Assessment of Mineral Trioxide Aggregate pulpotomy in mature permanent teeth with carious exposures.

Abstract

To assess the outcome of mineral trioxide aggregate (MTA) complete pulpotomy in permanent teeth with carious exposures. Fifty-two permanent molar teeth with fully developed roots and vital pulps in 43 patients aged 11-51years were included. Preoperative pulpal and periapical diagnosis was established. After informed consent, each tooth was anaesthetized, isolated with dental dam and disinfected with 5% NaOCl before caries excavation; subsequently, a full pulpotomy was performed. Haemostasis was achieved, and Grey MTA (Angelus, Londrina, Brazil) was placed as the pulpotomy agent; a moist cotton pellet was placed, and the tooth was temporized with the intermediate restorative material (IRM). Permanent restorations were placed 1week later if the tooth was asymptomatic, and a postoperative periapical radiograph was taken. Clinical and radiographic evaluation was completed at 3months, 6months, 1year and 3years postoperatively. Clinical signs and symptoms suggestive of irreversible pulpitis were established in 44/52 teeth, and periapical rarefaction was present in 14 teeth. Immediate failure occurred in one tooth. The recall rate ranged from 92% at 3months to 80.3% at 3years, with an overall 100% clinical and 97.5% radiographic success during the first year, and 92.7% success at 3years. All cases with periapical rarefaction were associated with improvement in the periapical index (PAI) score. Two cases had new periapical rarefaction associated with dislodgment of the permanent restoration. A hard tissue barrier was detected radiographically in 5 cases and canal narrowing in 7 cases. MTA full pulpotomy was a successful treatment option for cariously exposed pulps in mature permanent molar teeth.