Recommended procedures for managing carious lesions in primary teeth with pulp involvement-a scoping review

Abstract

Background: Managing dental caries in primary teeth with pulp involvement is a significant challenge. Clinical guidelines offer recommendations for effective management.

Aim: To identify and analyze policies, guidelines, and recommendations for treating primary teeth with pulp-involved carious lesions, highlighting existing research gaps and setting the foundation for future research.

Methods: A comprehensive search was conducted across databases (PubMed, Scopus, Embase, GIN, and LILACS) and grey literature sources (Trip and ProQuest) to identify guidelines, consensus, policy, and position statements on primary teeth pulp therapy and extraction thresholds. Two independent reviewers screened the abstracts and titles, followed by full-text screening.

Results: After removing duplication, of the 1098 records, 14 were selected for analysis. This review examined various treatments for deep caries lesions in primary teeth, including indirect/direct pulp capping, pulpotomy, pulpectomy, lesion sterilization/tissue restoration, and extraction. Time search was restricted to documents published from 30th January 2008 to 30th January 2024, offering insights into evolving clinical practices.

Conclusion: Treatment for carious lesions in primary teeth involving the pulp depends on clinical indications and may involve minimally invasive techniques. Recommended options are indirect pulp capping, pulpotomy, and pulpectomy, while direct capping and tooth removal are discouraged. Further research is needed to address gaps, improve guideline development, and enhance consistency of recommendations.

Fig. 1. The PRISMA study flow diagram of the studies and guidelines included in this review (n = 14).

The process consists of four stages: Identification, Screening, Eligibility, and Inclusion. Identification: a total of 1098 records were identified from various databases, including PubMed/Medline (n = 120), Embase (n = 135), Scopus (n = 176), Lilacs (n = 84), Trip (n = 170), ProQuest (n = 26), and other sources (n = 387). After removing 681 duplicate records, 417 records were screened. Screening: out of the 417 records screened, 387 were excluded based on title and abstract screening, and 30 reports were sought for retrieval. Eligibility: among the 30 reports, 8 were not retrieved. The remaining 22 reports were assessed for eligibility, with 8 reports being excluded due to updated versions being available. Inclusion: ultimately, 14 studies were included in the final review.

Fig. 2. Timeline of Indirect Pulp Capping (IPC) indications and recommendations.

This timeline summarises the evolution of IPC guidelines across various countries and regions from 2005 to 2022. It outlines the indications, recommendations, and levels of evidence in countries such as the UK, Chile, USA, New Zealand, and others. Specific recommendations range from total caries removal to selective caries removal with materials like calcium hydroxide and glass ionomer cement. Evidence levels vary from low to high across different years and regions.

Fig. 3. Timeline of Direct Pulp Capping (DPC) indications and recommendations.

The figure displays DPC guidelines across regions from 2005 to 2022, including the UK, USA, and international recommendations. Indications include traumatic pulp exposures and materials recommended include calcium hydroxide and MTA. Evidence levels range from low to not stated, reflecting the evolving clinical recommendations over the years.

Fig. 4. Timeline of pulpotomy indications and recommendations.

This figure highlights pulpotomy guidelines in the UK, Chile, Italy, and other regions from 2005 to 2022. Indications include symptoms of irreversible pulpitis, and materials recommended include formocresol (FC), MTA, and ferric sulfate. Evidence is rated from low to high depending on the year and location. The timeline also covers regional variations in managing pulpotomy procedures.

Fig. 5. Timeline of pulpectomy indications and recommendations.

The pulpectomy timeline from 2005 to 2022 illustrates recommendations from the UK, Chile, USA, and other countries. It covers the management of irreversible pulpitis and related pathology, with recommendations including the use of zinc oxideeugenol, MTA, and root canal instrumentation. Evidence levels range from low to moderate across different regions.

Fig. 6. Timeline of lesion sterilisation and tissue repair (LSTR) indications and recommendations.

This figure outlines LSTR treatment guidelines between 2005 and 2022 in regions like the USA and international contexts. The timeline reflects recommendations for disinfecting root canals using antibiotics like ciprofloxacin and metronidazole for cases of irreversible pulpitis and root resorption. Evidence is generally not stated.

Fig. 7. Timeline of extraction indications and recommendations.

From 2005 to 2022, this figure tracks extraction guidelines in the UK, Chile, USA, and other regions. Indications include nonrestorable teeth with extensive decay or advanced root resorption. Recommendations include balanced extractions and use of chlorhexidine (CHX) irrigation. Evidence levels vary from low to not stated.