Abstract
In this randomized controlled single-center clinical trial on 96 adult patients with parallel experimental groups (n = 48), the effects of washing a dentin/pulp wound in non-symptomatic teeth with extremely deep caries and pulpal exposure were compared between a 2.5% sodium hypochlorite (NaOCl) solution and a chemically-inert physiological saline control solution. After the allocated wound lavage, the pulps were capped with a mineral trioxide aggregate, covered by a glass-ionomer/resin liner, and the teeth were immediately restored with a resin-bonded-composite. In this first report, the early events were analyzed: postoperative discomfort (on an NRS-11 scale) at day-3 and -7 after intervention, and the occurrence of unbearable pain causing patients to contact the principal investigator to perform a root canal treatment (pulpectomy) during the first three months. The NaOCl solution caused a highly significant reduction in post-operative discomfort (p = 0.0010 day 3; p = 0.0007 day 7) and early painful failures (p = 0.0008) compared with the control. These novel findings highlight the importance of infection control in teeth with extremely deep carious lesions. Based on these observations, the use of an NaOCl solution to wash the exposed dentin/pulp wound in the vital pulp treatment is highly recommended in order to reduce pain and early failure.
Highlights
The maintenance of pulp vitality in teeth affected by deep caries is controversial, with restorative dentists and endodontists offering diverging opinions [1,2,3]
Systematic reviews analyzing approaches to vital pulp treatment (VPT) have highlighted that primary studies focus on the invasiveness of the operative procedure, i.e., indirect or direct pulp capping versus partial or full pulpotomy, as well as the type of capping material that is placed [4,5]
Pulp exposure should be avoided in asymptomatic cases, with consensus documents suggesting the removal of all deep caries and resulting pulp exposure to be overtreatment [1]
Summary
The maintenance of pulp vitality in teeth affected by deep caries is controversial, with restorative dentists and endodontists offering diverging opinions [1,2,3]. A randomized controlled trial reported unbearable postoperative pain after VPT procedures to be common, occurring in 7–8% of cases without pulp exposure and 51–63% of cases with pulpal exposure [8], other randomized clinical trials have shown considerably less postoperative pain, with severe pain accounting for less than 10% of pulp capping cases [9] These results highlight that unbearable pain is possible after management of carious-exposure with VPT, it is not clear how commonly it occurs; it does appear to be more likely than after more invasive treatment strategies such as a full pulpectomy [10]
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