Preoperative Periapical Status and Outcomes of Vital Pulp Therapy: A Systematic Review and Meta‐Analysis

This systematic review has investigated whether the preoperative periapical radiographic status (PPRS) is a predictor of VPT success/survival. Four databases were searched for studies published from inception to November 2024. The studies' characteristics were tabulated, and a meta-analysis was performed to evaluate the correlation between PPRS and the success rate of VPT. The QUIPS tool and the GRADE criteria were used to assess the risk of bias and the certainty of evidence. No significant association between preoperative periapical radiolucency and full pulpotomy success was observed (OR 0.75, 95% CI 0.30-1.87; p = 0.54; Z = 0.61), though heterogeneity among studies was noted (Τ² = 0.41; χ² = 0.29; I² = 59%). Overall high risk of bias was detected. The certainty of evidence was rated as low. The findings suggest that periapical radiolucency should not contraindicate VPT. However, the certainty of evidence regarding this prognostic factor should be improved to refine diagnostic criteria and guide clinical decision-making.