Efficacy of pulpotomy in managing irreversible pulpitis in mature permanent teeth: A systematic review and meta-analysis

OBJECTIVES

This paper evaluated the success rates of pulpotomy, compared its efficacy with non-surgical root canal treatment (NSRCT), evaluated different pulpotomy techniques, and analyzed the effectiveness of contemporary bioactive materials in managing irreversible pulpitis in mature permanent teeth.

DATA SOURCES

A comprehensive literature search was conducted across multiple databases including PubMed, Web of Science, Scopus, and the Cochrane Library. Search was conducted from the inception of each database to the present, adhering to PRISMA 2020 guidelines.

STUDY SELECTION

Studies were selected through a multi-step screening process, focusing on adult populations, randomized controlled trials, and single-arm trials.

DATA

Fifteen randomized controlled trials and eight single-arm trials were included. For a follow-up period of more than 24 months, pooled clinical success rate of pulpotomy was 92.9 % (95 %CI;82.1-99.0 %), whereas pooled radiographic success rate was 78.5 % (95 %CI;66.7-88.4 %). Meta-analyses showed that there was no significant difference in success rates between pulpotomy and NSRCT, between full and partial pulpotomy techniques, or between Mineral Trioxide Aggregate pulpotomy and Calcium Enriched Mixture pulpotomy. The results indicated comparable efficacy across these variables.

CONCLUSIONS

The study highlights the potential of less invasive treatments. Pulpotomy may be a viable alternative to NSRCT for managing irreversible pulpitis in mature permanent teeth. Limitations such as the low quality of some single-arm trials and the high risk of bias in some randomized controlled trials highlight the need for further research to standardize methodologies and broaden literature inclusion for a more comprehensive understanding of the efficacy of pulpotomy, considering the high success rates reported. Clinical Significance This quantitative systematic review recognizes the potential of full or partial pulpotomy as a viable treatment alternative to root canal therapy for managing irreversible pulpitis in mature permanent teeth. Future studies should aim for standardized protocols to validate these findings and improve patient treatment outcomes.

Novel cryotherapy technique for pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis- a randomized controlled trial

OBJECTIVES

To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic irreversible pulpitis.

MATERIALS AND METHODS

The study included sixty mature permanent mandibular molar teeth with symptomatic irreversible pulpitis and no periapical rarefaction. After coronal pulp tissue amputation, teeth were randomly allocated to one of two groups (n = 30 each). In group I (conventional pulpotomy), a sterile cotton pellet moistened with 2.5% NaOCl was used for haemostasis. In group II (cryotherapy), the pulp chamber was continuously lavaged with 2.50C normal saline solution for haemostasis using an indigenous portable cryotherapy irrigation unit. Following haemostasis, the pulp was capped with mineral trioxide aggregate and the tooth was restored with resin composite. The time taken to achieve haemostasis was recorded. Preoperative and 24, 48 and 72 h postoperative pain was measured using the Numerical Rating Scale. The pulpotomy outcome was assessed at the 12-month follow-up. Data were analyzed using Fischer's exact test, two-sample t-test, two-sample Wilcoxon rank-sum test, Friedman Test, and Wilcoxon Signed Rank Test.

RESULTS

The cryotherapy group achieved haemostasis in less time (p < 0.05). There was a significant pain reduction at 24 and 48 h in the cryotherapy group when compared with the conventional pulpotomy group (P < 0.005). The overall success rate of pulpotomy after 12 months was 88% (n = 22) in both study groups(p < 0.05).

CONCLUSIONS

Cryotherapy application reduces postoperative pain and has no adverse effect on the outcome of pulpotomy in permanent teeth with symptomatic irreversible pulpitis.

CLINICAL RELEVANCE

The cryotherapy can be incorporated in pulpotomy protocol as an adjunct to minimize post-operative pain.

Outcome and Prognostic Factors for Partial and Full Pulpotomy in the Management of Spontaneous Symptomatic Pulpitis in Carious Mature Permanent Teeth: A Randomized Clinical Trial

INTRODUCTION

The aim of this study was to compare the outcome and prognostic factors for partial and full pulpotomy in the management of mature teeth with spontaneous symptomatic pulpitis.

METHODS

The study was a parallel double-blind randomized clinical trial; 200 carious mature permanent teeth with spontaneous symptomatic pulpitis were randomized using a block randomization technique to either partial pulpotomy (n = 99) or full pulpotomy (n = 101). Intraoperative assessment of the pulp under magnification was performed, hemostasis was achieved with a 2.5% sodium hypochlorite moist pellet, and NeoPUTTY (Avalon Biomed, Bradenton, FL) was the pulpotomy material. Preoperative pain levels were recorded and re-evaluated after 1 week. Clinical and radiographic evaluation was performed after 6 and 12 months. Data were analyzed using the chi-square test, the Wilcoxon rank test, and regression analysis.

RESULTS

At 1 week, immediate failure occurred in 4 cases in partial pulpotomy, and 196 of 200 subjects reported pain relief and were satisfied with the treatment with no significant difference. At 6 months, 6 teeth failed in the partial pulpotomy group and 1 tooth in the full pulpotomy group, with a higher success rate for full pulpotomy (98.96 vs 89.69, P = .003). At 12 months, the recall rate was 98% (96/200). Full pulpotomy was more successful than partial pulpotomy (98.98% [98/99] vs 84.53% [82/97], P < .001). Multivariate analysis revealed that the odds of success for full pulpotomy were 13.6 times higher than partial pulpotomy. Increased age and higher time to hemostasis were significantly associated with decreased odds of success.

CONCLUSIONS

Full pulpotomy has a higher success rate than partial pulpotomy in the management of spontaneous symptomatic pulpitis. Hemostasis within 4 minutes in partial pulpotomy can be set as the cutoff point beyond which further tissue removal is indicated.

The use of medicaments in the management of symptomatic irreversible pulpitis: A community-based cohort study

AIM

To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom.

METHODOLOGY

All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre-operatively, data regarding patients' numerical ratings scale (NRS), pain score (0-10), analgesic use, oral-health impact profile-14 (OHIP-14) and need for time away from work were collected. For 7 days post-operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed-effects model with post hoc Tukey's multiple comparisons test for continuous data and chi-squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel-Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre- and post-operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2-points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work.

RESULTS

Eighty-five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p = .645), although patients self-reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p = .015).

CONCLUSIONS

This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue.

Treatment outcome of coronal pulpotomy and indirect pulp capping in mature permanent molars with symptoms of moderate pulpitis: A randomized clinical trial

Aim

This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars with moderate pulpitis over a 12-month period.

Materials and Methods

A total of 108 vital mature permanent molars with moderate pulpitis were randomly allocated to the IPC (n = 54) or coronal pulpotomy group (n = 54). Dycal and Biodentine were used as pulp-capping materials, followed by composite restoration. The absence of periapical infection and asymptomatic teeth that positively responded to the cold pulp sensitivity test (only in IPC) was considered posttreatment success at 12 months. Data from the study were analyzed using the Chi-square test and Kaplan-Meier survival analysis.

Results

There was a statistically significant difference between preoperative symptoms and the cold pulp sensibility test response (P = 0.000), indicating an association between symptoms and pulp sensibility. The average remaining dentine thickness (RDT) value was 0.48 ± 0.5 mm, with no statistically significant difference found between the location of caries and RDT (P = 0.084, P > 0.05). Compared to the IPC group, the pulpotomy group had a greater number of patients at 12 months after treatment that required no intervention. The Kaplan-Meier survival analysis revealed that the mean survival duration for pulpotomy was 48 weeks, and for IPC, it was 42.3 ± 2.35 weeks.

Conclusion

Coronal pulpotomy with Biodentine proved more effective in reducing symptoms, achieving radiographic success, and ensuring tooth survival compared to IPC with calcium hydroxide.

Irreversible pulpitis in mature permanent teeth: a cost-effectiveness analysis of pulpotomy versus root canal treatment

INTRODUCTION

Evidence-based dentistry suggests pulpotomy as a potential alternative to root canal treatment in mature permanent teeth with irreversible pulpitis. However, the evidence surrounding the cost-valuation and cost-efficacy of this treatment modality is not yet established. In this context, we adopted an economic modeling approach to assess the cost-effectiveness of pulpotomy versus root canal treatment, as this could aid in effective clinical decision-making.

METHODS

A Markov model was constructed following a mature permanent tooth with irreversible pulpitis in an 18-year-old patient over a lifetime using TreeAge Pro Healthcare 2022. Transition probabilities were estimated based on existing literature. Costs were estimated based on the United States healthcare following a private-payer perspective and parameter uncertainties were addressed using Monte-Carlo simulations. The model was validated internally by sensitivity analyses, and face validation was performed by an experienced endodontist and health economist.

RESULTS

In the base case scenario, root canal treatment was associated with additional health benefit but at an increased cost (1.08 more years with an incremental cost of 311.20 USD) over a period of an individual's lifetime. The probabilistic sensitivity analysis revealed pulpotomy to be cost-effective at lower Willingness-To-Pay (WTP) values (99.9% acceptable at 50 USD) whereas increasing the values of WTP threshold root canal treatment was a cost-effective treatment (99.9% acceptable at 550 USD).

CONCLUSION

Based on current evidence, pulpotomy was a cost-effective treatment option at lower WTP values for the management of irreversible pulpitis in mature permanent teeth. However, by increasing the WTP threshold, root canal treatment became a more cost-effective treatment option over a period of lifetime of an individual.

Evaluation of the reasons for preferring root canal treatment in mature permanent teeth potentially indicated for pulp preservation: a clinical case/photo-based questionnaire study

BACKGROUND

With advances in pulp preservation procedures (PPP), indications for PPP extend to exposed pulp with symptoms in teeth with carious lesions. Scenario/text-based questionnaire studies report a high preference for PPP for exposed pulp with no pulpal symptoms. However, negative perceptions towards PPP for exposed pulp in carious teeth are prevalent among dentists. Identifying the differences in PPP preference rates in questionnaire studies and actual clinical situations is necessary to determine the current status of PPP. In this study, a clinical case/photo-based design was devised to overcome the limitations of scenario/text-based questionnaires. This study aimed to evaluate the reasons dentists prefer root canal treatment (RCT) in cases where PPP is potentially indicated.

METHODS

A questionnaire containing three cases of PPP with successful results was administered to dentists. The cases were selected to elicit comprehensive responses from the dentists. Clinical photos of the pulp exposure sites were presented to dentists without describing the tooth conditions, including the extent of pulp exposure and tooth decay, pulpal surface conditions, or restorability. The questions were focused on the reasons for selecting RCT in cases where was practiced. Questionnaire data were collected using Google e-forms. Chi-squared and Fisher's exact test (P < 0.05) were used for statistical analyses.

RESULTS

Pulpal diagnosis was not a dominant factor in treatment decision-making for pulp exposure during caries removal. Reasons for selecting RCT where PPP was potentially indicated included the event of pulp exposure itself and the dentists' desire to prevent post-PPP symptoms. Apart from symptomatic pulp, the tooth conditions influenced the establishment of pulpal diagnosis and selection of treatment modality. Moreover, the tooth condition and dentists' desire for good patient prognosis influenced the negative perceptions towards PPP.

CONCLUSIONS

Unfavourable tooth conditions, in association with a desire for preventing post-PPP symptoms, prevent dentists from attempting PPP for pulp exposed during caries removal with no/slight symptoms. Improving negative perceptions towards PPP through accumulation of data on the high success rates of PPP is a prerequisite for achieving widespread application of PPP.

Evaluation of treatment and restoration preferences in deep carious teeth with various pulp exposure sizes: A questionnaire-based survey

This study evaluated the management preferences in a deep carious vital tooth. A questionnaire was e-mailed to members of the Turkish Dental Association. The questionnaire included a photograph and radiographs of an extremely deep carious molar (#16) of a 30-year-old man suffering from cold and chewing sensitivity. The dentists were asked to choose treatments for pulp exposure of <1, 1-2, and ≥2 mm and a permanent restoration. Chi-squared test was used to analyse data (p < 0.05). 504 (4.84%) of 10 411 dentists responded. When the pulp exposure was <1 mm: direct pulp capping (84.9%); 1-2 mm: root canal treatment (49.6%); ≥2 mm: root canal treatment (85.7%) were the most preferred treatments. 69.6% of the respondents chose direct composite restorations. If the tooth would be an abutment, most respondents preferred root canal treatment, regardless of the perforation size. The extent of pulp exposure and the type of permanent restoration influenced the treatment decision-making process.

Implications of root, pulp chamber, and canal anatomy on pulpotomy and revitalization procedures

OBJECTIVES

This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures.

METHODS

This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures.

RESULTS

Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up.

CONCLUSIONS

Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups.  CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.

Full Pulpotomy as a Treatment for Irreversible Pulpitis in Permanent Teeth: A Systematic Review of the Literature Based on Case Reports

The objective of this systematic review was to evaluate the current evidence of case reports where the treatment for permanent teeth with a diagnosis of irreversible pulpitis was a full pulpotomy. This study was carried out by two reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic electronic search was carried out in the PubMed, Google Scholar, and Scopus databases until the year 2022 to find articles in English where the treatment for irreversible pulpitis in permanent teeth was a full pulpotomy. Literature reviews, in vitro or animal studies, abstracts, and unpublished data were excluded. The intervention, control, and outcome parameters were selected following the "Population, Interventions, Control, and Outcome" (PICO) guidelines. A total of 636 articles were found, and 14 articles were selected to be included in this review. The selected articles describe cases of full pulpotomies in mature permanent teeth with a diagnosis of irreversible pulpitis with a total of 34 (100%) successful cases, where 18 were men and 16 were women, with an average age of 19.20 ± 10.59 years and an average follow-up of 35.82 ± 26.39 months, with 12 months being the minimum follow-up time. The material used most frequently for obturation of the full pulpotomy was mineral trioxide aggregate in 16 cases (47.06%). Within the limitations of this review, full pulpotomy presents a high success rate regardless of the tooth, age, or sex as a treatment for teeth diagnosed with irreversible pulpitis.

Treatment outcome of partial pulpotomy using two different calcium silicate materials in mature permanent teeth with symptoms of irreversible pulpitis: A randomized clinical trial

AIM

To assess the clinical and radiographic outcome of partial pulpotomy by comparing MTA Angelus and Total Fill BC, as pulpotomy agents, in mature teeth with deep caries and symptoms indicative of irreversible pulpitis.

METHODOLOGY

The study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www.

CLINICALTRIALS

gov (NCT04870398). Symptomatic mature permanent teeth with deep caries fulfilling the inclusion criteria were randomly treated using either MTA Angelus or Total Fill BC. A partial pulpotomy was performed and following complete haemostasis, the capping material was placed over the remaining pulp tissue and a postoperative periapical radiograph was taken. Clinical and radiographic follow-up evaluation was performed for a median time of 2 years, whereas levels of pain intensity were evaluated preoperatively and for 7 days after intervention using Visual Analogue Scale. For the primary outcome (failure/success of treatment), the Kaplan-Meier survival curves for the capping materials were plotted and a log-rank test for equality of survivor functions was applied. A multivariable random effects Cox Regression model was also applied. For the secondary outcome (postoperatively reported pain), a multivariable mixed effects ordinal logistic regression was structured.

RESULTS

One hundred and thirty-seven teeth in 123 patients underwent partial pulpotomy using randomly either MTA Angelus (N = 74) or Total Fill BC (n = 63). The percentage failure for MTA Angelus and Total Fill BC was 10.8% (8/74) and 17.5% (11/63), respectively, but the difference was not statistically significant [adjusted HR: 1.83; 95% confidence interval (CI): 0.68, 4.91; p = .23]. Weak evidence was found that secondary caries involvement may impose a 3.54 times greater hazard for treatment failure (adjusted HR: 3.54; 95% CI: 1.00, 12.51; p = .05). For each passing minute of procedural bleeding control, there was also a 57% higher hazard for treatment failure (adjusted HR: 1.57; 95% CI: 0.99, 2.48; p = .05). The odds for higher postoperative pain were 4.73 times greater for the Total Fill BC compared to MTA Angelus (adjusted OR: 4.73; 95% CI: 2.31, 9.66; p < .001).

CONCLUSIONS

Both materials exhibited similar and favourable outcome rates after partial pulpotomy in teeth with deep caries and symptoms of irreversible pulpitis. Total Fill BC was associated with a higher level of postoperative pain intensities.

Effectiveness of pulpotomy compared with root canal treatment in managing non-traumatic pulpitis associated with spontaneous pain: A systematic review and meta-analysis

BACKGROUND

Pulpitis characterized by spontaneous pain can result in debilitating pain. Dogma has existed to offer only have two treatment options, namely root canal treatment (RCT) or extraction, although pulpotomy has always remained a potential treatment modality.

OBJECTIVE

This review aimed to answer the following research question: 'Does pulpotomy (partial or full) (I) result in better patient and clinical reported outcomes (O), compared with RCT (C) in permanent teeth with pulpitis characterized by spontaneous pain (P) evaluated at various time intervals?' (T).

METHODS

Two authors independently performed study selection, data extraction and risk of bias assessment. The literature search was conducted in the following electronic databases: Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. English language clinical trials comparing the patient and clinical reported outcomes between RCT and pulpotomy were included. The meta-analysis was performed on a fixed-effect model and the quality of evidence assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

RESULTS

Two randomized clinical trials were included. Amongst two trials, one has published four reports at different time points involving the same cohorts. The meta-analysis revealed no difference in postoperative pain (Day 7) between RCT and pulpotomy (OR = 0.99, 95% CI 0.63-1.55, I2  = 0%) and quality of evidence was graded as 'High'. Clinical success was high at year 1, 98% for both interventions, however, decreased over time to 78.1% (pulpotomy) and 75.3% (RCT) at 5 years.

DISCUSSION

Pulpotomy is a definitive treatment modality that is as effective as RCT. This could have a significant impact on treatment of such patients affording the advantages of retaining a vital pulp and preventing the need for RCT.

CONCLUSION

This review could only include two trials, hence there is insufficient evidence to draw robust conclusions. The clinical data accumulated so far suggests no difference in pain between RCT and pulpotomy at Day 7 postoperatively and a single randomized control trial suggests that the clinical success rate for both treatment modalities is similar long term. There is a need for more well-designed trials by different research groups to develop a stronger evidence base in this area.

REGISTRATION

PROSPERO database (CRD42021259744).

Comparative evaluation of treatment outcome of partial pulpotomy using different agents in permanent teeth-a randomized controlled trial

AIM

To compare and evaluate the clinical and radiographic performance, post-operative pain, and anti-inflammatory intake after partial pulpotomy (PP) with calcium hydroxide (CH), mineral trioxide aggregate (MTA), Biodentine (BD), and Emdogain (EMD) as pulp capping agents in mature permanent molars with definitive diagnosis of reversible pulpitis.

MATERIALS AND METHODS

As part of this prospective, randomized clinical trial with four parallel arms (CTRI Registration No.: CTRI/2020/11/029329 dated 24/11/2020), hundred and ten permanent molars with a clinical diagnosis of reversible pulpitis and normal apical tissues, from patients between the ages of 15 and 45 years, were recruited and randomly assigned to four groups-CH, MTA, BD, and EMD. Operative procedure was performed under local anesthesia and dental dam isolation. After carious pulpal exposure, 2 mm of superficially inflamed coronal pulp tissue was amputated and either of the four pulp capping materials was placed. The outcome assessment was carried out at 1, 3, 6, and 12 month(s) and was categorized as success (asymptomatic patients with PAI score = 1) or failure (symptomatic patients or PAI score > 1).

RESULTS

There was a significant difference in post-operative pain and anti-inflammatory medication intake after partial pulpotomy with Emdogain vis-à-vis other three capping agents. No difference in both clinical and radiographic performances was observed among the four capping agents.

CONCLUSION

Partial pulpotomy when performed following evidence-based guidelines results in high success rates regardless of capping agent employed. EMD can be considered a valid and suitable pulp capping agent in PP.

CLINICAL RELEVANCE

Meticulous examination and removal of superficially inflamed pulp under magnification and complete asepsis lead to successful pulpal healing regardless of capping agent employed.

Selective Removal to Soft Dentine versus Full Pulpotomy for Management of Proximal Deep Carious Lesions: A Randomized Controlled Non-Inferiority Trial

The management of the deep carious lesion with reversible pulpitis is a dilemma for the dentist. The current study compared selective removal to soft dentine (SRSD) and full pulpotomy (FP) for treating proximal deep carious lesions in teeth with reversible pulpitis. Visual-tactile examination and bitewing radiographs were used to determine the depth of carious lesion, and American Association of Endodontists recommendations were used to formulate pulp diagnosis. Sixty mandibular molar teeth from healthy patients between the ages of 16-35 years and a diagnosis of proximal deep carious lesion with reversible pulpitis were included. Teeth were randomly allocated to two study groups. SRSD group (n = 30): soft dentine was preserved over the pulpal aspect. A hard-setting calcium hydroxide cement liner and resin-modified glass ionomer cement base were applied over the remaining soft carious dentine. FP group (n = 30): complete caries removal followed by mineral trioxide aggregate FP was performed. The teeth in both groups were restored with composite resin restoration. The established criteria for outcome assessment of SRSD and pulpotomy were used. Accordingly, only asymptomatic teeth with no radiological evidence of periapical rarefaction were considered successful at the 12-month follow-up. Two-sample t test, Pearson χ2 test/Fisher's exact test, and percentage agreement were used for statistical evaluation. According to the per-protocol analysis, the success rate of both SRSD and FP treatment was 95.45% and 95.65%, respectively, and the actual difference between the two treatments was 1% (95% CI: [-10, 9]). The data suggests that both treatments (SRSD and FP) appear to have a good success rate (>95%) when used to manage permanent mandibular molar teeth with proximal deep carious lesion and reversible pulpitis. As SRSD is a noninvasive procedure, it should be favored over FP in these instances.

Clinical and Radiographic Outcomes of Mineral Trioxide Aggregate Pulpotomies in Vital Permanent Teeth with Carious Pulp Exposure: A Pioneering Retrospective Study

Purpose

Vital partial pulpotomy (PP) or cervical pulpotomy (CP) in carious pulp-exposed permanent teeth preserves tooth vitality, promotes pulp healing, decreases treatment costs, and shortens treatment duration, which is a significant factor in treating noncooperative children. The aim of this retrospective study was to compare clinical and radiographic outcomes of partial and CP in vital carious-exposed permanent teeth.

Materials and methods

All vital permanent teeth with carious pulp exposure, treated by pulpotomy using mineral trioxide aggregate (MTA) during 2017-2019, by two operators in one dental center, were included in the study. Around 118 permanent teeth in 97 children and adolescents (mean age 10.9 years) were evaluated 6-57 months postoperatively.

Results

The total success rates of CP and PP were 82.5 and 80.8%, respectively (p = nonsignificant). The only factor that significantly affected the success rate was the presence of preoperative periapical pathology. Teeth without such pathology showed an 87.3% success rate compared to 74.1 and 58.3% in teeth with preoperative enlarged periodontal ligament (PDL) or with periapical radiolucency, respectively (p = 0.0301). Demographic variables, maturation state of the tooth, type of tooth (incisor, premolar, molar), postoperative variables, such as the presence of radiographic dentinal bridge, partial or full obliteration of the pulp during the follow-up period, and the integrity of the final restoration during the recall examinations did not affect the success rate of the treatment.

Conclusion

Partial and CP in vital permanent teeth with carious pulp exposure in children and adolescents might be a reliable alternative to full root canal treatment (RCT).

How to cite this article

Yoshpe M, Kaufman AY, Lin S, et al. Clinical and Radiographic Outcomes of Mineral Trioxide Aggregate Pulpotomies in Vital Permanent Teeth with Carious Pulp Exposure: A Pioneering Retrospective Study. Int J Clin Pediatr Dent 2023;16(4):555-559.

The Influence of Carious Lesion and Bleeding Time on the Success of Partial Pulpotomy in Permanent Molars with Irreversible Pulpitis: A Prospective Study

This prospective study aimed to evaluate the success rate of partial pulpotomy using mineral trioxide aggregate (MTA), in permanent molars with symptomatic irreversible pulpitis. Moreover, this study aimed to investigate the effect of carious lesion depth and activity and bleeding time on the outcome of partial pulpotomy. Forty permanent molars with deep and extremely deep carious lesions clinically diagnosed with symptomatic irreversible pulpitis were included. The status of the carious lesion was evaluated clinically and radiographically to determine its activity (rapidly or slowly progressing) and depth (deep or extremely deep). A partial pulpotomy was performed and MTA was used. Clinical and radiographic analysis were performed at 3, 6 and 12 months. Chi-square analysis and Fisher's exact test were used. Scanning electron microscope and energy dispersive X-rays were used to investigate the crystalline structures and their chemical composition onto MTA surfaces after immersion in several conditions. The partial pulpotomy was 88.9% successful, with no significant difference in outcome between deep and extremely deep carious lesions (p = 0.22) or between rapidly and slowly progressing lesions (p = 0.18). Nevertheless, all failed cases were associated with rapidly progressing lesions and extremely deep lesions. All failures occurred when the bleeding time was more than 3 min (p = 0.10). Different crystalline structures were detected on MTA surfaces, with higher calcium percentages in PBS conditions. Within the limitations of the present study, favorable results demonstrated that MTA might be recommended as a suitable agent for partial pulpotomy in permanent molars with irreversible pulpitis. The depth and activity of the carious lesion as well as the bleeding time are important factors in the success of partial pulpotomy treatment. The prolonged bleeding time and the extremely deep rapidly progressing caries could be related with the failure cases in partial pulpotomy treatment of irreversible pulpitis.

Vital pulp therapy for permanent teeth with diagnosis of irreversible pulpitis: biological basis and outcome

Root canal treatment (RCT) has been considered the conventional standard for the management of teeth with carious pulp exposure, particularly in mature teeth presenting with symptoms. Following a better understanding of the histopathology of deep carious lesions, the histology of the cariously exposed pulp and the healing potential of the inflamed pulp, vital pulp therapy (VPT) is increasingly adopted around the world for the management of permanent teeth with clinical signs and symptoms indicative of irreversible pulpitis. Furthermore, VPT became a recognized treatment modality by the European Society of Endodontology (ESE) and the American Association of Endodontists (AAE) by virtue of its high success rates reported in outcome studies using contemporary hydraulic calcium silicate-based cements. However, proper case selection, strict asepsis, capping materials and good coronal seal are mandatory for success. The aim of this paper is to review the biological basis for VPT in symptomatic teeth with carious pulp exposure and to report on the outcome of pulpotomy in teeth with clinical diagnosis of irreversible pulpitis.

Comparative Evaluation of Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp Therapy: A Randomized 6-month Clinical Study

Introduction

The study was performed to evaluate and compare the clinical and radiographic efficacy of chlorhexidine (CHX) polymer scaffold, 3Mixtatin, and formocresol for vital primary pulp therapy-a randomized clinical study.

Materials and methods

A total of 120 primary molars were included from children aged between 6 and 8 years in this randomized clinical study based on inclusion and exclusion criteria and were randomly allocated into three groups (group I-CHX polymer scaffold, group II-3Mixtatin, and group III-formocresol. Pulpotomy was performed in a vital cariously exposed primary tooth with healthy periodontium where their retention is more beneficial than extraction. Subjects were followed up at 1, 3, and 6 months for clinical and radiographic evaluations.

Results

At 6 months of follow-up, the overall success rate of pulpotomy in groups I, II, and III was 56.41, 71.05, and 60.52% in each group, respectively. Nonsignificant difference (p > 0.05) was seen during intergroup comparison.

Conclusion

However, among the three materials used in this study, 3mixtatin comparatively had better results.

How to cite this article

Goel N. Comparative Evaluation of Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp Therapy: A Randomized 6-month Clinical Study. Int J Clin Pediatr Dent 2023;16(3):478-482.

Influence of the restoration after pulpotomy on the strength of electrical stimulus reaching the pulp space: An in vitro investigation

Introduction

The study evaluated the influence of coronal restoration after pulpotomy on the strength of electrical stimulus reaching the radicular pulp using an electric pulp test (EPT).

Materials and Methods

The pulp tissue from ten freshly extracted mandibular premolar teeth was removed and replaced with an electroconductive gel. The cathode probe of Powerlab was inserted into the pulp space and the anode probe was attached to the EPT handpiece. The EPT probe coated with electro-conducting material was positioned in the middle third of the buccal crown surface. The EPT stimulus reaching the pulp space of an intact tooth at 40 numerical readings was recorded. The tooth was removed from model and endodontic access was made. The 2-mm thick mineral trioxide aggregate was placed at the cementoenamel junction followed by composite resin restoration. The experimental setup was re-established and postpulpotomy EPT stimulus data were recorded. The data collected were compared using the Wilcoxon signed-rank test.

Results

There was a statistically significant difference (P = 0.038) between observed between the strength of EPT stimulus reaching the pulp space in prepulpotomy (mean 91.18 ± 101.02 V and median 25.79 V) and postpulpotomy (mean 58.49 ± 77.13 V and median 13.75 V) tooth samples.

Conclusion

The placement of the restoration and pulp capping agent after pulpotomy dampens the strength of EPT stimulus reaching the pulp canal space.

Bioceramics in Endodontics: Updates and Future Perspectives

Bioceramics, with excellent bioactivity and biocompatibility, have been widely used in dentistry, particularly in endodontics. Mineral trioxide aggregate (MTA) is the most widely used bioceramic in endodontics. Recently, many new bioceramics have been developed, showing good potential for the treatment of endodontic diseases. This paper reviews the characteristics of bioceramics and their applications in various clinical endodontic situations, including root-end filling, root canal therapy, vital pulp therapy, apexification/regenerative endodontic treatment, perforation repair, and root defect repair. Relevant literature published from 1993 to 2023 was searched by keywords in PubMed and Web of Science. Current evidence supports the predictable outcome of MTA in the treatment of endodontic diseases. Although novel bioceramics such as Biodentine, EndoSequence, and calcium-enriched mixtures have shown promising clinical outcomes, more well-controlled clinical trials are still needed to provide high-level evidence for their application in endodontics. In addition, to better tackle the clinical challenges in endodontics, efforts are needed to improve the bioactivity of bioceramics, particularly to enhance their antimicrobial activity and mechanical properties and reduce their setting time and solubility.

Factors that influence the outcome of pulpotomy in permanent teeth

The promotion of minimally invasive treatments focussed on the maintenance of pulp vitality has become a priority area in Endodontics. These vital pulp treatments (VPT) include partial and full pulpotomy, during which diseased coronal pulp tissue is removed prior to placement of a capping biomaterial and restoration. Traditionally, pulpotomies were confined to the treatment of carious primary and traumatized permanent teeth. However, these treatments have now been proposed as definitive solutions for cariously exposed permanent teeth with mild symptoms or even symptoms indicative of irreversible disease. Until recently, it was recommended that carious exposure of mature permanent teeth be managed by root canal treatment. The promotion of pulpotomy as an alternative treatment has opened up a wave of laboratory and clinical research aimed at improving therapies or evaluating clinical outcomes. In modern evidence-based endodontics, it is imperative that the outcomes of both partial and full pulpotomy are considered and important prognostic factors identified, so that improvements can be made to aid clinical decision-making and to direct new research. In this narrative review, the outcomes of partial and full pulpotomy are discussed, before analysis of patient, intraoperative and postoperative factors that influence the outcome of the pulpotomy procedure. The review highlights that although partial and full pulpotomy for the treatment of even pulpal disease are highly successful procedures, this is based on low-quality evidence with a lack of prospective, comparative trials investigating potential prognostic factors. Based on current evidence, it appears that age, gender, tooth type, root development and intraoperative pulpal haemorrhage do not impact significantly on pulpotomy outcome, whilst others such as caries depth, inflammatory status of the pulp, capping material, level of inflammatory pulpal-biomarkers and the final restoration integrity do. Other factors, including the influence of exposure type, periodontal condition, pulpal lavage, magnification, operator experience, isolation of the operating field and type of pulpotomy, require further experimental investigation before definitive conclusions can be made relating to the success of the pulpotomy procedure. Finally, there is not only a need for future well-designed prospective research addressing these issues but also a widening of our understanding of outcome to include patient-reported as well as clinician-reported outcomes.

A retrospective study of iRoot BP Plus pulpotomy compared with Vitapex pulpectomy for irreversible pulpitis of primary molars with the presence of coronal pulp tissue

BACKGROUND

Pulpotomy has been successfully performed in immature and mature permanent teeth with irreversible pulpitis but rarely in primary teeth.

AIM

To evaluate the outcomes of iRoot BP Plus pulpotomy and Vitapex pulpectomy in primary molars with irreversible pulpitis.

DESIGN

We selected 130 primary molars of 99 patients, aged 3-7 years, diagnosed with irreversible pulpitis with coronal pulp tissue and treated with iRoot BP Plus pulpotomy or Vitapex pulpectomy (median follow-up period: 18 months). They were divided into the pulpotomy (n = 88) and pulpectomy (n = 42) groups according to treatment procedure. The pulpotomy group was further divided into asymptomatic (n = 46) and symptomatic (n = 42) subgroups according to preoperative symptoms. The chi-squared test and Cox regression were performed to analyze the outcomes.

RESULTS

Clinical and radiographic success rates were significantly higher in the pulpotomy group (98.9% and 95.5%) than in the pulpectomy group (88.1% and 54.8%) and did not differ significantly between asymptomatic and symptomatic pulpotomy subgroups.

CONCLUSION

Irreversible pulpitis of primary molars with coronal pulp tissue can be successfully treated with iRoot BP Plus pulpotomy. Early intraradicular resorption of materials is the main adverse outcome of Vitapex pulpectomy.

Outcome of partial and full pulpotomy in cariously exposed mature molars with symptoms indicative of irreversible pulpitis: A randomized controlled trial

AIM

The aim of this study was to assess and compare the clinical and radiographic outcome of partial pulpotomy and full pulpotomy using Biodentine in cariously exposed mature molar teeth with symptoms indicative of irreversible pulpitis.

METHODOLOGY

This study is an unicentric, double-arm, randomized superiority clinical trial with parallel experimental groups, registered under CTRI (CTRI/2019/12/022559). Fifty mature permanent molar teeth with carious exposures with symptoms indicative of irreversible pulpitis were randomly allocated equally into two groups. Partial pulpotomy (PP) and full pulpotomy (FP) were performed in the first and second group, respectively, following standardized protocols. Exposed pulp tissue was removed up to a depth of 2-3 mm for partial pulpotomy, whereas complete coronal pulp tissue was removed up to the level of root orifices for full pulpotomy. Haemostasis was achieved with placement of 2.5% sodium hypochlorite-moistened cotton pellets placed on amputated pulp tissue for a maximum of 10 min. Biodentine was used as the pulp capping material. Pain scores were evaluated using 11-point Visual Analogue Scale (VAS) preoperatively, at 24 h, 48 h and 7th day after the intervention(s). Clinical and radiographic evaluation was done at 3 months, 6 months and 1 year. The data were statistically analysed using chi-squared test, Mann-Whitney U-test, Friedman's test and Wilcoxon signed-rank test. The significance level was pre-determined at p < .05. Cumulative survival probabilities were assessed at 12 months using Kaplan-Meier analysis.

RESULTS

Intra-group analysis of pain scores revealed significant reduction in pain scores preoperatively and at 24 h, 48 h and 7th day in both the groups. However, the difference in the pain score(s) reduction between both the groups was not statistically significant at any time interval (p > .05). At 1-year follow-up, the success rate was 88% (22/25) and 91.6% (22/24) for PP and FP respectively (p > .05).

CONCLUSIONS

Partial pulpotomy showed comparable results to full pulpotomy in terms of clinical/radiographic treatment outcome. If the long-term results remain the same, partial pulpotomy can be proposed as an alternative treatment modality for mature teeth with cariously exposed pulp tissue presenting with signs of symptomatic irreversible pulpitis.

Advances in the Role of Sodium Hypochlorite Irrigant in Chemical Preparation of Root Canal Treatment

Irrigation of root canal system is of great significance to the success of endodontic treatment, where sodium hypochlorite (NaOCl) is the most widely used irrigant in chemical preparation. NaOCl functions by eliminating bacterial biofilms and dissolving organic tissue, which may vary according to several factors such as the microbiology of root canal infection and the concentration of the irrigant. It has been proposed that the effectiveness of NaOCl could be enhanced via several methods, including heating the irrigant, applying in conjunction with certain reagents, or activating by agitation techniques. Despite its antibacterial and tissue-dissolving capacities, NaOCl should be used with caution to avoid detrimental effect due to its cytotoxicity and negative effect on dentin properties. In this narrative review, we discussed the factors that affect the properties of NaOCl, the methods to improve its efficacy, and the side effects that might occur in clinical practice.

Modified pulpotomy procedure in immature permanent teeth with apical periodontitis: a randomised controlled trial

OBJECTIVES

The objective of this study was to evaluate the effectiveness of a modified pulpotomy (MP) procedure in immature permanent teeth with apical periodontitis (AP).

DESIGN

Randomised controlled trial.

SETTING

One public hospital in Shanghai, China PARTICIPANTS: A total of 33 teeth (31 patients) with a definitive diagnosis of AP with radiographic periapical radiolucency were recruited in this study. All the patients (teeth) completed the study accordingly.

METHODS AND INTERVENTION

Patients were randomly assigned to either MP or apexification treatment groups and were followed up for 12 months. Clinical symptoms and complications were recorded, and parallel periapical radiographic images were used to measure changes in root length and apical diameter. Wilcoxon's rank sum test and Fisher's exact test were used to compare the clinical and radiographic outcomes between MP and apexification, and analysed with analysis of variance.

MAIN OUTCOME MEASURE

The primary outcome was increase in root length at 12 months. The secondary outcomes included tooth survival, clinical success and decrease in apical diameter.

RESULTS

MP group showed a significant increase in root length (10.05%±2.14% vs 1.16%±0.79%, p<0.05) at 12 months and a decrease in apical diameter (48.88%±10.42% vs 15.90%±8.88%, p<0.05) as compared with the apexification group. The tooth survival rate was 100%, and 90.91% (30/33) of teeth were asymptomatic with apical healing in both treatment groups (p>0.05).

CONCLUSIONS

MP can be an option for treating immature permanent teeth with AP. MP showed better performance in terms of continued root maturation than apexification. MP and apexification achieved comparable outcomes with regard to the resolution of clinical symptoms and apical healing.

TRIAL REGISTRATION NUMBER

ChiCTR-INR-17012169.

Minimally invasive endodontics: a new era for pulpotomy in mature permanent teeth

Emerging clinical and histologic evidence is challenging the long-established dogma that root canal treatment (RCTx) is the only therapeutic option for preservation of vital mature permanent teeth diagnosed with irreversible pulpitis or carious pulp exposure. Vital pulp therapy procedures like pulpotomy are not only technically simpler and more economical, but also afford patients a host of other benefits over conventional RCTx. This narrative review provides an update on the contemporary understanding of pulp pathophysiology and defence mechanisms, the proposed new diagnostic terminologies for pulpal inflammation, and how the biological characteristics of hydrophilic calcium silicate cements have enabled consistent successful outcomes for pulpotomy-treated mature teeth. The paper also details the evidence base from clinical trials and systematic reviews conducted over the past decade and outlines the practical treatment considerations for pulpotomy in mature permanent teeth.

Evaluation of the outcome of apexogenesis in traumatised anterior and carious posterior teeth using mineral trioxide aggregate: a 5-year retrospective study

The purpose of this study was to evaluate the outcome of apexogenesis with mineral trioxide aggregate (MTA) in traumatised anterior and carious posterior teeth over 5 years. A comprehensive chart review was performed to obtain a retrospective of sequential previously completed cases with recalls. Clinical and radiographic data were collected for 97 vital immature teeth (40 traumatised anterior and 57 carious posterior teeth) pulpotomised (partial or full pulpotomy) using MTA with an average follow-up time of 5 years. Chi-squared test and Fisher's exact test were implemented to analyse data. The success rate in anterior teeth and posterior teeth was 82.5% and 96.4% respectively. Crown discolouration was observed in 25 (62.5%) anterior teeth. There was a significant difference between the number of successful and unsuccessful cases (P < 0.05) and there was no correlation between type of treatment and success/failure (P > 0.05). The success rate of apexogenesis using MTA in immature teeth was relatively high.

Coronal discoloration induced by calcium silicate-based cements used in full pulpotomy in mature permanent molars: a randomized clinical trial

OBJECTIVES

This study aimed to randomly compare in vivo coronal discoloration at 6 and 12 months after full pulpotomy in mature permanent molars using MTA, Biodentine, and TotalFill and to investigate the effect of variables such as remaining buccal wall thickness and time to achieve hemostasis.

MATERIALS AND METHODS

One hundred eight teeth that met the inclusion criteria received full pulpotomy and were randomly divided into 3 groups via a block randomization technique according to the calcium silicate cement (CSC): ProRoot WMTA, TotalFill, or Biodentine. Assessment of tooth color was carried out using a spectrophotometric device (VITA Easyshade Compact) after composite placement (T0), at 6- and 12-month follow-up. Buccal wall thickness and time to hemostasis were recorded. The primary outcome measure (color change ΔE) was calculated, and the results were analyzed by three-way ANOVA and crosstabulations in relation to material type and effect of variables.

RESULTS

Four cases were excluded after pulpotomy failure; 81 teeth were evaluated at 6 months and 95 teeth at 12 months. All CSCs caused tooth discoloration (defined as ΔE > 3.7); MTA significantly caused the highest color change at 6- and 12-month follow-up (76% (19/25) and 87.5% (28/32), respectively) compared to Biodentine (41% (9/22), 48% (13/27)) and TotalFill (44% (15/34), 53% (19/53)) (p = 0.022, p = 0.002), while no significant difference was found between the Biodentine and TotalFill groups (p = 0.813, p = 0.8). Buccal wall thickness (above or below 2.7 mm) had a significant effect on the degree of discoloration (p = 0.004).

CONCLUSIONS

The 3 CSCs caused tooth discoloration based on the threshold of ΔE > 3; the remaining buccal wall thickness was a significant factor. The use of Biodentine and TotalFill instead of MTA is encouraged to minimize discoloration.

CLINICAL RELEVANCE

While experimental studies report coronal discoloration after CSCs use, clinical data is lacking. This study assessed discoloration using a spectrophotometric device. The use of materials with lower discoloration potential in pulpotomy is encouraged.

TRIAL REGISTRATION

The study was registered with clinical trial registration number: NCT04346849 on 14.4.2020.

The scientific management of deep carious lesions in vital teeth using contemporary materials—A narrative review

Aim

The aim of this article is to review the scientific evidence for deep caries removal in permanent vital teeth and the choice of dentine replacement material and restoration of the teeth to maintain long term tooth vitality and function.

Method

The two position statements namely the European Society of Endodontology and the American Association of Endodontists position statements on vital pulp therapy will be scrutinized and compared with regards to the deep caries removal strategy and assessed for evidence of best practice. The properties of materials used to manage vital pulps and the best way to restore the teeth will be reviewed and guidance on the full management of vital teeth will be suggested.

Conclusions

Promoting new treatment modalities for reversible and irreversible pulpitis allowing for pulp preservation should be considered. Although debatable, cases with deep caries should be managed by complete non-selective caries removal which will allow for pulpal management if needed and a more predictable outcome can be expected when using the new materials and treatment modalities of vital pulp therapy.

A Pilot Feasibility Study to Establish Full Pulpotomy in Mature Permanent Teeth with Symptomatic Irreversible Pulpitis as a Routine Treatment in Mexican Public Healthcare Services

Symptomatic irreversible pulpitis is a common dental disease for which root canal treatment (RCT) has been the standard treatment. However, in many countries, RCT is considered a high-cost treatment that is not covered by public healthcare services; this forces patients to have dental extraction as their only option to relieve pain. In the last decade, several investigations have provided evidence that an alternative treatment known as full pulpotomy (FP) could be an alternative for patients who could not afford the cost of an RCT. Nevertheless, evidence is lacking on the success rate that could be obtained if it is performed in a public dental care clinic (PDCC). The present investigation has two main objectives. To be the first approach of a multicentric feasibility study to find out whether an FP performed by a general practice dentist (GPD) in a PDCC could be suitable and establish its success rate and patient satisfaction. Patients attending a PDCC with symptoms of irreversible pulpitis were invited to participate. FP was performed and followed up at 1, 3, 6, 9, and 12 months. The treatment success was assessed by combining three variables, patient satisfaction, clinical, and radiographic outcomes. Forty-one patients from 17 to 78 years old received the intervention. In total, 97.5% were completely satisfied with the treatment and were considered successful since none of the clinical or radiographic variables were present in any of the follow-ups. An FP performed by a GPD in a PDCC could be suitable as a routine treatment for symptomatic irreversible pulpitis due to the excellent success rate and patient satisfaction.

Outcome of pulpotomy in permanent teeth with irreversible pulpitis: a systematic review and meta-analysis

Treatment planning is key to clinical success. Permanent teeth diagnosed with "irreversible pulpitis" have long been implied to have an irreversibly damaged dental pulp that is beyond repair and warranting root canal treatment. However, newer clinical approaches such as pulpotomy, a minimally invasive and biologically based procedure have re-emerged to manage teeth with pulpitis. The primary aim of the study was to conduct a meta-analysis to comprehensively estimate the overall success rate of pulpotomy in permanent teeth with irreversible pulpitis as a result of carious pulp exposure. The secondary aim of the study was to investigate the effect of predictors such as symptoms, root apex development (closed versus open), and type of pulp capping material on the success rate of pulpotomy. Articles were searched using PubMed, Scopus, CENTRAL, and Web of Science databases, until January 2021. Outcomes were calculated by pooling the success rates with a random effect model. Comparison between the different subgroups was conducted using the z statistic test for proportion with significance set at alpha = 0.05. A total of 1,116 records were retrieved and 11 studies were included in the quantitative analysis. The pooled success rate for pulpotomy in teeth with irreversible pulpitis was 86% [95% CI: 0.76-0.92; I² = 81.9%]. Additionally, prognostic indicators of success were evaluated. Stratification of teeth based on (1) symptoms demonstrated that teeth with symptomatic and asymptomatic irreversible pulpitis demonstrated success rate of 84% and 91% respectively, with no significant difference (p = 0.18) using z-score analysis; (2) open apex teeth demonstrated a significantly greater success rate (96%) compared to teeth with closed apex (83%) (p = 0.02), and (3) pulp capping materials demonstrated that Biodentine yielded significantly better success rates compared to Mineral Trioxide Aggregate (MTA), calcium hydroxide, and Calcium Enriched Mixture (CEM.) Collectively, this is the first meta-analytical study to determine the clinical outcome of pulpotomy for carious teeth with irreversible pulpitis and it's predictors for success. Moreover, we identify the stage of root development and type of biomaterial as predictors for success of pulpotomy.

Histopathological evaluation of pulp response to portland cement compared to MTA after primary canines pulpotomy (in vivo study)

INTRODUCTION

ECC (Early childhood caries) is very common in children. Because of the small size of primary anterior teeth, endodontic exposures occur early. Pulp tissue response after pulpotomy of primary anterior teeth by both MTA and Portland Cement is very important when pulp exposures occur in these teeth.

AIM

This study aimed to evaluate in vivo pulp tissue responses after the primary canines pulpotomy with either White Portland Cement (WPC) or White Mineral Trioxide Aggregate (WMTA), by histopathological analysis.

MATERIALS AND METHODS

The study included 30 primary canines in 21 healthy children aged 6-9 years old and it was classified into 2 groups according to the material. Group 1: included 15 teeth capped by White Portland Cement, and Group 2: included 15 teeth capped by white MTA. The dentine bridge formation, soft Tissue Organization, tissue fibrosis, formed dentin bridge thickness, pulp calcifications, hemorrhage in the pulp tissue, and deposition of new dentin on the inner surface of the dentin at 3 months periods were recorded.

RESULTS

Data were analyzed statistically; the Mann-Whitney U test was performed for the assessment of histopathological criteria. Descriptive statistics were performed for the analysis of participant properties. Histopathological analysis showed complete dentin bridge formation and normal soft tissue organization for both materials. Statistical analysis showed no significant differences in dentine bridge formation (P value = 0.213), soft Tissue Organization (P value = 0.339), tissue fibrosis (P value = 0.079), formed dentin bridge thickness (P value = 0.139), pulp calcifications (P value = 0.581), hemorrhage in the pulp tissue (P value = 0.117), and deposition of new dentin (P value = 0.097), during the observation period.

CONCLUSIONS

Within the limitation of the current study WPC was similar to WMTA in terms of histological criteria so PC may serve as a good alternative to MTA in primary teeth pulpotomy.

Complicated Crown Fracture of Permanent Incisors: A Conservative Treatment Case Report and a Narrative Review

Dental trauma may have a severe impact on the social and psychological wellbeing of a patient. Most cases of dental injuries involve anterior teeth, especially the maxillary upper incisors. Crown fractures, with or without pulp exposure, are the most common trauma in permanent dentition. There are many methods of management, in which the initial state of the pulp, the time since the injury, and the presence of an accompanying injury play a key role. This case report aimed at showing a possible conservative treatment after complicated tooth fracture that consisted of partial pulpotomy followed by adhesive reattachment of the tooth fragment using a technique based on heated resin composite. Such a specific procedure represents a conservative approach to traumatic coronal lesions, providing a suitable opportunity to maintain the tooth vitality, aesthetics, and function. Indeed, reattachment of tooth fragment using a composite/adhesive is a simple technique to achieve excellent results in terms of aesthetic and function.

The Understanding of Vital Pulp Therapy in Permanent Teeth: A New Perspective

The indications of vital pulp therapy (VPT) are expanding, which cases are suitable for VPT, and how to improve the success rate of VPT is a problem that often bothers us. The main purpose of VPT is to eliminate pulpitis by promoting the formation of reparative dentin or calcium bridge, so that it can continue to perform various physiological functions, and finally achieve the purpose of preserving pulp vitality and long-term preservation of affected teeth. Pulp capping and pulpotomy are the most common methods for VPT. The research field of VPT has attracted the attention of many scholars, who have studied it from many aspects (such as indications, material selection, operation requirements, and long-term prognosis). This article reviews the recent advances in the techniques of VPT in permanent teeth.

Push-Out Bond Strength of Calcium Silicate-Based Cements in the Presence or Absence of a Smear Layer

Objectives. Variations between the material compositions and the presence of a smear layer on the dentin surface may influence the bond strength of the material, thus this study evaluated the push-out bond strength of different calcium silicate materials to root dentin in the presence or absence of smear layer. Materials and Methods. The palatal canal of sixty maxillary first premolars were prepared and divided into three groups according to the materials to be used: ProRoot WMTA, Biodentine, and TotalFill FS. Each group was then divided into two subgroups; with and without a smear layer. Roots were sectioned into three slices and filled with the tested materials. Push-out bond strength of materials was measured by universal machine. Results. Bond strength of Biodentine was significantly higher than the MTA and TotalFill FS in the presence or absence of smear layer. Overall, removing the smear layer reduced the bond strength of the three materials. The reduction was significant for MTA and TotalFill FS but not for Biodentine. Conclusions. Biodentine demonstrated the highest bond strength to radicular dentin followed by MTA, and then TotalFill FS. Overall, removal of the smear layer from dentin surface reduced the bond strength of the calcium silicate root repair materials.

Outcome of vital pulp therapy in deeply carious molars affected with molar incisor hypomineralisation (MIH) defects: a randomized clinical trial

PURPOSE

To evaluate clinical and radiographic outcomes of vital pulp therapy (VPT) in deeply carious young permanent first molars (PFM) affected with MIH over 24 months.

METHODS

In this prospective randomized clinical trial, n = 50 children with deeply carious young PFM affected with MIH, and diagnosed with reversible or irreversible pulpitis were randomized into 2 groups: indirect pulp treatment (IPT) and pulpotomy (partial or complete). Teeth were followed up clinically and radiographically for 24 months. Statistical analysis was done using Chi-square test; P ≤ 0.05 was considered significant.

RESULTS

A total of  n = 50 teeth/patients (n = 26 females (52%), n = 24 males (48%)) were included, and 14 upper and 36 lower PFM were treated. Mean age was 11 ± 3.2 years. Clinical and radiographic success rates were: 96% for IPT, 90% for PP and 82% for CP (and 86% for both types of pulpotomy combined) over 24 months. There were no significant differences in outcomes between treatment groups. Age, gender and tooth location/jaw were found to have no statistically significant difference in outcomes among treatment groups, nor did pulpal status or root maturity, regardless of type of VPT and follow up period.

CONCLUSIONS

VPT is a valid treatment option in deeply carious young permanent first molars affected with MIH over 24 months. IPT had a higher clinical and radiographic success rate (96%) than partial or cervical pulpotomy (total 86%), but the difference was not statistically significant. Future randomized clinical trials on VPT for teeth affected with MIH are recommended with larger sample size and longer follow-up.

Identification of Immune-Related lncRNA Regulatory Network in Pulpitis

Background. Long noncoding RNAs (lncRNAs) are emerging as critical regulators of various biological processes, including immune regulation. Methods. Due to the critical significance of immunological responses in the development and progression of pulpitis, we used an integrated algorithm to identify immune-related lncRNAs and then examined the lncRNA-immunity regulation network in pulpitis. Before identifying immune-related lncRNAs, the data from GEO datasets were precleaned. ConsensusClusterPlus was used to differentiate immune-related pulpitis subgroups. Enrichment analysis using GO and MSigDB databases was employed to determine the differences in molecular function, cellular component, and biological process between the two pulpitis subtypes. Results. An integrated algorithm was designed to filtrate immune-related lncRNAs accurately. 790 immune-related lncRNAs were found in 17 immunological categories, with 38 of them perturbated in pulpitis. The Cytoscape software was used to visualize the relationship between representative immune regulatory pathways and immune-related lncRNAs. Two immune-related pulpitis subtypes were discovered using differentially expressed immune-related lncRNAs. Subtype 2 has a stronger association with immune-related pathways than subtype 1 does. Conclusions. Our study identified many immune-related lncRNAs and investigated potential lncRNA regulation networks; meanwhile, the molecular subtypes of pulpitis were identified, all of which will be relevant for further research into inflammatory and immunological processes in pulpitis.

The micro‐shear bond strength of new endodontic tricalcium silicate‐based putty: An in vitro study

This study aimed to compare in vitro micro-shear bond strength (μSBS) of three different endodontic tricalcium silicate-based materials in contact with a bulk-fill resin-based composite. Thirty cylindrical resin blocks with a hole in the centre (2 mm in depth and 4 mm in diameter) were manufactured with a 3D printer and divided into three groups (n = 10), depending on the calcium silicate cement used: light curing TheraCal LC (Bisco, Schaumburg, IL, USA), liquid-powder NeoMTA 2 (NuSmile Avalon Biomed, Bradenton, FL, USA) and putty NeoPutty (NuSmile, Houston, TX, USA). Each sample was stored for 24 h at 37°C and 100% humidity. Then, after adhesive placement, the restorative material Filtek bulk-fill (3 M ESPE, St. Paul, MN, USA) was placed over the capping material using cylindrical plastic capsules (2 mm height and 2 mm) and polymerised for 20 s. Specimens were then tested in a universal testing machine for the compression load resulting in the μSBS. The data were compared with the one-way ANOVA (Welch) and the Tamhane test. The mean value was significantly higher in the TheraCal LC group than in the other two groups (p < 0.05). There was no significant difference between NeoMTA 2 and NeoPutty groups (p > 0.05). The majority of failure modes for all groups were cohesive within biomaterial. Using TheraCal LC in the pulp capping procedure can result in higher bond strength values to the tested bulk-fill resin-based composite than NeoMTA 2 and NeoPutty.

The Influence of New Bioactive Materials on Pulp–Dentin Complex Regeneration in the Assessment of Cone Bone Computed Tomography (CBCT) and Computed Micro-Tomography (Micro-CT) from a Present and Future Perspective—A Systematic Review

The present paper is the first article providing a systematic literature review on the visualization of tertiary dentin influenced by modern bioactive materials in CBCT and micro-CT. Six database searches of studies on tertiary dentin visualization using CBCT produced 622 records in total, and the search of the studies on tertiary dentin using micro-CT produced 502 records in total. The results were thoroughly selected considering the inclusion criteria, and five research papers using CBCT and nine research papers using micro-CT for visualization of tertiary dentin were eventually qualified for the analysis. All the non-randomized and randomized studies presented good and high levels of quality evidence, respectively. Among the bioactive materials used, the most frequently analysed were: MTA, Biodentine dentin matrix hydrogel, Pro Root MTA, and EndoSequence root repair material. The highest thickness of the tertiary dentin was achieved after the use of MTA material in both imaging techniques. The remaining parameters had different results, taking into account the CBCT and micro-CT analysis. The possibilities of the qualitative and quantitative assessment of the particular parameters of tertiary dentin using CBCT and micro-CT techniques were presented and analysed. CBCT and micro-CT analyses can be useful in the assessment of tertiary dentin formed beneath the bioactive material applied during vital pulp treatment. The research argues that the presented results differ depending on the material applied to the pulp, the study duration (4–6 weeks), difference in teeth, species (rats, human), as well as the applied technique and differences in computer software used for the analysis.

Outcome of full pulpotomy in mature permanent molars using 3 calcium silicate-based materials: A parallel, double blind, randomized controlled trial

AIM

The aim of the study was to compare the outcome of full pulpotomy using 2 calcium silicate-based materials compared with mineral trioxide aggregate (MTA) in symptomatic mature permanent teeth with carious pulp exposure.

METHODOLOGY

This study was designed as a parallel, double blind, randomized controlled trial where symptomatic mature permanent teeth with carious pulp exposure meeting the inclusion criteria were randomly treated with full pulpotomy using one of 3 calcium silicate-based materials (ProRoot MTA, Biodentine and TotalFill). Full pulpotomy was performed, and haemostasis was achieved via a cotton pellet moistened with 2.5% NaOCl. A 3-mm layer of the calcium silicate-based material was randomly placed as the pulpotomy agent through a block randomization process followed by a resin-based composite restoration. Postoperative periapical radiograph was taken. Clinical and radiographic evaluation were completed after 6 months and 1 year. The patient and evaluator were blinded to the type of materials used. Pain levels were scored preoperatively and 7 days after treatment. Effect of potential prognosis factors including gender, age, diagnosis, bleeding time and type of caries were also analysed.

RESULTS

One hundred and sixty-four teeth in 146 patients received full pulpotomy and were randomly assigned to either the tested or control material through block randomization technique (50 MTA, 50 Biodentine and 64 TotalFill). The age ranged from 10 to 70 years. The diagnosis was irreversible pulpitis in 112 teeth (72%) and reversible pulpitis in 28 teeth (28%). The majority of patients presented with severe pain, during the first week 96.9% reported complete relief of pain or mild pain. Four cases had immediate failure. At 6 months the overall success rate was 92.2%, over 1 year 156/164 teeth attended follow-up with 12 failures (2 restorative failures and 10 endodontic failures), the overall success of pulpotomy at 1 year was 92.3% (144/156); 91.8% in MTA, 93.3% in Biodentine and 91.9% in TotalFill with no significant difference amongst the groups and no side effects observed. No significant association was evident between outcome and the investigated variables.

CONCLUSIONS

The 1-year success rate of full pulpotomy did not differ significantly between Biodentine pulpotomy, TotalFill pulpotomy, and MTA pulpotomy. The study was registered with clinical trials; registration number (NCT04345263).

Comparative evaluation of complete and partial pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis: A randomized clinical trial

AIM

The study aimed to compare the outcome of complete pulpotomy (CP) and partial pulpotomy (PP) techniques when utilised for the management of mature permanent teeth with carious pulpal exposure and symptomatic irreversible pulpitis (SIP).

METHODOLOGY

The study protocol was registered with ClinicalTrials.gov (NCT04397315). One hundred and six permanent mandibular molars with carious pulpal exposure and clinical diagnosis of SIP with periapical index ≤2, from patients aged between 18 and 40 years were randomly allocated in equal proportion to either CP or PP group. Allocated procedures were performed using standardised protocols. The allocated procedure was abandoned in cases where pulpal bleeding could not be controlled within 6 min using cotton pellets soaked in 3% sodium hypochlorite. MTA was used as a pulpotomy agent and teeth were restored using a base of glass ionomer followed by composite restoration. The pain was recorded by the patient preoperatively before administration of local anaesthesia and postoperatively every 24 h for 1 week using visual analogue scale. Success was analysed at 12 months based on clinical and radiographic examination. Mann-Whitney U test was used to compare age, pain scores and mean analgesic consumption between the groups. Categorical data were analysed using chi-square test. Fisher's exact test was used to assess the clinical and radiographic success and incidence of pain. Kaplan-Meier analysis was used to assess the survival of teeth. A p-value <.05 was considered as statistically significant.

RESULTS

One hundred and one patients were analysed at follow up. Higher success was observed in CP (89.8%) in comparison to PP group (80.8%), but the difference was non-significant statistically (p = .202). Although no significant difference was observed in pain incidence between the groups at 24 h (p = .496), a significant difference in pain intensities was observed between groups at all the tested time intervals, with lower values reported in CP group (p < .05).

CONCLUSIONS

Both CP and PP resulted in favourable outcomes in the management of cariously exposed permanent teeth with signs indicative of SIP. Given the more conservative nature of PP, it may be attempted first before proceeding to CP in such cases.

[Evaluation of bioceramic putty repairmen iRoot and mineral trioxide aggregate in mature permanent teeth pulpotomy]

OBJECTIVE

To evaluate the clinical characteristics and effectiveness of pulpotomy in mature permanent teeth with bioceramic putty repairmen iRoot and mineral trioxide aggregate (MTA).

METHODS

Pulpotomy was performed on mature permanent premolars and molars with carious exposures at the Department of General Dentistry of Peking University School and Hospital of Stomatology, from November 2017 to September 2019. The patients were randomly divided into 2 groups, Group iRoot (n=22) and Group MTA (n=21). In Group iRoot, bioceramic putty repairmen iRoot was used as pulp capping agent, while in Group MTA, mineral trioxide aggregate was used as pulp capping agent. All the patients had signed informed consent forms. The clinical efficacy was evaluated by clinical examinations (temperature and electrical activity test) and imaging examinations 3, 6, and 12 months after surgery. Blinding was used for the patients and evaluators, but due to the obvious differences in the properties of the two pulp capping agents, the blinding method was not used for the treatment provider (the attending physician).

RESULTS

There was no significant difference in gender, average age, dentition and tooth position distribution between the two groups (P>0.05). In the study, 7 cases were lost to follow-up 12 months after operation (4 cases in Group iRoot, and 3 cases in Group MTA). One case in each of the two groups had transient sensitivity at the end of the 3-month follow-up, and the pulp vitality was normal at the end of the 6-month follow-up. One case in Group iRoot showed sensitivity at the end of the 12-month follow-up. The success rates of the two groups at the end of 12-month follow-up were 100%, and the cure rates were 94.4% (Group iRoot) and 100% (Group MTA), respectively, and the difference was not statistically significant (P>0.05). No cases in Group iRoot had obvious crown discoloration, while 3 cases in Group MTA had.

CONCLUSION

The clinical characteristics and effectiveness of pulpotomy in mature permanent teeth with bioceramic putty repairmen iRoot were similar with MTA. Bioceramic putty repairmen iRoot is an acceptable material when used in pulpotomy of mature permanent teeth. Because it is not easy to cause tooth discoloration after treatment and is convenient to operate, bioceramic putty repairmen iRoot has a better clinical application prospect.

Present status and future directions - Vital pulp treatment and pulp preservation strategies

Therapeutic strategies focussed on the pulp preservation, are important when managing vital teeth with deep caries and an exposed pulp. These vital pulp treatments (VPTs); however, are not new, with indirect and direct pulp capping procedures being described as a therapy for carious teeth for over a century. As a result of unpredictable outcomes, the traditional indications for VPT particularly when the pulp was exposed were limited to the treatment of immature teeth with incomplete root formation. Over the last 20 years, the advent of regenerative endodontics and the promotion of biologically based therapies aimed at reducing intervention have reinvigorated VPT with new waves of basic science and clinical research indicating a role for VPT not only in mature cariously affected teeth, but also in teeth with signs and symptoms indicative of irreversible pulpitis. Driven by new materials such as hydraulic calcium silicate cements, a better understanding of pulpal immunity and biology as well and improved tissue handling, VPT has been at the forefront of treatment recommendations made by global Cariology and Endodontic organizations. Care must be exercised, however, as key gaps in scientific knowledge remain alongside severe limitations in educational dissemination amongst dentists. Although research has highlighted that carious injury to the dentine–pulp complex stimulates a wide range of responses and that the interaction between infection, inflammation and repair will eventually impact on the outcome of pulpitis, our ability to accurately and objectively diagnose the true inflammatory state of the pulp remains poor. An overreliance on symptoms leaves clinicians with subjective, crude diagnostic tools by which to inform treatment planning and decision‐making, which results in large variations in the treatments offered to patients. Not only is there an urgent need to develop preoperative and intraoperative diagnostic tools, but there is also a paucity of the high‐quality comparative evidence required to answer the most important questions and justify treatment options. The aim of this review was to consider the current status of VPT and to discuss the principle problems that are hindering clinical acceptance of these techniques. Potential solutions and opportunities are offered to suggest ways that VPT may become a more consistently prescribed evidenced‐based treatment in dental practice.

Evaluation of complete pulpotomy with Biodentine® on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis: 12 months follow-up

INTRODUCTION

Complete pulpotomy is the removal of the coronal portion of a vital pulp and is a means of preserving the vitality of the remaining root portion. The objective of this study was to evaluate the 12-month success rate of complete pulpotomy with Biodentine® on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis.

MATERIALS AND METHODS

A total of 68 molars diagnosed with symptomatic irreversible pulpitis in 68 patients aged 20 years and older were included in this study. The exclusion criteria were intraoperative clinical signs of pulp necrosis on the molar to be treated such as no bleeding, or uncontrollable pulp hemorrhage (more than 5 min of hemostasis) on at least one canal. A complete pulpotomy with Biodentine® was performed on molars with symptomatic irreversible pulpitis by the same operator and with the same protocol. At 12-month post-operative follow-up was conducted to evaluate clinical and radiological success.

RESULTS

A total of 66 patients received complete pulpotomy. Fifty-two could be examined at 12 months postoperatively. Clinical and radiological analysis at 12 months postoperatively revealed a success rate of 87% (45/52 molars) and a failure rate of 13% (7/52 molars). There was a relationship between age, tooth type, pre-operative periapical condition and treatment success with P<0.05.

CONCLUSION

Compliance with the indications and protocol for complete pulpotomy with Biodentine® on mature permanent molars with symptomatic irreversible pulpitis gives positive results at 12 month follow-up.

Effect of Er:YAG Laser and Reduced Time of Acid Etching on Bond Strength of Self-adhesive Resin Cement to MTA and Biodentine

Introduction: Considering the recent trend to use mineral trioxide aggregate (MTA) and Biodentine and resin cements, more conservative approaches concurrent with adequate bond strength have always been requested. The present study aimed to evaluate the effect of pretreatment with Er:YAG laser etching versus acid-etching for 5 and 15 seconds on the micro shear bond strength of self-adhesive resin cement (SRC) to MTA and Biodentine. Materials and Methods: Forty-eight samples of each cement (MTA and Biodentine) were prepared and distributed into four groups based on surface pretreatment: 1) control, no treatment; 2) Er:YAG laser etching with energy of 60 mJ; 3) 5-second acid-etching; 4) 15-second acid-etching. All specimens were cemented using SRC. Microshear bond strengths were tested following 24-hour water storage. Debonded specimens were examined and surface topography was assessed using an atomic force machine (AFM). Data analysis was performed using the two-way ANOVA and Tukey multiple comparisons test. Results: The three testing groups of laser etch and 5-s and 15-s acid-etch demonstrated a significantly higher SBS than the control group (P < 0.05) with negligible differences among them (P > 0.05). Furthermore, Biodentine showed better adhesive bonding than MTA in all groups. Conclusion: Laser etching of 60 mJ and 5-s acid-etching were as beneficial as 15-s acid-etching in terms of bond strength of SRC to MTA and Bodentine.

Response to Pulp Sensibility Tests after Full Pulpotomy in Permanent Mandibular Teeth with Symptomatic Irreversible Pulpitis: A Retrospective Data Analysis

INTRODUCTION

This retrospective study analyzed the 12-month pulp sensibility (cold and electric) test response after mineral trioxide aggregate (MTA) full pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis.

METHODS

The records of 120 subjects from 3 completed and 1 ongoing clinical study on MTA full pulpotomy were retrieved. Ninety-six first and second mandibular molar teeth with a diagnosis of symptomatic irreversible pulpitis that underwent a single-visit MTA full pulpotomy and had completed a 12-month clinical, radiographic, and pulp sensibility (cold and electric) test follow-up were included. The data were analyzed using the Fisher exact test, the Pearson chi-square test, and the McNemar test. The significance level was predetermined at P < .05.

RESULTS

A higher percentage of teeth (94.7%) responded to the electric pulp test in comparison with the cold test (13.5%) (P < .05). Sex-based responses to the electric pulp test (P > .05) and the cold test were similar (P > .05). The age-based response was similar for the electric pulp test (P > .05) but was significant for the cold test (P < .05). The tooth quadrant (left and right), the tooth (mandibular first and second molar), and the location of restoration (proximal or occlusal) did not influence the response of either the electric pulp test (P > .05) or the cold test (P > .05). At the 1-year follow-up, all the teeth that were classified as clinically and radiographically successful responded to the electric pulp test; however, only 13 teeth responded to the cold test (P = .00).

CONCLUSIONS

The majority (94.7%) of the teeth that underwent MTA full pulpotomy responded to the electric pulp test at a 1-year time interval.

Vital Pulp Therapy in Aesthetic Zone-Identifying the Biomaterial That Reduces the Risk of Tooth Discolouration

Calcium silicate-based cements are biocompatible materials for vital pulp therapy. However, they discolour the tooth tissue, which is important for the aesthetics of the anterior teeth. The aim of this study was to investigate the effect of calcium silicate-based cements on tooth discolouration. The study included 70 extracted bovine incisors. The crown of the tooth was cut off from the root, 2 mm below the cement-enamel junction. The pulp tissue was removed via a cervical cut with a barbed broach. The teeth were randomly divided into five experimental, one positive, and one negative control groups. The evaluated materials included Biodentine, Ortho MTA, Retro MTA, MTA Plus, MTA Repair HP, and in the positive group, ProRoot MTA. A VITA Easyshade Compact 5.0 spectrophotometer was used before the application, after 1 week, 1 month, 3 months, and 6 months. The significance levels were set at p < 0.05. All materials significantly changed the teeth colour (p < 0.05). However, Ortho MTA, ProRoot MTA, MTA Plus, and Biodentine (ΔE > 6) caused maximum colour change after 6 months. While the ProRoot MTA, Ortho MTA, and MTA Plus caused grey discolouration, Biodentine darkened the shade of the base colour. Thus, Retro MTA and MTA Repair HP can be safely used in the aesthetic dentition zone. According to these clinical results, the possibility of using Biodentine, due to its lack of gray discoloration, can be considered.

4-Year Follow-up of Full Pulpotomy in Symptomatic Mature Permanent Teeth with Carious Pulp Exposure Using a Stainproof Calcium Silicate-based Material

INTRODUCTION

This study aimed to assess the pulpal and restorative outcome of full pulpotomy in symptomatic mature permanent teeth with carious pulp exposure over 4 years.

METHODS

Under local anesthesia, full pulpotomy was performed using the aseptic technique and a stainproof calcium silicate-based material (NeoMTA Plus; Avalon Biomed Inc, Bradenton, FL). The pain level was scored preoperatively and at 1 week posttreatment. Clinical and radiographic evaluation was performed at 6 months, 1, 2, and 4 years. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to analyze the data. Failed cases were classified as endodontic or restorative failure.

RESULTS

Full pulpotomy was completed in 109 teeth in 90 patients with an age range of 14-60 years (mean = 25 years). The study sample available for follow-up was 100 teeth in 86 patients with a recall rate above 90%. Preoperative pulp diagnosis was reversible pulpitis in 39 teeth and irreversible pulpitis in 61 teeth. The cumulative survival rates of pulpotomy were generally high (ie, 98%, 97.4%, 93%, and 83.8% at 6 months and 1, 2, and 4 years, respectively). The overall mean survival time of pulpotomy was 3.89 years (95% confidence interval, 3.84-3.95). The mean survival time was significantly higher for patients aged ≤25 years. However, in the multivariate analysis, the only significant predictor of pulpotomy failure was severe preoperative pain. Over the 4 years, 23 cases failed; only 10 of 23 failures were classified as endodontic failure, and the success of pulpotomy can be assumed to be 90%.

CONCLUSIONS

Full pulpotomy in cariously exposed pulp of mature permanent teeth sustained a high success rate over 4 years. The coronal seal is crucial for long-term survival.