Outcomes of coronal pulpotomy on permanent first molars in children: a retrospective cohort study.

Abstract

To investigate the survival probability of permanent first molars (PFMs) after coronal pulpotomy (CP) using two outcome definitions: success-focused and functional survival-focused, and to identify factors influencing tooth survival. A retrospective cohort study reviewing records of children undergoing CP with calcium silicate-based cements (CSCs) on PFMs. Each CP-treated PFM was classified as success, uncertain, failure, or censored. Survival probability was analyzed using Kaplan-Meier estimators. Success-focused definition considered failures and uncertain outcomes as events, while functional survival-focused definition considered only failures as events. Prognostic factors were analyzed using Cox regression analysis. Seventy-seven CP-treated PFMs with a follow-up period of 6-111months. Using the success-focused definition (two failures and 12 uncertain outcomes as events), survival probabilities were 93.1% (95% CI 84.3-97.1%) at 12months, 78.7% (95% CI 65.6-87.3%) at 36months, and 74.9% (95% CI 59.5-89.0%) at 60-111months. However, with the functional survival-focused definition, survival probabilities were 100% at 12months and 96.6% (95% CI 86.9-99.1%) at 24-111months. In multivariable analysis, proximal lesions increased failure risk compared to occlusal lesions (HR 17.17, 95% CI 2.18-135.31, p < 0.01), and resin composite restorations had higher failure risk than stainless steel crowns (HR 13.97, 95% CI 1.49-130.69, p < 0.05). CP using CSCs shows long-term survival potential as an alternative treatment for cariously exposed PFMs in children. Proximal lesions and resin composite restoration could contribute to the lower survival, indicating the need for careful consideration of restoration options and lesion location during treatment planning.