymptomatic permanent teeth using a standardized protocol. Patients were contacted at 24 h, 1 week, and 3 months following treatment and data was collected on post-operative pain and analgesic intake using a standardized questionnaire. At 6 months after treatment, an in-person clinical exam was performed which included standard vitality tests along with exposure of a periapical radiograph. Success was defined as an asymptomatic, functional tooth without any clinical or radiographic pathology. Data was analyzed using logistic regression. VPT was successful in 84.3% of patients at the 6 months timepoint. The percentage of patients that experienced pain at 24-h, 1 week, and 3-month time periods was 38, 22, and 12%, respectively. Pain at 3 months was significantly correlated with decreased outcome (p = 0.028). This data suggests that postoperative pain in the first 3 months after VPT is predictive of a poor treatment outcome.

Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals—A Review

2021 ◽  
pp. 089875642110463
Author(s):  
Amalia Zacher ◽  
Sandra Manfra Marretta
Keyword(s):  
Treatment Options ◽  
Mineral Trioxide Aggregate ◽  
Permanent Teeth ◽  
Small Animals ◽  
Unique Challenge ◽  
Pulp Capping ◽  
Pulp Therapy ◽  
Vital Pulp Therapy ◽  
Pulp Vitality ◽  
And Function

Immature permanent teeth with crown fractures present a unique challenge in human and animal patients. Immature permanent teeth have not yet developed completely, often presenting with thin dentin walls, incomplete apical formation, and increased crown-to-root ratios. Loss of pulp function at this stage has devastating long-term implications for these teeth. Ideally, attempts should be made to preserve pulp vitality in immature permanent teeth to allow for continued dental development. The range of treatment options for vital teeth includes odontoplasty with bonding and sealing +/− restoration, indirect pulp capping, and direct pulp capping/vital pulp therapy. These treatments have long been established in human and veterinary medicine, and cases have been reported in dogs and cats. Apexification using calcium hydroxide is a well-established treatment for nonvital immature teeth. The advent of mineral trioxide aggregate and other bioceramic materials for use in vital pulp therapy and apexification has reduced treatment sessions and improved outcomes. Recent developments in the field of regenerative endodontic therapy further expand treatment options and provide the possibility for continued development of a formerly nonvital tooth. Selecting the appropriate treatment based on the severity of tooth fracture and status of pulp vitality can avoid a lifetime of poor structure and function for the affected tooth. This article provides multiple step-by-step protocols for the management of immature permanent teeth with crown fractures in small animals.

scholarly journals Wound Lavage in Studies on Vital Pulp Therapy of Permanent Teeth with Carious Exposures: A Qualitative Systematic Review

2020 ◽  
Vol 9 (4) ◽  
pp. 984 ◽  
Author(s):  
Amina Munir ◽  
Matthias Zehnder ◽  
Dan-Krister Rechenberg
Keyword(s):  
Permanent Teeth ◽  
Pulp Capping ◽  
Recall Interval ◽  
Pulp Therapy ◽  
Vital Pulp Therapy ◽  
Qualitative Systematic Review ◽  
Significant Difference ◽  
Study Characteristics ◽  
Pulp Exposure ◽  
Calcium Silicate Cements

The aim of this study was to systematically review pulp wound lavage in vital pulp therapy (VPT). A search was conducted in six life science databases to identify clinical trials carried out on permanent teeth with a carious pulp exposure and a recall interval of at least six months. Twenty-seven trials of low to moderate risk of bias (RoB-2 and ROBINS-I) were included. Data was extracted and analyzed regarding study characteristics and methods used for pulp wound lavage. The agent used for pulp wound lavage was specified in all included trials. Most of the identified trials (23/27) randomized the pulp capping material. Many (14/27) reported the use of sodium hypochlorite (NaOCl); ten used only saline or water. One trial was identified that compared pulp wound lavage with 2.5% (NaOCl) to saline, another compared 5% glutaraldehyde to water, both in immature molar pulpotomies. Both studies were underpowered. Neither showed a significant difference between treatments. The use of NaOCl was positively correlated to recent year of publication and use of hydraulic calcium silicate cements for pulp capping (p < 0.05). In conclusion, despite a lack of well-designed trials on pulp wound lavage in VPT, a trend towards using NaOCl for this purpose was observed.

scholarly journals Dentist-related factors influencing the use of vital pulp therapy: a survey among dental practitioners in China

2019 ◽  
Vol 47 (6) ◽  
pp. 2381-2393
Author(s):  
Mengjie Li ◽  
Xiaoli Hu ◽  
Xiaolan Li ◽  
Shuxiang Lei ◽  
Ming Cai ◽  
...  
Keyword(s):  
Mineral Trioxide Aggregate ◽  
Permanent Teeth ◽  
Direct Pulp Capping ◽  
Online Questionnaire ◽  
Related Factors ◽  
Pulp Capping ◽  
Factors Associated ◽  
Pulp Therapy ◽  
Vital Pulp Therapy ◽  
Dental Practitioners

Objective To evaluate dentist-related factors associated with the use of vital pulp therapy (VPT) for the treatment of pulp exposures in permanent teeth. Methods This survey-based study sent an online questionnaire to collect data on the demographics of the respondents, the use of VPT and the choice of materials for VPT, to all members of the Society of Endodontology of Guangdong, China. Results A total 183 of 380 members responded (48.2%). The majority (89.6%; 164 of 183) had performed direct pulp capping (DPC) while 55.2% (101 of 183) had performed partial pulpotomy (PP) at least once. The most-cited reason for not performing VPT was unfamiliarity with the technique. Mineral trioxide aggregate was the most commonly used material for both DPC (67.1%; 110 of 164) and PP (73.3%; 74 of 101). Endodontists, compared with general practitioners, preferred to perform DPC and chose calcium silicate materials (CSMs) for VPT (odds ratios 5.81 and 8.07, respectively). DPC and CSMs for VPT were also favoured more by respondents who had practised for > 5 years. Senior respondents were more likely to use PP. Conclusions Speciality, years of practise and age of dentists influenced the decision making and the choice of materials for VPT. Continuing education is essential to promote the clinical use of VPT.

The knowledge about vital pulp therapy of permanent teeth among Saudi internship dentists and dental students

2020 ◽  
Vol 10 (2) ◽  
pp. 83
Author(s):  
Mazen Doumani ◽  
ShahadTalea Almutairi ◽  
NaifTami Talal Alshammari ◽  
AsmaNaeem Alshami ◽  
AbdulazizSaeed Alharbi ◽  
...  
Keyword(s):  
Dental Students ◽  
Permanent Teeth ◽  
Pulp Therapy ◽  
Vital Pulp Therapy

scholarly journals Knowledge and practice of vital pulp therapy in young permanent teeth among general dental practitioners in Kerman, Iran

2018 ◽  
Vol 6 (1) ◽  
pp. 29
Author(s):  
Lida Pishbin ◽  
Fatemeh Sadat Sajadi ◽  
Maryam Mahmoudi ◽  
Hassan Shahabinejad
Keyword(s):  
Material Selection ◽  
Permanent Teeth ◽  
Average Score ◽  
Cross Sectional ◽  
Pulp Capping ◽  
Pulp Therapy ◽  
Vital Pulp Therapy ◽  
Dental Practitioners ◽  
Knowledge And Practice ◽  
The University

The dental pulp is the living tissue of the tooth and its vitality is essential for long-term tooth survival. The vitality or non-vitality of the pulp as well as the presence or absences of a radicular pathology determine the type of pulp therapy. The knowledge of the dentist is important in selecting and carrying out a proper complete treatment. Therefore, this study was conducted to assess general dental practitioner`s (GDP) knowledge of indication, methods and prognosis of vital pulp therapy (VPT) for young permanent teeth (YPT).Method A total of 160 GDPs from dental clinics and offices in Kerman participated in this descriptive cross-sectional study. Data were collected using an initial questionnaire consisted of 15 items examining the knowledge and practice of indication, methods and prognosis of VPT for YPT among GDPs. The participants were asked to choose from the provided answers.Result of 160 questionnaires 154 were used for final evaluation.The overall obtained average score of the total items of the questionnaire was 4.53 ± 3.56. There was not any significant correlation between the knowledge of indication, examination, diagnosis, patients selection, effective factors in success of treatment and gender, number of the years since graduation and the university where the degree was obtained for VPT among GDPs. While knowledge of selecting the right materials for pulp-capping was significantly correlated with the number of the years since graduation and the university where the degree was obtained.Conclusion Although GDPs' level of knowledge in regard to VPT is not favorable, the time since graduation and place of education influenced the suitable material selection for pulp capping. Hence, GDPs, who perform pulp therapy , need to keep themselves updated with these procedures.

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