A Systematic Review and Meta-analysis of Regenerative Pulpotomy in the Treatment of Vital Primary Teeth

Objective To assess the clinical and radiographic success rates of regenerative pulpotomy compared to devitalising or preservative pulpotomy in treating vital pulp exposure in primary teeth. Methods Comprehensive search with PubMed/MEDLINE, Cochrane Library, Web of Science, Google Scholar and Open Grey databases was done and two reviewers extracted the data after assessing the studies for eligibility criteria. The Cochrane Collaboration Tool and Minors Checklist assessed the quality of the selected studies. A meta-analysis was performed using RevMan (P<0.05). Results Forty-nine articles were included for qualitative synthesis, of which, 44 were included in the meta-analysis. The authors found no significant differences between the clinical and radiographic failure rates of Mineral trioxide aggregate (MTA) versus formecresol (FC). MTA resulted in a success rate of 1.01 (95% CI: 0.99–1.03), 1.09 (95% CI: 0.99–1.21), 1.02 (95% CI: 0.99–1.05), 1.01 (95% CI: 0.98–1.04), and 1.04-fold (95% CI: 0.97–1.11) higher than that for FC. The radiographic success rate showed a statistically significant difference favouring MTA and Ferric Sulphate comparison with a 1.2-fold (95% CI: 1.05–1.43) higher radiographic success rate for MTA at 24-months follow-up. The radiographic or clinical failure rates of Biodentine (BD) and FC or of BD and FS or CH and FC showed no substantial differences. At 6 months follow-up, BD showed 9.253-fold higher radiographic success rate as compared to FC showing a statistically significant difference (RR, 9.253, 95% CI: 1.62–55.98). Further, 24 months follow-up, CH showed 0.85-fold lower radiographic success rate as compared to FC showing a statistically significant difference (RR, 0.85 95% CI: 0.73–0.98). Conclusion Within the limitations of the study, it can be concluded that MTA seemed to be the better alternative to FC and FS, showing a lower risk of failure and can be recommended for pulpotomy in primary teeth. BD also demonstrated promising results as a pulpotomy medicament.