Association between patient age and vital pulp therapy outcomes: A systematic review and meta-analysis of prognostic studies

Abstract

Background: Summarizing the association between patient age and vital pulp therapy (VPT) outcomes is important to improve clinical decision-making.

Objectives: To investigate whether patient age is a predictor of VPT success/survival, using a research question based on the PICOTS acronym: (P) participants presenting mature permanent teeth undergoing VPT; (I) participants age; (C) gender, systemic condition, preoperative symptoms/diagnosis, caries extent/location, restoration extent/type, bleeding time; (O) clinical and radiographic success/survival; (T) data collected immediately before and during the clinical procedure and follow-up performed at least 1 year later; (S) clinical trials and observational studies developed in dental schools and services.

Methods: PubMed, EMBASE, Lilacs and Web of Science databases were searched for studies published from inception to 29 June 2024. Two independent reviewers selected and extracted data; senior reviewers resolved disagreements. Study characteristics were tabulated, and a meta-analysis was conducted, using RevMan software. The QUIPS tool assesses the risk of bias, whilst the GRADE criteria assess the certainty of evidence.

Results: Thirty-four studies were included in the qualitative synthesis, and 23 in the meta-analysis. Bivariate associations showed higher direct pulp capping (DPC) success rates for participants younger than 40 years [OR = 4.85, 95% CI (2.27-10.39)]. The association between age and full pulpotomy (FP) + partial pulpotomy (PP) survival was not significant in multivariate meta-analysis [HR = 1.02, 95% CI (0.98-1.05)]. Bias related to outcome measurements, confounding/statistical analysis and reporting were the main concerns of the studies' quality, and the overall risk of bias was moderate to high. The certainty of the evidence was very low for the analysis of the DPC 25-year-old cut point, high for the multivariate analysis and moderate for the other analysis.

Discussion: Age did not influence PP and FP outcomes. In contrast, it is associated with DPC success, probably influenced by difficulties during direct inspection of pulp tissue. Further studies with multivariate-adjusted analyses are required to improve the certainty of the evidence.

Conclusions: Patient age is not associated with the outcomes of PP and FP in permanent teeth but should be considered a risk predictor for patients over 40 years old undergoing DPC.

Registration: CRD42021273826 (PROSPERO).

Keywords: aging; dental pulp capping; pulpotomy; treatment outcome; vital pulp therapy.