Pulpotomy Versus Root Canal Therapy: A Randomized Multicenter Noninferiority Trial

Abstract

Introduction The aims were to compare postoperative pain relief as well as clinical and radiographic success rates of root canal therapy (RCT) versus pulpotomy with calcium-enriched mixture (CEM) cement or MTA in permanent molar teeth with irreversible pulpitis. Methods A total of 615 patients met the inclusion criteria. The patients were randomly allocated into three arms including one-visit RCT (ORCT: n = 202) as the reference treatment, pulpotomy with CEM (PCEM: n = 205), and pulpotomy with MTA (PMTA: n = 208), as two alternatives of treatment. A numeric rating scale questionnaire was used by patients to record pain intensity (PI). Success was assessed clinically and radiographically 6 and 12 months after treatment. The data were analyzed statistically using analysis of variance, Kaplan-Meier, analysis of covariance, chi-square, Cohen kappa, and t tests. Results Despite no statistically significant difference between the mean PI at baseline, the changes during first week showed significant difference in the three study arms ( p < 0.001). In this regard, patients in the ORCT arm suffered significantly more pain than those in pulpotomy arms ( p < 0.001); such a difference was also observed with percussion tests ( p < 0.001). Clinical success after 6 and 12 months did not show a statistical difference between the three arms; but surprisingly, the radiographic success rates in the pulpotomy arms were significantly greater than the ORCT arm ( p < 0.001). Conclusions Pulpotomy is a realistic alternative treatment option to RCT in human permanent mature molars with irreversible pulpitis. PMTA and PCEM had favorable success rates at the 1-year follow-up. The clinical ease of pulpotomy and the promising reduction in cost of CEM are factors that advocate significant weight to this treatment dilemma at least for developing nations.