Pulp Therapy Research Articles

Is it safe to learn about vital pulp capping from YouTube™ videos? A content and quality analysis

AimTo evaluate YouTube videos on vital pulp capping (VPC) for content, quality, source, usefulness, and reliability. Materials and MethodsThis study assessed 249 English-language videos on vital pulp therapy using the Total Content Score (TCS), Video Information and Quality Index (VIQI), Global Quality Scale (GQS), Journal of the American Medical Association (JAMA) score and modified DISCERN score. Videos were categorized based on communication quality, duration, likes and dislikes, views, source, and video type. Of the videos analyzed, 22.1% met the inclusion criteria. Data were analyzed using Shapiro-Wilk, Kruskal-Wallis, and post hoc Bonferroni tests. Sperman's correlation, Kendal tau tests for correlations, and Fisher's exact test were used to assess associations between categorical variables. ResultsThe study identified significant correlations between various parameters. A higher TCS was correlated with increased VIQI (p = 0.005) and GQS scores (r = 0.685, p < 0.05). A moderate positive correlation was found between GQS scores and TCSs (r = 0.577, p < 0.05). VIQI scores were significantly and positively correlated with TCS (r = 0.573, p < 0.05) and comment count (r = 0.306, p < 0.05). JAMA scores were positively correlated with upload time (r = 0.304, p < 0.05), comment count (r = 0.337, p < 0.05), and likes (r = 0.301, p = 0.05). ConclusionsYouTube videos provided low-to-average quality VPC information and tended to be inaccurate. Therefore, public videos may be incorrect, incomplete, and low-quality. Clinicians and patients should seek reliable information from specialists.

Harnessing antimicrobial peptides in endodontics.

Endodontic therapy includes various procedures such as vital pulp therapy, root canal treatment and retreatment, surgical endodontic treatment and regenerative endodontic procedures. Disinfection and tissue repair are crucial for the success of these therapies, necessitating the development of therapeutics that can effectively target microbiota, eliminate biofilms, modulate inflammation and promote tissue repair. However, no current endodontic agents can achieve these goals. Antimicrobial peptides (AMPs), which are sequences of amino acids, have gained attention due to their unique advantages, including reduced susceptibility to drug resistance, broad-spectrum antibacterial properties and the ability to modulate the immune response of the organism effectively. This review systematically discusses the structure, mechanisms of action, novel designs and limitations of AMPs. Additionally, it highlights the efforts made by researchers to overcome peptide shortcomings and emphasizes the potential applications of AMPs in endodontic treatments.

Success Rates of Antibiotic Sterilization, Indirect Pulp Treatment, and Pulpotomy in the Management of Primary Teeth with Deep Carious Lesions.

A new concept of antibiotic sterilization has come into existence which can be used to sterilize the demineralized portion of the teeth with minimal or ultraconservative excavation of caries in deep dentinal carious lesions as an alternative for indirect pulp therapy (IPT) and pulpotomy to avoid further complications. This study was undertaken to compare the success rates of antibiotic sterilization, indirect pulp treatment, and pulpotomy in the management of primary teeth with deep carious lesion. Ninety teeth involving deep carious lesions approaching pulp in primary molars were selected and randomly divided into three groups containing 30 teeth. Group I was treated with antibiotic sterilization using 3Mix-MP paste, group II was treated with indirect pulp treatment using calcium hydroxide, and group III was treated with conventional pulpotomy using 15.5% ferric sulfate (FS) solution. Clinical and radiographic analysis of all three groups was performed at 1, 3, 6, 9, and 12 months to evaluate the success of treatment procedures using predetermined criteria. Pearson's Chi-squared test and McNemar test were used for statistical analysis. At the end of the 12-month follow-up period, the overall clinical and radiographic success was determined to be 96.3% for group I, 100% for group II, and 96.4% for group III. There were no statistically significant differences observed between the success of three groups, suggesting that either of the procedures can be adopted for the management of deep carious lesions approaching pulp in primary teeth. Antibiotic sterilization can be introduced as a newer modality in the management of deep carious lesions approaching pulp in primary teeth which is ultraconservative in nature and reduces the risk of pulp exposure in comparison with indirect pulp treatment and pulpotomy procedures. Saxena D, Garg N, Pathivada L, et al. Success Rates of Antibiotic Sterilization, Indirect Pulp Treatment, and Pulpotomy in the Management of Primary Teeth with Deep Carious Lesions. Int J Clin Pediatr Dent 2024;17(3):237-242.

Exploring vital pulp Therapies: A bibliometric analysis of the most cited articles

AimThe aim of this study was to identify and analyze the most cited articles on vital pulp therapies. MethodologyBibliographical data related to the abstract, citations, keywords, and other relevant information was extracted using different combinations of keywords. Further evaluation and visualization of the selected data were performed with the help of various tools, including MS Excel, Microsoft Word, Google open refine, BibExcel, and VOS viewer. An initial search revealed 91 documents, of which 40 were chosen for further analysis. We used the Kolmogorov–Smirnov test and Spearman correlation coefficient test, and our adopted significance level was p < 0.05. ResultsIn total, the articles received 1,905 citations, with six of them receiving at least 100 citations. Among the top 40 articles, the United States of America (10 articles) and Ireland (6 articles) were the countries with the highest number of cited articles. The journals “Journal of Endodontics” (14 articles; 650 citations) and “International Endodontic Journal” (13 articles; 577 citations) published most of the articles among the 50 most cited ones. Duncan H. was the author with the highest number of works cited (11 articles; 339 citations). Of the articles, systematic reviews accounted for 32%, literature reviews for 14%, in vitro experimental studies for 12%, clinical trials for 8%. Among the biomaterials used in vital pulp therapies, mineral trioxide aggregate (MTA) was discussed in 37 articles (74%), followed by calcium hydroxide, mentioned in 30 studies (60%). Interestingly, the publication year did not demonstrate a significant impact on citation count. ConclusionThe present study provided a detailed list of the top 50 most cited and classic articles on vital pulp therapies. This will help researchers, students, and clinicians in the field of endodontics with an impressive source of information.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ЦИТОТОКСИЧНОСТИ СИЛЕРОВ ДЛЯ ПРОВЕДЕНИЯ ПЛОМБИРОВАНИЯ КОРНЕВЫХ КАНАЛОВ (IN VITRO)

Endodontics, being a part of the discipline "Dentistry", includes sections on the study of morphology, physiology and pathology of dental pulp and human periapical tissues, as well as the prevention and treatment of diseases and injuries associated with these tissues. Its scope of application includes the diagnosis and treatment of pain of pulpar and/or periapical origin, vital pulp therapy, regenerative endodontic procedures, non-surgical root canal treatment, surgical or non-surgical re-treatment of teeth with persisting infection and intracanal teeth whitening with discoloration. Ultimately, the main goal is to preserve the natural dentition.&#x0D; Like other dental specialties, endodontics combines two inseparable parts in its practical part: art and science. The art lies in performing technical procedures during root canal treatment. The scientific part includes fundamental and clinical disciplines, studying.&#x0D; Objectives. To study the cytotoxicity of epoxy resin-based silers in laboratory conditions on human cell lines and conduct their comparative analysis.&#x0D; Methodology. The article presents an analysis of the results of in vitro cytotoxicity of silers by assessing cell viability with direct injection of the studied materials into human cell culture.&#x0D; Conclusion. It has been experimentally proven that samples 1 (AH plus, Dentsply Sirona, Germany) and 3 (Epoxidin DUO, TecnoDent, Russia) do not have cytotoxic properties, unlike 2 samples (Sealart, Dentac, Turkey).

Survival of pre-formed zirconia crowns in primary teeth: a prospective practice-based cohort study.

This study aimed to investigate the (1) survival probabilities of prefabricated zirconia crowns (PZCs) placed on primary teeth and (2) identify demographic and tooth-related factors that might affect survival probability. This study prospectively followed children treated under general anaesthesia by a single practitioner between 2012 and 2020. Demographic variables including the age at treatment, gender and tooth-related variables including FDI tooth number, crown size used and any procedural complications at postoperative reviews were collected. A total of 155 children involving 319 teeth with PZCs were followed up between 12 and 78 months postoperatively with a mean of 38 months. Of the 319 crowns followed, five failures were observed in three patients requiring extraction. Other procedural complications noted included fracture (n = 3), overhangs (n = 3), internal resorption (n = 5) and 24% of crowns showed signs of radiographic changes on postoperative radiographs when these were taken. Age at treatment, tooth type and need for pulp therapy were not statistically associated with clinical success (P > 0.1). PZCs provide an aesthetic and durable solution in the management of children with early childhood caries. This study shows very good clinical success and survival extending up to 78 months for PZCs placed on primary teeth under general anaesthesia.

Short Term Effects of Inhalation Sedation on Child Dental Fear and Anxiety.

Dental procedures profoundly affect a child's dental fear and anxiety, rendering dental treatment difficult. Inhalation sedation with a mixture of nitrous oxide and oxygen (NO2/02) breathed through a nosepiece is a form of light conscious sedation widely used in apprehensive children to help them relax and accept dental treatment. This, however, can have both shortand long-term effects on child dental fear and anxiety. This study aimed to assess the short-term immediate effect of inhalation sedation on child dental fear and anxiety scores. This analytical cross-sectional study was conducted at the Department of Paediatric Dentistry at Rehman College of Dentistry, Peshawar, Pakistan, over a period of 1.9 years (January 2019- October 2020). A total of 171 children aged 6-11 years were selected with moderate to severe dental anxiety using the Child Fear Survey Schedule-Dental Subscale (CFSS-DS), requiring pulp therapy in at least one of their deciduous molars. Baseline anxiety scores were calculated using Venham Clinical Anxiety Score (VCAS) and Venham Picture test (VPT) with a dental check-up and fluoride application. VCAS and VPT scores were then assessed at the end of their scheduled second dental visit involving dental anaesthesia and inhalation sedation. VCAS and VPT scores at the end of treatment were compared with the baseline scores. Out of 171 children, 86 were male and 85 were female, with a mean age of 7.77. Females showed a higher range of VCAS and VPT scores (p ≤0.001) compared to males. The VCAS and VPT scores declined just at the end of the second dental visit following dental anaesthesia with inhalation sedation (mean difference = 1.96 and 3.39, respectively), which was statistically significant (p ≤0.001). Inhalation sedation has a significant role in reducing child dental fear and anxiety in the short term.

Effectiveness of TheraCal LC versus MTA in Vital Pulp Therapy of Cariously-Exposed Young Permanent Molars: Five-Year Follow up of a Randomised Clinical Trial

Effectiveness of TheraCal LC versus MTA in Vital Pulp Therapy of Cariously-Exposed Young Permanent Molars: Five-Year Follow up of a Randomised Clinical Trial

Shear bond strength of calcium silicate-based cements to glass ionomers

BackgroundA shear bond strength between the biomaterial and restorative material is crucial for minimizing bacterial microleakage and ensuring a favorable long-term prognosis for vital pulp therapy. This study aimed to conduct a comparative evaluation of the shear bond strength between calcium silicate-based biomaterials utilized in vital pulp treatment and various glass ionomer cement materials, both with and without the application of adhesive agents.MethodsA total of 270 acrylic blocks, each featuring cavities measuring 4 mm in diameter and 2 mm in depth, were prepared. Calcium silicate-containing biomaterials (ProRoot MTA, Medcem Pure Portland Cement, and Medcem MTA), following manufacturers’ instructions, were placed within the voids in the acrylic blocks and allowed to set for the recommended durations. The biomaterial samples were randomly categorized into three groups based on the restorative material to be applied: conventional glass ionomer cement, resin-modified glass ionomer cement, and bioactive restorative material. Using cylindrical molds with a diameter of 3.2 mm and a height of 3 mm, restorative materials were applied to the biomaterials in two different methods, contingent on whether adhesive was administered. After all samples were incubated in an oven at 37 °C for 24 h, shear bond strength values were measured utilizing a universal testing device. The obtained data were statistically evaluated using ANOVA and post-hoc Tukey tests.ResultsThe highest shear bond strength value was noted in the Medcem MTA + ACTIVA bioactive restorative material group with adhesive application, while the lowest shear bond strength value was observed in the ProRoot MTA White + Equia Forte HT Fil group without adhesive application (P < 0.05).ConclusionActiva Bioactive Restorative may be considered a suitable restorative material in combination with calcium silicate-based biomaterials for vital pulp treatment. The application of adhesives to calcium silicate-based biomaterials can effectively address the technical limitations.

Outcomes and predictive factors of vital pulp therapy in a large-scale retrospective cohort study over 10 years

This cohort study evaluated the long-term success/survival of vital pulp therapies (VPTs) after carious pulp exposure in adult teeth. Additionally, factors influencing long-term success were identified. Teeth treated during 2011–2022 in a private clinic were studied with clinical/radiographic follow-ups. Data included patient demographics, tooth specifics, and treatment details. Outcomes were classified as success/failure based on clinical/radiographic findings, with tooth functionality determining the survival rate. Encompassing 1149 patients and 1257 VPT-treated teeth, the average monitoring period was 42.2 months. Overall VPTs’ survival and success rates were 99.1% and 91.6%, respectively. Success rates for 768 direct pulp cappings, 217 miniature pulpotomies, and 272 full pulpotomies were 91.9%, 92.6%, and 90.1%, respectively (P > 0.05). Influencing factors included symptomatic irreversible pulpitis (SIP; HR 1.974, 95% CI 1.242–3.137; P = 0.004), radiographic signs of apical periodontitis (AP; HR 2.983, 95% CI 1.961–4.540; P < 0.001), restoration type (HR 2.263, 95%CI 1.423–3.600; P = 0.001), and restoration surfaces (HR 1.401, 95%CI 1.034–1.899; P = 0.030). This study concludes that VPT techniques consistently exhibit high long-term success/survival rates in treating carious pulp exposures. Critical predictors include initial clinical signs of SIP/AP, caries extent, and use of composite restorations.

Evaluation of the genotoxicity, cytotoxicity, and bioactivity of calcium silicate-based cements

BackgroundAs calcium silicate-based cements (CSCs) have found success in various vital pulp therapy applications, several new CSC products have emerged. This study aimed to assess the genotoxicity, cytotoxicity, and bioactivity of four CSCs by comparing the newly introduced materials Bio MTA+ and MTA Cem with previously studied materials, Biodentine and NeoMTA.MethodsGenotoxicity was evaluated using the micronucleus (MN) assay in human peripheral blood lymphocyte cells, measuring MN frequency and nuclear division index (NDI). Cytotoxicity was assessed in human dental pulp stem cells through the Water-Soluble Tetrazolium Salt-1 (WST-1) colorimetric assay. Bioactivity was determined by ELISA, measuring the levels of angiogenic and odontogenic markers (BMP-2, FGF-2, VEGF, and ALP). Statistical analyses included ANOVA, Dunnet and Sidak tests, and Wald chi-square test. (p < .05).ResultsThe MN frequency in the groups was significantly lower than that in the positive control group (tetraconazole) (p < .05). NDI values decreased with increasing concentration (p < .05). Bio MTA+ and NeoMTA showed decreased cell viability at all concentrations in 7-day cultures (p < .01). All materials increased BMP-2, FGF-2, and VEGF levels, with Biodentine and NeoMTA showing the highest levels of BMP-2 and FGF-2 on day 7. Biodentine displayed the highest VEGF levels on day 7. Biodentine and NeoMTA groups exhibited significantly higher ALP activity than the Bio MTA+ and MTA Cem groups by day 7.ConclusionBio MTA+ and MTA Cem demonstrated no genotoxic or cytotoxic effects. Moreover, this study revealed bioactive potentials of Bio MTA+ and MTA Cem by enhancing the expression of angiogenic and osteogenic growth factors.

The residency levels' effect on pediatric dental rehabilitation operation time

BackgroundPostgraduate pediatric dental residents' competency, to perform dental rehabilitation procedures under General anesthesia (GA), at different levels of training is challenging for operation time control. An adequate operation time (OT) for children decreases morbidity risk and improves hospital time utilization efficiency. The aim of the study is to assess the effect of pediatric dental resident training level on OT for pediatric dental rehabilitation procedures under GA at King Abdulaziz Medical City (KAMC).MethodsA cross-sectional study included pediatric dental rehabilitation performed under GA by pediatric dental residents at (KAMC) -Jeddah from October/2015 to September/2022. The primary outcome was OT, and the predictive variable was resident training levels. A linear regression analysis was used to compare OT between procedures performed by junior (years 1–2) or senior (years 3–4) trainees, adjusting for patient and operative factors.ResultsOne thousand seven pediatric dental rehabilitation cases were performed under GA by junior (13) and senior (31) residents. The univariant analysis indicated that OT for senior residents was significantly longer (13 min) than for junior residents. However, the linear regression analysis showed that senior residents had a significantly shorter OT when considering the more dental procedures performed per case under GA than junior residents. Senior residents took significantly more radiographs and performed more primary pulp therapies and multi-surface anterior colored restorations under GA than junior residents.ConclusionsThe OT for pediatric dental rehabilitation procedures under GA is associated with resident training level. The total OT was significantly longer based on procedure number, type, and resident level. The study indicated that senior residents could manage more complex cases in a shorter time. The finding emphasizes the importance of assigning GA cases to residents based on their level and the case's complexity. Additionally, it helps standardize the resident privileges under GA and understand the impact of residency training on hospital efficiency.

Evaluation and comparison of the mechanism of two bioactive materials in vital pulp therapy: a molecular dynamics simulation approach

Evaluation and comparison of the mechanism of two bioactive materials in vital pulp therapy: a molecular dynamics simulation approach

Assessment of Dental Anxiety during Pulp Therapy, Restorations &amp; Extraction in 6- to 9-year-old Children Using Drawings and Questionnaire – A cross sectional study.

Background: Childhood dental fear and anxiety are prevalent from an early age through adolescence, posing a significant challenge in pediatric dental care. Understanding children's emotions during dental procedures is crucial for pediatric dentists to anticipate and address behavioral responses in future visits. Utilizing drawings and questionnaires can effectively gauge an individual's self-concept, anxiety, attitude, or conflicts. Aim: This study aimed to assess children's drawings and questionnaires as means to measure dental anxiety related to dental treatment. Methodology: Forty children aged 6-9 years participated in this study. During the initial therapeutic session, all participants underwent pulp therapy and restorative treatment with local anesthesia administration. Objective assessment of distress during treatment was conducted using the Sound, Eye, Motor (SEM), and Frankl Scales. Subsequently, children were provided with a predetermined set of questions before the treatment, and their responses were recorded. Following the interview, children were asked to draw a picture of their surroundings. Pediatric dentists and psychologists scored the children's drawings using the Child Drawing: Hospital (CD: H) scale. The findings were compared with Frankl and SEM Scores. Results: A statistically significant association was observed between Frankl score and SEM Score (p&lt;0.001*). A strong positive correlation was found between CD:H Scores Examiner 1 and CD:H Scores Examiner 2 (p&lt;0.001*; r=0.760). Conclusion: Assessing dental anxiety through children's drawings, which reflect their inner feelings, offers an alternative to self-report techniques for pediatric dentists. Drawing, being both easier and enjoyable, emerges as a valuable tool for measuring children’s levels of dental anxiety.

The Management of Hyperplastic Pulpitis in Immature Permanent Molar Using Vital Pulp Therapy: A Case Report with 12 Months Follow‐Up

Hyperplastic pulpitis is an irreversible type of pulpitis that primarily affects young patients. It occurs when an inflamed pulp becomes exposed due to factors such as dental caries, dental trauma, or other causes. Root canal treatment is commonly employed to manage hyperplastic pulpitis. However, vital pulp therapy can be considered as a less invasive option. The main objective of this treatment is to preserve the vitality and functionality of the remaining pulp tissue. This case report discusses the potential management of hyperplastic pulpitis in an immature molar using vital pulp therapy instead of a full root canal treatment. The report includes clinical and radiographic follow‐up at six and twelve months.

Bioceramic Materials: A Boon in Pediatric Dentistry: A Literature Review

Abstract Over the past few decades, bioceramic materials have developed from extremely biocompatible, but low-strength dental materials to novel product compositions for broader clinical uses in pediatric dentistry. The most crucial thing is to better understand the elements that encourage remineralization and how they operate dynamically. Some of the major drawbacks of prior generations of endodontic materials have been effectively solved by new bioceramic materials. In particular, these materials have been used for vital pulp therapy treatment, restorative, and root canal procedures in a variety of dental applications. They may be used in clinical pediatric dentistry since they have been demonstrated to be more biocompatible, induce tissue regeneration, have low cytotoxicity, excel at sealing, cause little to no postoperative pain, and have improved physiochemical properties. When employing bioceramic materials, it is crucial to adhere to suitable clinical standards and techniques to guarantee positive results in pediatric dentistry. Therefore, the focus of this review is on the properties and advantages of using bioceramic materials in pediatric dentistry.

A questionnaire-based study on the management of deep carious lesions and exposed pulp among members of the Indian conservative dentistry and endodontic societies

Aim: Lack of unanimity in decision-making regarding the management of deep caries and exposed pulp has been highlighted by several questionnaire-based studies from various geographic regions. There is no research available in the Indian setting. The aim of the present study was to evaluate the perspectives of the Indian Endodontic Society and Indian Association of Conservative Dentistry and Endodontics members using an online questionnaire. Methods: An online structured questionnaire of 17 questions was mailed to 200 members based on the periapical radiographs of two cases (18 and 55 years of age) highlighting deep carious lesions and normal periapex in a mandibular molar. Each case had three hypothetical scenarios based on pulpal symptoms, i.e., asymptomatic pulp, reversible, and irreversible pulpitis, respectively. Results: A response rate of 65.5% (n = 131) was achieved. Nonselective caries removal was chosen by 40% and 36% of the participants in young patients with asymptomatic pulp and reversible pulpitis. On pulpal exposure, direct pulp capping was chosen by a majority of the members (66% and 54%, respectively) in a young patient. For irreversible pulpitis, pulpectomy was favored by 70%. In an older patient, less vital pulp therapy and more pulpectomy were preferred. The symptoms and patient age significantly altered treatment decisions, as determined by Chi-square and Fisher’s exact tests (P &lt; 0.05). Conclusion: There was a lack of agreement in managing deep carious lesions. There was partial awareness of the management of exposed pulp.

Reparative Mineralized Tissue Characterization by Different Bioactive Direct Pulp-capping Agents

ABSTRACT The aim of direct pulp caping (DPC) is to support the formation of mineralized tissue and encourage pulp healing by placing a dental biomaterial directly over the exposed pulp. The era of vital pulp therapy has been influenced by the introduction of various pulp-capping materials. Emphasis has shifted from the “doomed” organ concept of an exposed pulp to one of hope and recovery; this comprehensive review thus discusses the ability of different direct pulp-capping materials to form a dentin bridge. Furthermore, this review will discuss the quality and quantity of dentinal bridge formation by different pulp-capping agents.

Potential factors affecting the success rate of indirect pulp therapy in primary molars with deep caries: a retrospective study.

Indirect pulp therapy (IPT) is a common conservative treatment for deep dental caries. However, the potential risk factors for the prognosis of IPT have not been well studied. This study retrospectively investigated the success rate of IPT in treating primary molars with deep caries and the factors potentially affecting the two-year success rate. A total of 303 primary molars in 202 children (106 boys and 96 girls) were included in this study. These primary molars were identified as having deep caries by clinical and radiographic examinations and were treated with IPT. The factors potentially affecting the IPT success rate were analyzed after two years of follow-up. The results indicated that the two-year IPT success rate was 86% (262/303). The success rate of primary molars with and without stainless steel crowns was 96% (120/125) and 80% (142/178), respectively. Primary molars treated with stainless steel crowns showed a significantly lower risk of failure (hazard ratio (HR) = 0.18, 95% confidence interval (CI): (0.10, 0.34), p = 0.01). There were no significant differences in other factors, including gender (male vs. female), age (preschool vs. school age), cooperation level (Frankl 2 vs. 3 or 4 scales), arch type (maxillary vs. mandibular), tooth type (first vs. second primary molar), or pulp capping material (calcium hydroxide vs. glass ionomer cement). IPT is an effective, conservative treatment modality for primary molars with deep caries. Stainless steel crowns could significantly improve the IPT success rate.

Vital pulp therapies versus conventional endodontics for the treatment of mature teeth with pulp inflammation: A systematic review

Introduction: To compare the effectiveness of vital pulp therapies (pulpotomy and direct pulp capping) with that of conventional endodontics for the treatment of mature teeth with pulp inflammation and to analyze which pulp capping material is more effective for the treatment of mature teeth with pulp inflammation. Materials and Methods: A bibliographic search of electronic databases (PUBMED, COCHRANE LIBRARY, SCOPUS, ScienceDirect, and SciELo) was conducted. The inclusion criteria were comparative studies in patients who underwent conventional endodontic and vital pulp therapy in mature teeth with pulp inflammation and comparative studies comparing Mineral Trioxide Aggregate (MTA) versus calcium hydroxide as direct pulp capping materials in mature teeth with pulp inflammation. Risk of bias was assessed using RoB2 or ROBINS-I. Results: Eight clinical trials were included, all of which had a high risk of bias. The data analysis showed that pulpotomy has similar clinical success rates to conventional endodontics. No studies comparing conventional endodontics versus direct pulp capping were found. MTA has better clinical results than calcium hydroxide as a direct pulp capping material. Conclusion: Vital pulp therapies are a valid alternative for the treatment of mature teeth with pulp inflammation. There is a need for more clinical trials with longer follow-up time and which consider other variables related to the characteristics of the patient and the tooth.