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

Abstract

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.

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

“…In our study, those patients who intraoperatively showed signs indicative of necrosis (partial/total necrosis and absence of bleeding) and cases in which bleeding could not be stopped (within 10 min) were excluded from the study altogether to ensure appropriate case selection for VPT. The use of the results of Ramani et al (2022) or Cushley et al (2019) would have influenced the sample size calculation; however, at the time of planning, Elmsmari et al (2019) was the most appropriate study to use for sample size calculation being a systematic review with meta-analysis.…”

“…A growing body of histological and clinical evidence suggests that the cariously exposed pulp even if associated with signs and symptoms indicative of irreversible pulpitis may not actually be beyond conservative treatment (Ramani et al, 2022; Ricucci et al, 2014). In response to the invasion of bacteria and release of their by‐products, the pulp has been shown to react in a graded manner that progresses gradually in an apical direction (Heyeraas & Berggreen, 1999).…”

“…Partial pulpotomy (PP) comprises removal of 2–3 mm of coronal pulp, whilst full pulpotomy (FP) involves complete removal of coronal pulp tissue till the level of the root canal orifices. The insights garnered from histological analysis explains the high success rate reported for partial and full pulpotomy in cariously exposed teeth diagnosed with irreversible pulpitis (Ramani et al, 2022; Taha & Khazali, 2017; Uesrichai et al, 2019).…”

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

“…Later, more scholars began to study related content [76,77]. For teeth with deep caries exposed pulp rather than irreversible pulpitis, partial pulpotomy is effective [38], while for teeth with irreversible pulpitis, total pulpotomy has a higher success rate [59,[78][79][80]. In 2021, a review analyzed the treatment results of total pulpotomy and partial pulpotomy in recent years.…”

Analgesic intake after pulpotomy and root canal treatment of permanent molars with carious exposure

“…The pulpotomy group had considerably reduced analgesic consumption, showing that the short-term goal of pain management was better attained with pulpotomy. This might be because pulpotomy ensures better clearance of infected and inflamed pulp, resulting in a faster recovery from pain 18 . In order to standardize the data and link analgesic usage to postoperative discomfort or pain change, just one type of painkiller was administered.…”