Vıtal Pulpa Tedavisinde Başarı Kriterlerı ve Prognozu Etkileyen Faktörler
Özet
Vital pulpa tedavisi (VPT), pulpal vitalitenin korunmasını ve dişin doğal fonksiyonunun sürdürülmesini amaçlayan, biyolojik temelli ve minimal invaziv yaklaşımları kapsayan koruyucu bir tedavi konseptidir. Vital pulpa tedavisinin başarısı; doğru vaka seçimi, uygun biyomateryal kullanımı, aseptik çalışma koşullarının sağlanması ve sızdırmaz bir restorasyonun uygulanması gibi birçok faktöre bağlıdır. Son yıllarda özellikle kalsiyum silikat esaslı biyoseramik materyallerin geliştirilmesi, vital pulpa tedavisinin klinik başarı oranlarının artmasına önemli katkı sağlamıştır. Bu bölümde vital pulpa tedavisinin başarı kriterleri ve prognozu etkileyen faktörler güncel literatür ışığında ele alınmaktadır.
Vital pulp therapy (VPT) is a conservative treatment concept that aims to preserve pulpal vitality and maintain the natural function of the tooth through biologically based and minimally invasive approaches. The success of vital pulp therapy depends on several factors, including appropriate case selection, the use of suitable biomaterials, the maintenance of aseptic clinical conditions, and the placement of a well-sealed restoration. In recent years, the development of calcium silicate–based bioceramic materials has significantly contributed to improving the clinical success rates of vital pulp therapy. This chapter discusses the success criteria of vital pulp therapy and the factors affecting its prognosis in light of the current literature.
Referanslar
Coll JA, Dhar V, Guelmann M, et al. Vital pulp therapy in permanent teeth: a systematic review and meta-analyses. Pediatric Dentistry. 2025;47(3):137–150.
Santos JM, Pereira JF, Marques A, et al. Vital pulp therapy in permanent mature posterior teeth with symptomatic irreversible pulpitis: a systematic review of treatment outcomes. Medicina. 2021;57(6):573. doi:10.3390/medicina57060573
Duncan HF, Galler KM, Tomson PL, et al. European Society of Endodontology position statement: management of deep caries and the exposed pulp. International Endodontic Journal. 2019;52(7):923–934. doi:10.1111/iej.13080
Colloc TNE, Tomson PL. Vital pulp therapies in permanent teeth: what, when, where, who, why and how? British Dental Journal. 2025;238(7):458–468. doi:10.1038/s41415-025-8560-3
Asgary S, Roghanizadeh L, Eghbal MJ, Akbarzadeh Baghban A, Aminoshariae A, Nosrat A. Outcomes and predictive factors of vital pulp therapy in a large-scale retrospective cohort study over 10 years. Sci Rep. 2024 Jan 24;14(1):2063. doi:10.1038/s41598-024-52654-8
Leong DJX, Yap AU. Vital pulp therapy in carious pulp–exposed permanent teeth: an umbrella review. Clin Oral Invest. 2021 Dec;25(12):6743–56. doi:10.1007/s00784-021-03960-2
Coll JA, Dhar V, Guelmann M, Crystal YO, Chen CY, Marghalani AA, et al. Guideline for Use of Vital Pulp Therapy in Permanent Teeth. Pediatric Dentistry. 2025 Sep 15;47(5):299–311.
Cabrera-Fernández A, Dominguez-Dominguez L, Pérez-Pérez A, et al. Clinical and radiographic outcomes of vital pulp therapy using resin-modified versus conventional calcium silicate-based materials: a systematic review and meta-analysis. Journal of Functional Biomaterials. 2026;17(1):32. doi:10.3390/jfb17010032
Akhlaghi N, Khademi A. Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature. Dental Research Journal. 2015;12(5):406–417. doi:10.4103/1735-3327.166187
American Association of Endodontists. AAE Position Statement on Vital Pulp Therapy. Journal of Endodontics. 2021;47(9):1340–1344. doi:10.1016/j.joen.2021.07.015
Kumar V, Juneja R, Duhan J, et al. Comparative evaluation of platelet-rich fibrin, mineral trioxide aggregate, and calcium hydroxide as pulpotomy agents in permanent molars with irreversible pulpitis: a randomized controlled trial. Contemporary Clinical Dentistry. 2016;7(4):512–518. doi:10.4103/0976-237X.194107
Duncan HF, El‐Karim I, Dummer PMH, Whitworth J, Nagendrababu V. Factors that influence the outcome of pulpotomy in permanent teeth. Int Endodontic J. 2023 Mar;56(S2):62–81. doi:10.1111/iej.13866
Moretto C, Kopper PMP, Münchow EA, et al. Association between patient age and vital pulp therapy outcomes: a systematic review and meta-analysis of prognostic studies. International Endodontic Journal. 2025;58(6):809–832. doi:10.1111/iej.14223
Taha NA, Khazali MA. Partial pulpotomy in mature permanent teeth with clinical signs indicative of irreversible pulpitis: a randomized clinical trial. Journal of Endodontics. 2017;43(9):1417–1421. doi:10.1016/j.joen.2017.03.033
Kang CM, Sun Y, Song JS, et al. A randomized controlled trial of various MTA materials for partial pulpotomy in permanent teeth. Journal of Dentistry. 2017;60:8–13. doi:10.1016/j.jdent.2016.07.015
Careddu R, Duncan HF. A prospective clinical study investigating the effectiveness of partial pulpotomy after relating preoperative symptoms to a new and established classification of pulpitis. International Endodontic Journal. 2021;54(12):2156–2172. doi:10.1111/iej.13629
Nosrat A, Seifi A, Asgary S. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. International Journal of Paediatric Dentistry. 2013;23(1):56–63. doi:10.1111/j.1365-263X.2012.01224.x
Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA. The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study. Journal of the American Dental Association. 2006;137(12):1699–1705. doi:10.14219/jada.archive.2006.0116
Hemostasis in vital pulp therapy for children and adolescents: does duration matter? A systematic review of randomized clinical trials. JOCPD. 2025;49(4):10. doi:10.22514/jocpd.2025.071
Ballal NV, Duncan HF, Wiedemeier DB, et al. MMP-9 levels and NaOCl lavage in randomized trial on direct pulp capping. Journal of Dental Research. 2022;101(4):414–419. doi:10.1177/00220345211046874
Herbst SR, Pitchika V, Herbst CS, et al. Effectiveness of calcium hydroxide compared to hydraulic calcium silicate cements for direct pulp capping in managing deep caries in vital permanent teeth: a systematic review and meta-analysis. International Endodontic Journal. 2025;58(8):1110–1125. doi:10.1111/iej.14256
Ashi T, Mancino D, Hardan L, Bourgi R, Zghal J, Macaluso V, et al. Physicochemical and Antibacterial Properties of Bioactive Retrograde Filling Materials. Bioengineering. 2022 Nov;9(11):624. doi:10.3390/bioengineering9110624
Kaur M, Singh H, Dhillon JS, Batra M, Saini M. MTA versus Biodentine: review of literature with a comparative analysis. J Clin Diagn Res. 2017;11(8):ZG01–ZG05. doi:10.7860/JCDR/2017/25840.10374.
Widyastuti W, Anggraini W, Fibryanto E, Roeslan MO, Gunardi I, Rizal MI, et al. The evolving trends in vital pulp therapy through the application of various biomaterials: a bibliometric study. Jurnal Ilmiah Medicamento. 2025;11(2):172-184. doi:10.36733/medicamento.v11i2.11749.
Xavier MT, Costa AL, Ramos JC, Caramês J, Marques D, Martins JNR. Calcium silicate-based cements in restorative dentistry: vital pulp therapy clinical, radiographic, and histological outcomes on deciduous and permanent dentition—A systematic review and meta-analysis. Materials (Basel). 2024;17(17):4264. doi:10.3390/ma17174264.
Karunakaran S, Praveen N, Selvandran KE, Leburu A, Madhuram K, Kumar ARA. Effectiveness of mineral trioxide aggregate and its modifications in inducing dentin bridge formation during pulp capping: a systematic review. J Conserv Dent Endod. 2025;28(3):222-230. doi:10.4103/JCDE.JCDE_848_24.
Rajasekar V, Abdalla MM, Huang M, Neelakantan P, Yiu CKY. Next-Generation Biomaterials for Vital Pulp Therapy: Exploring Biological Properties and Dentin Regeneration Mechanisms. Bioengineering (Basel). 2025;12(3):248. doi:10.3390/bioengineering12030248
Umale KG, Gade VJ, Asani RN, Kosare PR, Gaware S, Gawande R. TheraCal LC: A boon to dentistry. Arch Dent Res. 2021;11(2):112-117. doi:10.18231/j.adr.2021.019.
Peskersoy C, Lukarcanin J, Turkun M. Efficacy of different calcium silicate materials as pulp-capping agents: randomized clinical trial. J Dent Sci. 2021;16(2):723-731. doi:10.1016/j.jds.2020.08.016.
Ozano-Guillén A, López-García S, Rodríguez-Lozano FJ, Sanz JL, Lozano A, Llena C, Forner L. Comparative cytocompatibility of the new calcium silicate-based cement NeoPutty versus NeoMTA Plus and MTA on human dental pulp cells: an in vitro study. Clin Oral Investig. 2022;26(12):7219-7228. doi:10.1007/s00784-022-04682-9.
Mora A, García-Bernal D, Rodríguez-Lozano FJ, Ghilotti J, Lozano A, López-García S. Biocompatibility and osteogenic potential of novel tricalcium silicate-based materials in human dental pulp stem cells: advancing vital pulp therapies. Dent Mater. 2025;41(6):644-657. doi:10.1016/j.dental.2025.03.011.
Referanslar
Coll JA, Dhar V, Guelmann M, et al. Vital pulp therapy in permanent teeth: a systematic review and meta-analyses. Pediatric Dentistry. 2025;47(3):137–150.
Santos JM, Pereira JF, Marques A, et al. Vital pulp therapy in permanent mature posterior teeth with symptomatic irreversible pulpitis: a systematic review of treatment outcomes. Medicina. 2021;57(6):573. doi:10.3390/medicina57060573
Duncan HF, Galler KM, Tomson PL, et al. European Society of Endodontology position statement: management of deep caries and the exposed pulp. International Endodontic Journal. 2019;52(7):923–934. doi:10.1111/iej.13080
Colloc TNE, Tomson PL. Vital pulp therapies in permanent teeth: what, when, where, who, why and how? British Dental Journal. 2025;238(7):458–468. doi:10.1038/s41415-025-8560-3
Asgary S, Roghanizadeh L, Eghbal MJ, Akbarzadeh Baghban A, Aminoshariae A, Nosrat A. Outcomes and predictive factors of vital pulp therapy in a large-scale retrospective cohort study over 10 years. Sci Rep. 2024 Jan 24;14(1):2063. doi:10.1038/s41598-024-52654-8
Leong DJX, Yap AU. Vital pulp therapy in carious pulp–exposed permanent teeth: an umbrella review. Clin Oral Invest. 2021 Dec;25(12):6743–56. doi:10.1007/s00784-021-03960-2
Coll JA, Dhar V, Guelmann M, Crystal YO, Chen CY, Marghalani AA, et al. Guideline for Use of Vital Pulp Therapy in Permanent Teeth. Pediatric Dentistry. 2025 Sep 15;47(5):299–311.
Cabrera-Fernández A, Dominguez-Dominguez L, Pérez-Pérez A, et al. Clinical and radiographic outcomes of vital pulp therapy using resin-modified versus conventional calcium silicate-based materials: a systematic review and meta-analysis. Journal of Functional Biomaterials. 2026;17(1):32. doi:10.3390/jfb17010032
Akhlaghi N, Khademi A. Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature. Dental Research Journal. 2015;12(5):406–417. doi:10.4103/1735-3327.166187
American Association of Endodontists. AAE Position Statement on Vital Pulp Therapy. Journal of Endodontics. 2021;47(9):1340–1344. doi:10.1016/j.joen.2021.07.015
Kumar V, Juneja R, Duhan J, et al. Comparative evaluation of platelet-rich fibrin, mineral trioxide aggregate, and calcium hydroxide as pulpotomy agents in permanent molars with irreversible pulpitis: a randomized controlled trial. Contemporary Clinical Dentistry. 2016;7(4):512–518. doi:10.4103/0976-237X.194107
Duncan HF, El‐Karim I, Dummer PMH, Whitworth J, Nagendrababu V. Factors that influence the outcome of pulpotomy in permanent teeth. Int Endodontic J. 2023 Mar;56(S2):62–81. doi:10.1111/iej.13866
Moretto C, Kopper PMP, Münchow EA, et al. Association between patient age and vital pulp therapy outcomes: a systematic review and meta-analysis of prognostic studies. International Endodontic Journal. 2025;58(6):809–832. doi:10.1111/iej.14223
Taha NA, Khazali MA. Partial pulpotomy in mature permanent teeth with clinical signs indicative of irreversible pulpitis: a randomized clinical trial. Journal of Endodontics. 2017;43(9):1417–1421. doi:10.1016/j.joen.2017.03.033
Kang CM, Sun Y, Song JS, et al. A randomized controlled trial of various MTA materials for partial pulpotomy in permanent teeth. Journal of Dentistry. 2017;60:8–13. doi:10.1016/j.jdent.2016.07.015
Careddu R, Duncan HF. A prospective clinical study investigating the effectiveness of partial pulpotomy after relating preoperative symptoms to a new and established classification of pulpitis. International Endodontic Journal. 2021;54(12):2156–2172. doi:10.1111/iej.13629
Nosrat A, Seifi A, Asgary S. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. International Journal of Paediatric Dentistry. 2013;23(1):56–63. doi:10.1111/j.1365-263X.2012.01224.x
Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA. The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study. Journal of the American Dental Association. 2006;137(12):1699–1705. doi:10.14219/jada.archive.2006.0116
Hemostasis in vital pulp therapy for children and adolescents: does duration matter? A systematic review of randomized clinical trials. JOCPD. 2025;49(4):10. doi:10.22514/jocpd.2025.071
Ballal NV, Duncan HF, Wiedemeier DB, et al. MMP-9 levels and NaOCl lavage in randomized trial on direct pulp capping. Journal of Dental Research. 2022;101(4):414–419. doi:10.1177/00220345211046874
Herbst SR, Pitchika V, Herbst CS, et al. Effectiveness of calcium hydroxide compared to hydraulic calcium silicate cements for direct pulp capping in managing deep caries in vital permanent teeth: a systematic review and meta-analysis. International Endodontic Journal. 2025;58(8):1110–1125. doi:10.1111/iej.14256
Ashi T, Mancino D, Hardan L, Bourgi R, Zghal J, Macaluso V, et al. Physicochemical and Antibacterial Properties of Bioactive Retrograde Filling Materials. Bioengineering. 2022 Nov;9(11):624. doi:10.3390/bioengineering9110624
Kaur M, Singh H, Dhillon JS, Batra M, Saini M. MTA versus Biodentine: review of literature with a comparative analysis. J Clin Diagn Res. 2017;11(8):ZG01–ZG05. doi:10.7860/JCDR/2017/25840.10374.
Widyastuti W, Anggraini W, Fibryanto E, Roeslan MO, Gunardi I, Rizal MI, et al. The evolving trends in vital pulp therapy through the application of various biomaterials: a bibliometric study. Jurnal Ilmiah Medicamento. 2025;11(2):172-184. doi:10.36733/medicamento.v11i2.11749.
Xavier MT, Costa AL, Ramos JC, Caramês J, Marques D, Martins JNR. Calcium silicate-based cements in restorative dentistry: vital pulp therapy clinical, radiographic, and histological outcomes on deciduous and permanent dentition—A systematic review and meta-analysis. Materials (Basel). 2024;17(17):4264. doi:10.3390/ma17174264.
Karunakaran S, Praveen N, Selvandran KE, Leburu A, Madhuram K, Kumar ARA. Effectiveness of mineral trioxide aggregate and its modifications in inducing dentin bridge formation during pulp capping: a systematic review. J Conserv Dent Endod. 2025;28(3):222-230. doi:10.4103/JCDE.JCDE_848_24.
Rajasekar V, Abdalla MM, Huang M, Neelakantan P, Yiu CKY. Next-Generation Biomaterials for Vital Pulp Therapy: Exploring Biological Properties and Dentin Regeneration Mechanisms. Bioengineering (Basel). 2025;12(3):248. doi:10.3390/bioengineering12030248
Umale KG, Gade VJ, Asani RN, Kosare PR, Gaware S, Gawande R. TheraCal LC: A boon to dentistry. Arch Dent Res. 2021;11(2):112-117. doi:10.18231/j.adr.2021.019.
Peskersoy C, Lukarcanin J, Turkun M. Efficacy of different calcium silicate materials as pulp-capping agents: randomized clinical trial. J Dent Sci. 2021;16(2):723-731. doi:10.1016/j.jds.2020.08.016.
Ozano-Guillén A, López-García S, Rodríguez-Lozano FJ, Sanz JL, Lozano A, Llena C, Forner L. Comparative cytocompatibility of the new calcium silicate-based cement NeoPutty versus NeoMTA Plus and MTA on human dental pulp cells: an in vitro study. Clin Oral Investig. 2022;26(12):7219-7228. doi:10.1007/s00784-022-04682-9.
Mora A, García-Bernal D, Rodríguez-Lozano FJ, Ghilotti J, Lozano A, López-García S. Biocompatibility and osteogenic potential of novel tricalcium silicate-based materials in human dental pulp stem cells: advancing vital pulp therapies. Dent Mater. 2025;41(6):644-657. doi:10.1016/j.dental.2025.03.011.
