Survival analysis and risk factors of indirect pulp capping in children with severe early childhood caries: a retrospective study

Background Indirect pulp capping (IDPC) is a preferred treatment for pulp preservation in primary teeth. However, the survival rate of IDPC in primary teeth and impact factors is still equivocal. Aims To evaluate the survival rate of IDPC in primary teeth with a deep carious lesion approximating the pulp but without irreversible pulpitis or periapical disease. Methods The medical records of children who were diagnosed with severe early childhood caries (S-ECC) and received IDPC under dental general anaesthesia from January 2015 to December 2020 were screened and collected. The shared frailty model was used to explore potential factors affecting the success rate of IDPC in primary teeth. Results There were 352 children with S ECC and 1,197 teeth were included in the study. A total of 47 children had IDPC that failed in the follow-up period (67 teeth). The survival rates of the teeth treated with IDPC at 48 months was 82.3%. The risk of IDPC primary tooth treatment failure in mandibular teeth was 2.35 times that of maxillary teeth and risk of failure in lesions with mesial surface involvement was 2.76 times higher than those without mesial surface involvement. Conclusion In the present study, the overall survival rate of IDPC did not decrease remarkably with time, regardless of anterior or posterior teeth. The tooth arch position and whether the mesial surface was involved in the carious lesion were found to influence the outcome of IDPC.