Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: a randomized controlled trial

Abstract

Objective The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth. Materials and methods A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT ( n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal–Wallis. Results At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms ( p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences ( p = 0.544). Conclusion In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results. Clinical relevance Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.

Research Progress and Meta-analysis of Calcium Enriched Mixture for Vital Pulp Therapy

“…After reading the title and abstract of the literatures, 580 literatures were excluded. After reading the full text of the remaining 19 literatures, a total of 7 literatures met the inclusion and exclusion criteria of the study [10][11][12][13][14][15][16].…”

“…Five clinical trials [10][11][12][13]16] reported the postoperative clinical success rate, including 625 affected teeth, 305 in the experimental group and 320 in the control group. Heterogeneity test showed that there was no heterogeneity between studies (I 2 =0, P=0.99).…”

“…Five clinical trials [10][11][12][13]16] reported the success rate of postoperative imaging, including a total of 625 affected teeth, 305 in the experimental group and 320 in the control group. Heterogeneity test showed that there was no heterogeneity between studies (I 2 =0, P=0.99), and the fixed effect model combined with effect size was used for analysis.…”

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

“…These hydrophilic CSCs have demonstrated more consistent clinical success (85-100%) when used as the pulpotomy medicament in mature permanent teeth. 40,41,42,43,44,45,46,47 The contrast in clinical outcomes was especially stark when direct comparisons were made between CH and CSCs for VPT. 39,48,49 New-generation bioactive CSCs are not only dimensionally stable with excellent sealing abilities, but also have beneficial biocompatible, immunomodulatory and osteogenic properties.…”

“…Pulpotomy has traditionally not been part of the treatment considerations for mature permanent teeth diagnosed with irreversible pulpitis. However, there is now increasing evidence from retrospective studies, 54,55,56 prospective cohort studies 40,41,47,57,58,59,60 and randomised controlled trials, 39,42,43,44,45,46,61,62,63,64,65,66,67,68,69,70 showing high success rates for pulpotomy in treating mature permanent teeth with irreversible pulpitis or carious pulp exposures (online Supplementary Table 1). Systematic reviews, meta-analyses and recent umbrella reviews (Table 2) have also concluded that pulpotomy could be a prospective substitute to conventional RCTx in managing vital mature permanent teeth diagnosed with irreversible pulpitis or carious pulp exposure.…”