Comparative evaluation of platelet-rich fibrin, mineral trioxide aggregate, and calcium hydroxide as pulpotomy agents in permanent molars with irreversible pulpitis: A randomized controlled trial

Abstract

Background:Pulpotomy has been proposed as an alternative for the management of irreversible pulpitis in permanent molars with closed apices.Aim:To compare the performances of calcium hydroxide (CH), mineral trioxide aggregate (MTA), and platelet-rich fibrin (PRF) as pulpotomy agents in mature permanent molars with irreversible pulpitis.Materials and Methods:Fifty-four permanent mandibular molars with carious exposure and symptoms of irreversible pulpitis were randomly allocated to three groups, and full pulpotomy was performed using CH, MTA, or PRF as pulpotomy agents. Pain intensity was recorded using numeric rating scale score at baseline, 24 h, 7 days, 6 months, and 1 year. Clinical and radiographic assessments were done at 6 months and 1 year.Statistical Analysis:Kruskal–Wallis test and Friedman test were used for intergroup and intragroup comparison of pain scores, respectively. The radiographic outcomes between the three study arms were compared using Chi-square test.Results:Clinical success rate was 94.4% at 7 days, which dropped to 85.4% at 12 months. All three agents were equally effective in providing pain relief at all the intervals tested, with no significant difference between them (P > 0.05 at all intervals). However, at 6 months and 12 months, 26.2% and 52.4% teeth depicted slight widening of periodontal ligament space. No significant difference was observed between the radiographic success rates observed with the three groups (P = 0.135 at 6 months, 0.717 at 12 months).Conclusion:Pulpotomy exhibited a high clinical success rate in mature molars with irreversible pulpitis and selection of biomaterial did not affect its outcome.

Vital Pulp Therapy in Permanent Mature Posterior Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review of Treatment Outcomes

“…Articles have reported one-year outcomes [2,5,34,36,37,41], two-year outcomes [3,6,7], and 3-to-5-year outcomes [4,6,8,35] (Tables 3 and 4). At one-year, high clinical success rates ranging from 92 to 100%, and high radiographic success rates ranging from 92 to 98%, have been reported for FP using either MTA, CEM or Biodentine™ [2,5,36,37].…”

“…Nine reviewed articles followed a randomized controlled trial methodology. Using the Cochrane Collaboration Rob 2 tool (Supplemental Tables S5 and S6), the final risk of bias for this article was assessed as 'low' for only one [8], as 'fair' for seven [2][3][4][5][6][7]41], and as 'high' for one [34]. Of the three reviewed prospective cohort studies assessed with the Cochrane Collaboration ROBINS I tool (Supplemental Table S7), the risk of bias was assessed as 'low' for two [36,37] and as 'serious' for one [35].…”

“…When the same three studies were assessed with the Newcastle-Ottawa Scale (Supplemental Table S8), one study each scored four [35], five [36] and six [37] out of a maximum of nine stars. The results of the two articles assessed as having 'high' [34] or 'serious' [35] risk of bias were considered secondary to those of the remaining 10 articles.…”

“…Supported by the current understanding of the capacity of the inflamed pulp tissue to recover and regenerate [1,9], FP and PP using HCSCs have been applied in permanent mature teeth to treat deep carious lesions with exposed pulps, yielding good outcomes [26,[31][32][33]. The application of FP has also been extended to permanent mature teeth with symptomatic irreversible pulpitis [2][3][4][5][6][34][35][36][37][38], suggesting that also those teeth, traditionally considered beyond pulpal repair, can be predictably treated by the removal of the inflamed and affected tissue, resulting in maintained vitality of the remaining pulp and periapical health [2][3][4][5][6][7][8][34][35][36][37][38][39][40][41].…”

To compare mineral trioxide aggregate, platelet-rich fibrin, and calcium hydroxide in teeth with irreversible pulpitis: A clinical study

“…However, nonsignificant results were found between the groups. Kumar et al [ 8 ] in their study included 54 molar teeth, which were divided into three groups of 18 each. Group I teeth were restored with CH, Group II with MTA, and Group III with PRF as pulpotomy agents, which revealed nonsignificant difference in pain score recorded regularly on recalled visits.…”