Vital pulp therapy—Factors influencing decision‐making for permanent mature teeth with irreversible pulpitis: A systematic review

Background There is an increased tendency towards adopting minimally invasive interventions in dentistry, supported by advancement in materials and techniques. However, the decision‐making process in choosing conservative or invasive treatments is influenced by several factors, particularly in perma...

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Published in:International endodontic journal 2024-05, Vol.57 (5), p.505-519
Main Authors: Alfaisal, Yasmen, Idris, Ghassan, Peters, Ove A., Zafar, Sobia, Nagendrababu, Venkateshbabu, Peters, Christine I.
Format: Article
Language:English
Subjects:
Cardiovascular diseases
COVID-19
Decision making
Dental Care
Dental pulp
Dentistry
Dentists
Dentition, Permanent
Humans
influencing factors
irreversible pulpitis
Pain
Patients
permanent teeth
Pulpitis - therapy
Pulpotomy - methods
Quality control
root canal treatment
Teeth
vital pulp therapy
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Summary:Background There is an increased tendency towards adopting minimally invasive interventions in dentistry, supported by advancement in materials and techniques. However, the decision‐making process in choosing conservative or invasive treatments is influenced by several factors, particularly in permanent teeth with irreversible pulpitis. Objectives The objective of the study was to systematically review the literature regarding factors that influence decision‐making for vital pulp therapy (VPT) as definitive treatment option in permanent mature teeth diagnosed with irreversible pulpitis. Methods Two independent reviewers searched five electronic databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library). Grey literature was searched through Google Scholar and contact with experts. Defined search keys were applied, and all peer‐reviewed literature published with no language nor publication date limits were included. The All studies investigating the factors influencing treatment decision‐making in mature permanent teeth with irreversible pulpitis were included. The quality of included studies was assessed by two independent reviewers using the Joanna Briggs Institute quality assessment tool. Results Six articles were included in the review. All included studies used questionnaires to characterize clinician preferences and attitudes in choosing treatment options for mature permanent teeth with irreversible pulpitis. The available evidence suggests that dentist‐related factors have a significant influence on the chosen treatment in teeth with irreversible pulpitis, with speciality training and years of experience influencing the choice of VPT over other treatment options. COVID‐19 reportedly swayed the dentists’ decision to favour VPT. Only one article studied the influence of patient‐related factors, such as age and presence of spontaneous pain on decision‐making. Of note, a history of cardiovascular disease moved dentists towards prescribing VPT. Discussion Collectively, the included studies demonstrated an overriding influence of dentist‐related factors on choosing among treatment options for painful teeth diagnosed with irreversible pulpitis. Patient‐related factors were acknowledged but there are also potential factors such as socio‐economic constraints that were not included in the component studies. Conclusion In teeth with irreversible pulpitis clinicians educational background influence the decision towards a specific treatment option. Fu
ISSN:0143-2885
1365-2591
1365-2591
DOI:10.1111/iej.14036