Association between patient age and vital pulp therapy outcomes: A systematic review and meta-analysis of prognostic studies

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE International endodontic journal Pub Date : 2025-03-25 DOI:10.1111/iej.14223

Carla Moretto, Patrícia Maria Poli Kopper, Eliseu Aldrighi Münchow, Roberta Kochenborger Scarparo

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Abstract

Background

Summarizing the association between patient age and vital pulp therapy (VPT) outcomes is important to improve clinical decision-making.

Objectives

To investigate whether patient age is a predictor of VPT success/survival, using a research question based on the PICOTS acronym: (P) participants presenting mature permanent teeth undergoing VPT; (I) participants age; (C) gender, systemic condition, preoperative symptoms/diagnosis, caries extent/location, restoration extent/type, bleeding time; (O) clinical and radiographic success/survival; (T) data collected immediately before and during the clinical procedure and follow-up performed at least 1 year later; (S) clinical trials and observational studies developed in dental schools and services.

Methods

PubMed, EMBASE, Lilacs and Web of Science databases were searched for studies published from inception to 29 June 2024. Two independent reviewers selected and extracted data; senior reviewers resolved disagreements. Study characteristics were tabulated, and a meta-analysis was conducted, using RevMan software. The QUIPS tool assesses the risk of bias, whilst the GRADE criteria assess the certainty of evidence.

Results

Thirty-four studies were included in the qualitative synthesis, and 23 in the meta-analysis. Bivariate associations showed higher direct pulp capping (DPC) success rates for participants younger than 40 years [OR = 4.85, 95% CI (2.27–10.39)]. The association between age and full pulpotomy (FP) + partial pulpotomy (PP) survival was not significant in multivariate meta-analysis [HR = 1.02, 95% CI (0.98–1.05)]. Bias related to outcome measurements, confounding/statistical analysis and reporting were the main concerns of the studies' quality, and the overall risk of bias was moderate to high. The certainty of the evidence was very low for the analysis of the DPC 25-year-old cut point, high for the multivariate analysis and moderate for the other analysis.

Discussion

Age did not influence PP and FP outcomes. In contrast, it is associated with DPC success, probably influenced by difficulties during direct inspection of pulp tissue. Further studies with multivariate-adjusted analyses are required to improve the certainty of the evidence.

Conclusions

Patient age is not associated with the outcomes of PP and FP in permanent teeth but should be considered a risk predictor for patients over 40 years old undergoing DPC.

Registration

CRD42021273826 (PROSPERO).

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患者年龄与重要牙髓治疗结果之间的关系：预后研究的系统回顾和荟萃分析。

背景：总结患者年龄与重要牙髓治疗（VPT）结果之间的关系对改善临床决策具有重要意义。目的：研究患者年龄是否是VPT成功/生存的预测因素，使用基于PICOTS首字母缩略词的研究问题：(P)参与者呈现成熟恒牙进行VPT；（一）参与者年龄；(C)性别、全身情况、术前症状/诊断、龋齿程度/位置、修复程度/类型、出血时间；(O)临床和放射学的成功/生存；(T)在临床手术之前和期间立即收集的数据以及至少1年后进行的随访；(5)牙科学校和牙科服务机构开展的临床试验和观察性研究。方法：检索PubMed、EMBASE、Lilacs和Web of Science数据库，检索自成立至2024年6月29日发表的研究。两个独立的审稿人选择和提取数据；资深审稿人解决了分歧。将研究特征制成表格，并使用RevMan软件进行meta分析。QUIPS工具评估偏倚风险，GRADE标准评估证据的确定性。结果：34项研究被纳入定性综合，23项研究被纳入meta分析。双变量关联显示，年龄小于40岁的参与者直接髓盖（DPC）成功率更高[OR = 4.85, 95% CI(2.27-10.39)]。多因素荟萃分析显示，年龄与全髓切开术(FP) +部分髓切开术（PP）生存率的相关性无统计学意义[HR = 1.02, 95% CI(0.98-1.05)]。与结果测量、混淆/统计分析和报告相关的偏倚是研究质量的主要关注点，偏倚的总体风险为中等至高。DPC 25岁切点分析的证据确定性非常低，多变量分析的证据确定性很高，其他分析的证据确定性中等。讨论：年龄不影响PP和FP的结果。相反，它与DPC成功有关，可能受到直接检查牙髓组织时困难的影响。需要进一步研究多变量调整分析，以提高证据的确定性。结论：患者年龄与恒牙PP和FP的预后无关，但对于40岁以上的患者，年龄应被视为风险预测因素。注册：CRD42021273826（普洛斯彼罗）。

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来源期刊

International endodontic journal 医学-牙科与口腔外科

CiteScore

10.20

自引率

28.00%

发文量

195

审稿时长

4-8 weeks

期刊介绍： The International Endodontic Journal is published monthly and strives to publish original articles of the highest quality to disseminate scientific and clinical knowledge; all manuscripts are subjected to peer review. Original scientific articles are published in the areas of biomedical science, applied materials science, bioengineering, epidemiology and social science relevant to endodontic disease and its management, and to the restoration of root-treated teeth. In addition, review articles, reports of clinical cases, book reviews, summaries and abstracts of scientific meetings and news items are accepted. The International Endodontic Journal is essential reading for general dental practitioners, specialist endodontists, research, scientists and dental teachers.