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

Abstract

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.

Diagnostic and Prognostic Predictors for the Success of Pulpotomy in Permanent Mature Posterior Teeth with Moderate to Severe Pulpitis: A Scoping Review

“…Anta et al [51] limited the time to hemostasis to 5 min but found that the bleeding stoppage time did not influence the outcome of treatment. Aldeen et al [35] limited bleeding time to 6 min and observed that all failures occurred in the 4-6-min bleeding time category, but this was not statistically significant. According to Baranwal's findings, achieving hemostasis typically required 8-10 min in the majority of cases.…”

“…However, molar RCT is expensive, technique-sensitive, and time-consuming, as it often requires multiple appointments. One advantage of a partial or complete pulpotomy is that it can be completed in a single appointment, which includes the placement of a definitive restoration [34,35]. The procedure is also less technically difficult-with fewer iatrogenic complications possible-less costly, and less timeconsuming to perform than RCT [5,36].…”

“…Asgary's papers excluded any patients with active systemic disease, and physical or mental disability, though these parameters were not defined [5,29,57]. Some papers only included patients who had a non-contributory medical history, though this was also not defined [46,49], while other papers failed to mention the medical status altogether [15,35,50,53]. Most papers mentioned only including healthy patients [36,41,47,48,51,52].…”

“…Extremely deep caries penetrates the entire thickness of the dentine, being continuous with the pulp space radiographically [28]. Aldeen et al [35] designed their study to determine how the activity level/speed of progression (determined by the color and surface texture after removal of peripheral caries) and depth (deep or extremely deep) of caries affected the outcome of partial pulpotomy with MTA. They found that the degree of caries activity did not significantly affect the outcome.…”

“…Multiple studies excluded teeth that were necrotic or "partially necrotic" on exposure, defined as non-bleeding or insufficient bleeding, respectively [18,35,46,47,49,[51][52][53]55,58]. Other studies excluded teeth that had no pulp exposure after caries removal, yet the teeth had signs and symptoms of moderate to severe pulpitis [15,18,46,47,49,50,52,53,57,58].…”