Management strategies for pulpitis in vital permanent teeth in children and adolescents: a systematic review and meta-analysis of randomized clinical trials.

Abstract

Purpose: Vital pulp treatment (VPT), including pulp capping and pulpotomy, is a conservative approach designed to maintain pulp vitality and health in reversible and partially irreversible pulpitis cases, particularly in children and adolescents with immature or mature permanent teeth. Despite extensive research, the comparation of various VPTs remains uncertain. This study evaluated the efficacy of different VPT techniques and capping materials, including calcium hydroxide (CH), mineral trioxide aggregate (MTA), and other pulp-protecting agents (PPA), and explored heterogeneity across trials, particularly with respect to pulp status (reversible vs. irreversible) and coronal restorations, using meta-regression analysis.

Methods: A systematic review and meta-analysis, adhering to PRISMA guidelines, was conducted through a comprehensive search in PubMed and Scopus up to August 2024. The PICO framework was used to define the inclusion criteria: Population (children/adolescents with vital permanent teeth diagnosed with pulp inflammation), Intervention (various VPTs), Comparison (different PPAs and restoration types), and Outcome (success rates based on clinical/radiographic criteria). Odd ratios (ORs) were calculated using random-effects models. Statistical heterogeneity was assessed using the I² test. Meta-regression analysis was performed to explore the influence of co-interventions on the success rate (P < 0.05).

Results: Nineteen randomized controlled trials involving 1183 participants were included. The meta-analysis revealed no significant difference between CH and MTA/PPA at 6 months (OR = -0.62; P = 0.26); however, at 12 months, CH demonstrated a significantly lower success rate compared to MTA/PPA (OR = -1.34; P = 0.01). Meta-regression analysis indicated that factors such as pulp status, restoration type, and VPT techniques did not significantly predict treatment success.

Conclusions: The findings suggest that various VPT techniques utilising MTA/PPA are effective for managing reversible/irreversible pulpitis in mature/immature permanent teeth in children/adolescents. In contrast, CH is less favourable and not recommended for VPT. These results reinforce the growing evidence supporting the use of MTA and other evidence-supported PPAs over CH for long-term success in VPTs.