The Effect of Single versus Multiple-stage Restorative Approaches on the Pulp Outcomes of Symptomatic Vital Cracked Teeth: A Systematic Review and Meta-analysis

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics Pub Date : 2025-10-01 DOI:10.1016/j.joen.2025.06.013

Dimitrios Gavriil DDS, MClinDent , Angeliki Kakka DDS, MSc , Massimo Del Fabbro MSc, PhD

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引用次数: 0

Abstract

Introduction

This systematic review aimed to compare single-stage treatment (SST) and multiple-stage treatment (MST) regarding pulp survival, pulp success, and tooth survival in symptomatic vital cracked teeth and to assess the influence of secondary interventions and baseline factors on pulp outcomes.

Methods

Electronic searches were conducted in PubMed, Scopus, Web of Science, Cochrane Library, and “Gray Literature” through December 3, 2024, supplemented by hand searching. Clinical studies reporting pulp survival of permanent symptomatic vital cracked teeth with ≥1-year follow-up after complete SST or MST were included. Risk of bias was evaluated using the Newcastle-Ottawa Scale and the Revised Cochrane risk-of-bias tool. A single-arm random-effects meta-analysis was performed. The certainty of the body of evidence was assessed via the Grading of Recommendations Assessment, Development and Evaluation approach.

Results

Fourteen cohort studies qualified. No significant difference was observed between SST and MST for 1- or 2-year pulp survival and 1-year pulp success (P > .05). However, SST with indirect restorations demonstrated significantly higher pulp success than MST with indirect (P < .05) and SST with direct (P < .001). Indirect onlays exhibited superior pulp outcomes compared to crowns (P < .05). Direct restorations were comparable to onlays for pulp survival (P > .05) but inferior for pulp success (P < .001). Short duration of interim treatment (1–2 weeks) yielded greater pulp success than long duration (2–3 months) (P < .05). One-year tooth survival was consistently high (96.1%–100%). The certainty of evidence was graded as very low due to the inclusion of observational studies and substantial between-study heterogeneity.

Conclusions

This review suggests with very low level of certainty that SST with indirect restorations may improve pulp success over MST. Onlays outperform crowns, while direct restorations may not fully alleviate symptoms. Short interim treatment duration is preferable in MST. Timely intervention is critical for tooth survival.

查看原文本刊更多论文

单阶段与多阶段修复方法对症状性重要牙裂牙髓结局的影响：一项系统回顾和荟萃分析。

本系统综述旨在比较单阶段治疗（SST）和多阶段治疗（MST）对症状性生命性裂牙（SVCT）的牙髓存活、牙髓成功和牙齿存活的影响，并评估二次干预和基线因素对牙髓结局的影响。方法：截止2024年12月3日，在PubMed、Scopus、Web of Science、Cochrane Library和“灰色文献”中进行电子检索，并辅以手工检索。临床研究报告了完全SST和/或MST后随访≥1年的永久性SVCT的牙髓存活情况。偏倚风险采用纽卡斯尔-渥太华量表和修订Cochrane偏倚风险工具进行评估。进行单臂随机效应荟萃分析。通过GRADE方法评估证据体的确定性。结果：14项队列研究符合要求。SST和MST在1年或2年牙髓存活和1年牙髓成功方面没有显著差异（P < 0.05）。然而，SST间接修复的牙髓成功率明显高于MST间接修复（P< 0.05）和SST直接修复（P< 0.001）。间接嵌体的牙髓效果优于冠（P < 0.05）。直接修复体在牙髓存活方面与单纯修复体相当（P < 0.05），但在牙髓成功方面不如单纯修复体（P < 0.001）。短期治疗（1-2周）比长期治疗（2-3个月）的牙髓成功率高（P< 0.05）。1年牙齿成活率一贯较高（96.1% ~ 100%）。由于纳入了观察性研究和大量的研究间异质性，证据的确定性被评为非常低。结论：这篇综述以非常低的确定性表明SST与间接修复相比MST可以提高牙髓成功率。而直接修复可能不能完全缓解症状。MST的中间治疗时间越短越好。及时干预对牙齿的存活至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of endodontics 医学-牙科与口腔外科

CiteScore

8.80

自引率

9.50%

发文量

224

审稿时长

42 days

期刊介绍： The Journal of Endodontics, the official journal of the American Association of Endodontists, publishes scientific articles, case reports and comparison studies evaluating materials and methods of pulp conservation and endodontic treatment. Endodontists and general dentists can learn about new concepts in root canal treatment and the latest advances in techniques and instrumentation in the one journal that helps them keep pace with rapid changes in this field.