Abstract
Vital pulp therapies have been used in primary teeth and immature permanent teeth. However, with the advent of new bioactive material, the paradigm is shifting toward permanent teeth with mature apices of roots. There are many prospective and retrospective studies, randomized controlled trials, and systematic reviews that report coronal pulpotomy with bioactive material in permanent teeth with pulpal pathosis proved to be as successful as root canal therapy (RCT). Coronal pulpotomy is cost-effective, not very technical demanding like root canal therapy and less time consuming for both the dentists and patients. This treatment can be offered to the patient as an alternative to endodontic therapy.The objective of this study is to review the literature related to the clinical outcome of coronal pulpotomy in permanent teeth with mature apex and having pulpal pathosis. This evidence-based review will facilitate clinical decision making in situations to choose coronal pulpotomy over root canal therapy in mature permanent teeth with irreversible pulpitis.
Highlights
BackgroundA pulpotomy is defined as “the removal of the coronal portion of the vital pulp as a mean of preserving the vitality of the remaining radicular portion” [1]
According to American Academy of Pediatric Dentistry (AAPD) guidelines “A pulpotomy is performed in a tooth with extensive caries without evidence of radicular pathology when caries removal results in a carious or mechanical pulp exposure” [2]
No difference was detected in success rates between pulpotomy and root canal treatment clinically at 6th and 12th months of follow-up, radiographically, the pulpotomy group performed significantly better than root canal treatment (P < 0.001) [11]
Summary
A pulpotomy is defined as “the removal of the coronal portion of the vital pulp as a mean of preserving the vitality of the remaining radicular portion” [1]. There are a number of studies on coronal pulpotomy showing the success rate comparable to root canal therapy in permanent teeth with pulpal diseases [10,11,12]. In another study done by Simon et al pulpotomy with MTA in permanent teeth was found to be highly successful (82% on two years) [23] In their prospective study on complete coronal pulpotomy using Biodentine in permanent teeth with mature apices and irreversible pulpal inflammation at one year follow-up Taha and Abdulkhader found a high clinical success rate was of up to 100% and radiographic success of up to 93.8% [24]. Results of all clinical studies and systematic reviews showed a favorable outcome of pulpotomy in mature permanent teeth with irreversible pulpitis at two or three years and five years of follow-up. MTA and CEM have been found exhibiting better success rates than calcium hydroxide due to biocompatibility and excellent sealing ability [37, 38]
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