Management of Carious Pulp Exposure in Vital Permanent Teeth: An Evidence-based Clinical Practice Guideline

Abstract

Introduction: Annually ~2 million permanent teeth are lost in public dental clinics in Iran. Many of these losses are caused by difficulties inprovision of timely root canal treatment (RCT) or their low quality. The present guideline aimed to find and recommend the best treatmentoptions for management of vital permanent teeth with carious exposure.Materials and Methods: The guideline domain was examined andtreatment options were determined as scenarios comprised of indications and possible interventions. Two main indications includingcarious pulp exposure with or without irreversible pulpitis in open-apex and in closed-apex permanent teeth were included. Nine treatmentoptions were found for each indication based on the available literature. Exhaustive search was performed to find the current evidence and theretrieved studies were critically reviewed. Treatment options and their supporting evidence were extracted. Search for the side effects andbenefits of each treatment option was also performed. The expenses regarding each treatment were then determined and treatment options withLevel of Evidence (LOE) I and II evidence were presented to an expert panel for each indication. Each clinical scenario was examined and ratedby each member considering six aspects: effectiveness of the intervention, costs, side effects, side benefits, applicability of the scenario andgeneralizability of the treatment. The best scenarios were chosen based on the expert panel ratings and the recommendations were extracted.Results: Based on the present guideline, full pulpotomy with calcium enriched mixture (CEM) cement is recommended in vital permanent teethwith open- or closed-apex, with or without irreversible pulpitis, following carious pulp exposure (Grade A recommendation).Conclusion: Adherence to the present guideline may help preserve pulp vitality and decrease the risk of loss of vital permanent teeth with cariouspulp exposure.