Vital Pulp Therapy for Traumatic Pulpal Exposure in Permanent Teeth: A Path to Healing? Insights From Existing Systematic Reviews.

Abstract

Aim: To critically evaluate existing systematic reviews to assess the current status of vital pulp therapy (VPT) for managing traumatic pulpal exposures in permanent teeth.

Methods: A comprehensive literature search of multiple electronic databases was conducted for systematic reviews published until November 30, 2024, without language restrictions. Eligible reviews assessed the clinical effectiveness of VPT compared to alternative treatments or no intervention. Reviews that included case reports, laboratory studies, animal studies, and narrative reviews were excluded. The methodological quality was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2 tool, while the overlap among primary studies was quantified using the covered area and corrected covered area metrics.

Results: Four systematic reviews and meta-analyses, incorporating 32 primary studies, met the inclusion criteria. The overlap among primary studies was 18.75%, indicating a high degree of overlap. AMSTAR-2 revealed that all included reviews had a critically low level of confidence due to limitations in search strategies, inconsistency in risk of bias assessment, and lack of reporting of primary study funding sources. Despite these limitations, VPT demonstrated promising outcomes, with partial pulpotomy achieving higher success rates than direct pulp capping and emerging as the preferred approach for immature and mature permanent teeth with complicated crown fractures. However, conflicting evidence prevented definitive conclusions regarding the superiority of pulpotomy over pulp capping with calcium hydroxide Ca(OH)₂ or mineral trioxide aggregate (MTA). Additionally, no significant differences were observed between bioceramic materials and Ca(OH)₂ in pulpotomy cases.

Conclusion: Partial pulpotomy appears to be a promising treatment for traumatic pulp exposures in permanent teeth; however, the current evidence base, characterized by critically low AMSTAR-2 ratings, remains insufficient to support definitive clinical recommendations. Given the conflicting and low-quality evidence on the preferred material and the high overlap of primary studies among the included reviews, well-designed randomized controlled trials with long-term follow-up are essential for definitive clinical recommendations.

Trial registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42025650026.