Vital Pulp Therapy in Permanent Teeth with Irreversible Pulpitis Caused by Caries: A Prospective Cohort Study

Abstract

Background: When a tooth is diagnosed with irreversible pulpitis, root canal therapy (RCT) is generally performed to completely remove pulp tissue, which might lead to a higher risk of loss of vascularity, and teeth being more prone to fracture. Vital pulp therapy (VPT) is a personalized method of treating irreversible pulpitis, which conforms to the trend of minimally invasive endodontics. The remaining vital pulp could promote the physiological development of the roots of young permanent teeth with incomplete apical foramen. However, clear guidelines for VPT indication are still missing. Objective: This prospective cohort study evaluated the outcomes of vital pulp therapy (VPT) using iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, BC, Canada) in permanent teeth of 6- to 20-year-old patients with irreversible pulpitis caused by caries and analyzed the preoperative factors affecting VPT prognosis. Methods: Fifty-nine permanent teeth in 59 patients with irreversible pulpitis caused by caries were treated with VPT using iRoot BP Plus. All patients received VPT under a standardized protocol. After informed consent, teeth were isolated with a dental dam, then operators performed VPT with iRoot BP Plus and restored the teeth with composite resin or stainless steel crown. Patients were postoperatively recalled after 3, 6 and 12 months and then recalled annually. Successful cases were defined as successful in both clinical and radiographic evaluations. A statistical analysis was performed using the Fisher exact test, and the level of significant difference was p < 0.05. Results: After 6–36 months of follow-up, a total of 57 teeth from 57 patients were accessible for evaluation. The mean age of subjects was 11.75 ± 3.81 years. The overall clinical and radiographic success rate of VPT was 91.2% (52/57). With an observation time of one year or more, the success rate was 90.5% (38/42). All the symptoms and physical examination findings showed no significant effect on VPT prognosis (p > 0.05) using a binary logistic regression model. Conclusions: Permanent teeth in 6- to 20-year-old patients diagnosed as irreversible pulpitis caused by caries can be successfully treated with VPT using iRoot BP Plus.

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

“…Compared with developed permanent teeth, the pulp tissue of young permanent teeth has the characteristics of rich blood supply and high cell composition, which makes its regeneration and repair ability stronger. Therefore, the remaining pulp after VPT can promote the physiological development of apical foramen of young permanent teeth [ 14 ].…”

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

“…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.…”

Identification of key module and hub genes in pulpitis using weighted gene co-expression network analysis

“…Additionally, pulp tissue from patients with clinically diagnosed irreversible pulpitis might not present severe inflammation pathologically [ 4 ]. Therefore, VPT could be applied to treat even irreversible pulpitis and reported a high successful rate [ 5 ]. Histopathological examination is required to determine whether the inflammation state is reversible [ 6 ].…”