Regeneration, Reconstruction & Restoration (Triple R)

Abstract

Introduction: Annually ~2 million permanent teeth are lost in public dental clinics in Iran. Many of these losses are caused by difficulties in
provision of timely root canal treatment (RCT) or their low quality. The present guideline aimed to find and recommend the best treatment
options for management of vital permanent teeth with carious exposure.

Materials and Methods: The guideline domain was examined and
treatment options were determined as scenarios comprised of indications and possible interventions. Two main indications including
carious pulp exposure with or without irreversible pulpitis in open-apex and in closed-apex permanent teeth were included. Nine treatment
options were found for each indication based on the available literature. Exhaustive search was performed to find the current evidence and the
retrieved studies were critically reviewed. Treatment options and their supporting evidence were extracted. Search for the side effects and
benefits of each treatment option was also performed. The expenses regarding each treatment were then determined and treatment options with
Level of Evidence (LOE) I and II evidence were presented to an expert panel for each indication. Each clinical scenario was examined and rated
by each member considering six aspects: effectiveness of the intervention, costs, side effects, side benefits, applicability of the scenario and
generalizability 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 teeth
with 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 carious
pulp exposure.