Irreversible Pulpitis Research Articles

Literature review and case study: unveiling the complexities of mandibular second molar with three distal canals.

The occurrence of morphological deviations in root canal anatomy is challenging and can influence treatment outcomes. While mandibular second molars typically have 2 roots and 3 canals, a unique case emerged in a 23-year-old Indian male with a symptomatic permanent left mandibular second molar showing three distal, two mesial canals, and two roots. The tooth presented as non-mobile but tender on percussion. The patient was diagnosed with symptomatic irreversible pulpitis with symptomatic apical periodontitis. The presence of mid distal canal was radiographically and visually confirmed with the aid of limited FOV cone-beam computed tomography and the dental operating microscope. Successful nonsurgical root canal treatment with 6-month follow-up has been documented in this case report.

Pulpitis tendency in teeth with vital pulp restored with composite resins: a cross-sectional retrospective study

Background: This study evaluates pulpitis tendency in vital teeth restored with composite resin after at least one year, focusing on the effect of cavity depth and the use of a base material on pulp status. Methods: A retrospective analysis was conducted on 212 patients with one tooth restored by dental senior students. At the follow-up, periapical and bitewing radiographs, cold tests, percussion, and palpation were performed. Cavity depth was measured from bitewing radiographs, and the periapical index (PAI) was recorded. The restored teeth were compared with contralateral sound teeth to assess the impact of the resin on pulp tissue. Results: Composite resin restorations significantly affected pulp status compared to intact teeth (p=0.002). Five out of 212 teeth became necrotic, and four developed symptomatic irreversible pulpitis (SIP). Four necrotic cases occurred in cavities deeper than 3.60 mm, and all SIP cases were associated with cavities deeper than 3.10 mm. Cavity depth was a significant predictor of adverse pulpal outcomes. However, using calcium hydroxide as a base did not significantly affect pulp health. Conclusions: The study concludes that composite resin restorations, mainly in deep cavities, can negatively impact pulp vitality. Cavity depth is a key factor in the risk of pulp necrosis and SIP, while calcium hydroxide base did not reduce pulpitis incidence. Larger studies with longer follow-up periods are recommended to confirm these findings and explore potential protective factors.

Postobturation Pain of three Novel Calcium Silicate-based sealers with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis: prospective clinical trial

BackgroundBioceramic-based root canal sealers are increasingly important in root canal treatment because of their biocompatible properties. This study aimed to evaluate postobturation pain incidence and intensity after root canal obturation with NeoSealer Flo, MTA-Bioseal, and GuttaFlow bioseal calcium silicate-based sealers and AH Plus epoxy resin-based sealer in patients with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis.MethodsA total of 120 participants with single-rooted teeth were included and randomly divided into four groups according to the root canal sealer used (n = 30). The patients were subsequently categorised based on the pulp vitality (vital or nonvital) in each group (n = 15) and all teeth were obturated in a single-visit. The postobturation pain scores were recorded on a visual analogue scale (VAS) at 6 h, 24 h, 48 h, 72 h, 7 d and 30 d. Moreover, analgesic intake was also noted at 24 h and 48 h. The Mann–Whitney U test, Kruskal‒Wallis H test, Friedman test, and Spearman’s correlation test were used, and a p value < 0.05 was considered significant.ResultsVAS scores were highest for the 6 h > 24 h > 48 h ≈ 72 h ≈ 7 d ≈ 30 d time intervals for both pulp status in each root canal sealer. A significant decrease in the VAS score was observed for all sealers from 6 h to 48 h (p 0.05). Nonvital cases had lower VAS scores at all time intervals. Analgesic intake was greater in the first 24 h (p < 0.05) in vital cases (p < 0.05) and also in females than males.ConclusionThe level of pain experienced after obturation was similar in patients with different pulp status for all the root canal sealers. Analgesic intake was greater in vital cases and females within 24 h.Trial registrationClinicalTrial.gov, NCT06515756, record date: 2024-07-17, retrospectively registered.

Articaine Versus Mepivacaine in Inferior Alveolar Nerve Block for Patients With Irreversible Pulpitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Inferior alveolar nerve block (IANB) as an anesthetic strategy has shownconflicting results in terms of efficacy in the treatment of patients with irreversible pulpitis. Mepivacaine and articaine are anesthetic agents commonly used in the IANB technique for pulpal anesthesia. This review aimed to compare mepivacaine and articaine regarding pain and success rate. We conducted a search on the databases PubMed, Scopus, Web of Science (WOS), and Cochrane Central for randomized controlled trials (RCTs) assessing mepivacaine versus articaine until September 2024. The primary outcome of interest was success rate, while the secondary outcomes were pain intensity assessed by a 10-point visual analog scale (VAS) and incidence of severe pain. Data were pooled as odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) in a random-effect model using STATA. Five RCTs including 568 patients were included in the final analysis. While there was no significant difference between the two studied groups regarding the success rate (OR: 0.92, 95% CI: 0.69 to 1.21, p=0.54), articaine significantly reduced the pain intensity compared to mepivacaine (MD: 0.59, 95% CI: 0.31 to 0.86], p<0.001). Moreover, no significant difference was observed regarding the incidence of severe pain. Articaine reduced the intensity of pain post-procedure, with comparable results regarding success rate and incidence of severe painwith mepivacaine. Further large-volume RCTs are warranted to study the differences between the two options in the long term.

Effect of Cryotherapy and Occlusal Reduction on Postoperative Endodontic Pain in Mandibular First Molars with Symptomatic Apical Periodontitis: A Prospective, Parallel, Double-Blinded Randomized Controlled Trial.

This study aimed to compare the intensity of postoperative pain following the final rinse using cold saline compared with room temperature saline and occlusal reduction. A prospective, parallel, double-blinded randomized controlled trial was conducted on 69 first mandibular molars diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. Single-visit root canal treatment was performed; access cavity preparations and chemomechanical preparations were carried out using the ProTaper Gold rotary system under copious irrigation using 3% sodium hypochlorite and 17% EDTA. The patients were divided into three groups (n = 23): control group: room temperature saline (25°C) final rinse without occlusal reduction; cryotherapy group: cold saline (2.5-4°C) final rinse without occlusal reduction; and occlusal reduction group: room temperature saline with occlusal reduction. Pain scores were recorded using the visual analog scale preoperatively and postoperatively via telephone at 6, 24, 48, 72 hours, and 7 days intervals. Age data were analyzed using one-way analysis of variance followed by Tukey's post hoc test. Pain score data were analyzed using Kruskal-Wallis' test followed by Dunn's post hoc test for intergroup comparisons and Friedman's test followed by Nemenyi's post hoc test for intragroup comparisons. Correlations were analyzed using Spearman's rank-order correlation coefficient. The significance level was set at p < 0.05 within all tests. Cryotherapy reduced postoperative pain compared with the control group with a statistically significant difference at 24 hours only (p = 0.016). At other intervals, no statistically significant difference in pain score was measured between all three groups (p > 0.05). After 7 days, all patients recorded a zero pain score. Cryotherapy was as effective as the occlusal reduction in reducing postoperative pain in cases of symptomatic irreversible pulpitis with symptomatic apical periodontitis, significantly more than the control group.

Clinical Evaluation of Buccal Infiltration with Articaine for Endodontic Anesthesia in Mandibular Molars with Irreversible Pulpitis

Clinical Evaluation of Buccal Infiltration with Articaine for Endodontic Anesthesia in Mandibular Molars with Irreversible Pulpitis

Effect of Sodium Hypochlorite Concentration on the Outcome of Full Pulpotomy in Mature Permanent Teeth with Irreversible Pulpitis - A Systematic Review.

To determine the outcome of full pulpotomy in management of mature permanent teeth with irreversible pulpitis when 2.5% versus other concentrations of sodium hypochlorite (NaOCl) were used to achieve haemostasis. Electronic searches were performed in PubMed, Embase, Web of Science, International Clinical Trials Registry Platform, and ClinicalTrials.gov for English language articles until July 2021. Randomised clinical trials and cohort, cross-sectional, and case-control studies where full pulpotomy was performed to manage mature permanent molar teeth with irreversible pulpitis and no periapical radiolucency were included. Newcastle Ottawa Scale and the Cochrane risk of bias tool were used for quality assessment. The success rate for full pulpotomy was documented. The protocol was registered in PROSPERO database (CRD42020177214). Out of 861 studies, four were considered for data analysis. Three studies were single-arm prospective trials on pulpotomy, while one was a randomised control trial comparing pulpotomy and root canal treatment. A combined success rate of 93% from 117 teeth was reported from three studies using 2.5% NaOCl as a haemostatic agent. One study used 5% NaOCl and reported a success rate of 100% (n = 6 teeth). The certainty of evidence substantiated by the GRADE approach was of low quality. Overall quality assessment revealed a considerable risk of bias in three studies. Irrespective of the NaOCl concentration, the success rate of pulpotomy in mature permanent teeth with irreversible pulpitis was high. No study compared the different concentrations of NaOCl as a haemostatic agent. Further, randomised controlled trials are required to investigate the effect of NaOCl concentration for haemostasis on the outcome of pulpotomy.

Beyond The Usual Suspects: A Challenging Case Of Radix Entomolaris With Endodontic-Periodontal Lesion: A Case Report

The purpose of this case report is to present an unusual endodontic periodontal lesion along with radix entomolaris in tooth 46 in a 31-year-old female patient with intermittent pain and sensitivity to hot and cold stimuli. Clinical examination revealed deep dentinal caries and periodontal pocket depth of 5mm in tooth #46.The radiographic examination revealed an extra distal root with a periapical radiolucency in tooth #46. patient was diagnosed with irreversible pulpitis and chronic apical periodontitis, with secondary periodontal involvement due to an endodontic-periodontal lesion. Non-surgical root canal treatment was performed, followed by canal obturation with resin-based sealer and final restoration with a porcelain fused to metal crown. After a 3-month follow-up, the patient remained asymptomatic, radiographs showed bone reposition, and periodontal probing depth decreased, indicating successful treatment.

Evaluation of Cold and Electric Pulp Tests for Assessing the Success of Inferior Alveolar Nerve Block for Mandibular First Molars diagnosed with Symptomatic Irreversible Pulpitis

IntroductionFear of dentistry, often due to past painful experiences, is a significant barrier preventing patients from visiting dentists. Achieving effective pain control, especially during root canal treatments, is crucial. However, inferior alveolar nerve blocks (IANB) have a low success rate, influenced by factors such as anxiety, anatomical variations, and technique limitations, leading to anesthesia failure. Although numerous studies have examined the cold test and EPT in assessing the success of local anesthesia, no standardized method has been established. This study evaluated the effectiveness of electric pulp test (EPT) and cold tests in assessing the depth of anesthesia in patients with symptomatic irreversible pulpitis (SIP) in the mandibular first molar teeth. MethodsA cross-sectional study was conducted on 50 patients with SIP who met the inclusion criteria and exhibited lip numbness. Following the administration of the IANB and confirmation of lip numbness, cold tests and EPT were performed on all patients. Subsequently, the preparation of the access cavity (gold standard test) was initiated, and patients' responses during cavity preparation were recorded as either "presence of pain or discomfort" or "absence of pain or discomfort," indicating IANB failure and success, respectively. Sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LR-/+), and accuracy (AC) with 95% confidence intervals (CI) were calculated for each test separately as well as for sequential testing. ResultsIANB failure was determined in 56% of the patients. A comparative analysis of diagnostic tests (cold test and EPT) showed no significant difference in SN, NPV, and AC; however, the cold test had higher SP, PPV, and LR+. Combining cold test and EPT evaluations improved SN, NPV, PPV, and LR-, but SP and AC were similar to EPT alone. No correlation was found between IANB success and patient age, sex, or initial pain. ConclusionsDespite evidence of lip numbness, a significant number of IANBs failed in cases of painful pulpitis. A positive result from the cold test strongly indicated anesthesia failure. The findings of the current study suggested that when the cold test yielded a negative result, further evaluation with EPT was necessary to confirm anesthetic success and ensure complete pain control.

Deep caries and pulp exposures management preferences in permanent teeth: A survey amongst Spanish dentists.

To assess Spanish dentists' management preferences for deep caries removal and exposed pulps in permanent teeth. A web-based open and anonymous survey was distributed by social media and a specific website for this project amongst dentists practicing in Spain. The questionnaire comprised 40 questions, divided into five sections: (1) demographic data and professional activity; (2) carious tissue removal; (3) decision-making regarding pulp exposure; (4) direct pulp capping and (5) pulpotomy procedures in permanent teeth. Results were descriptively analysed. Logistic regression (95% CI) analyses and X2 tests were carried out. A total of 538 responses were received. Half the respondents (53.7%) preferred to perform complete caries excavation for shallow and moderate carious dentin lesions, and selective excavation to firm dentin for deep lesions (57.8%). Selective removal to soft dentin and stepwise removal were much less indicated (15.4% and 10.9%, respectively). Exposed pulps in asymptomatic teeth were treated by direct pulp capping (over 80%), decreasing in the presence of reversible pulpitis symptoms (57.1%). If irreversible pulpitis was diagnosed, a pulpectomy would be performed by 53.5% and 89.9% of the respondents in, respectively, immature and mature teeth. Pulpotomy was performed routinely only by 26.4% of the clinicians. Patients' attitudes and priorities were the most relevant criteria when performing direct pulp capping and pulpotomy, together with the history of pain and the presence of bleeding. Regarding the clinical procedure, dry cotton was preferred to obtain haemostasis and Biodentine was the material of election. Caries removal preferences and management of pulp exposure by dentists practicing in Spain deviated from vital pulp treatment guidelines, mainly regarding indications and case selection. Pulp exposure was managed by direct pulp capping in asymptomatic cases, whilst immature permanent molars favoured the indication of pulpotomy when pulpitis was diagnosed. Most clinicians used hydraulic calcium silicate cement, specifically Biodentine, to perform vital pulp treatments. Postgraduate formation and continuing education in caries lesions management and vital pulp treatments were consistently related to more conservative and updated decisions.

Reasons for Patients Preferring Extraction over Root Canal Treatment in a Tertiary Care Hospital

Introduction: Dental caries is a major global oral health issue, potentially progressing to irreversible pulpitis and causing substantial discomfort. Although advancements in materials, instruments and knowledge have improved the success rates of root canal procedures, some patients opt for tooth extraction instead of root canal treatment. This choice can result in tooth loss, necessitating costly prosthetic replacements. Objective: The objective of this study was to determine the reasons for patients choosing extraction over root canal treatment. Methods: A descriptive cross-sectional study was conducted among 205 patients visiting the Department of Conservative Dentistry and Endodontics at Kathmandu Medical College for the treatment of irreversible pulpitis, who ultimately opted for extraction. A structured questionnaire was utilized, and responses were recorded and analyzed using the Statistical Package for the Social Sciences. Mean, standard deviation, frequency and percentage were calculated depending upon the nature of data. Results: The study found that the primary reason for patients not undergoing root canal treatment (RCT) was the high cost of RCT and crown, accounting for 42.9% (88 patients), followed by the need for more appointments with pain, at 31.2% (64 patients). Conclusions: This study revealed the cost of RCT and crown to be the major factor for patients opting out from RCT. The study provides valuable insights into the psychology of patients regarding RCT, highlighting reasons for its rejection. Such understanding assists dentists and specialists in tailoring treatment plans that align with patient preferences and needs.

Efficacy of vital pulp therapy for carious pulp injury in permanent teeth: a study protocol for an open-label randomized controlled noninferiority trial.

Vital pulp therapy (VPT) has recently been reported as an effective approach for preventing and treating carious pulp injury in permanent teeth. Compared with root canal treatment (RCT), which involves complete removal of the pulp tissue, VPT effectively maintains pulp vitality and retains the physiological functions of the pulp. In the research pool, large-scale randomized controlled trials evaluating the treatment outcome of VPT using calcium silicate cements and RCT in cariously exposed permanent teeth are lacking. Here, we present a monocentric clinical protocol to compare the effects of VPT using iRoot BP Plus (Innovative Bioceramix, Vancouver, BC, Canada) as a pulp-capping material with RCT. The proposed trial is an open-label, single-centre, randomized, controlled, noninferiority trial. In total, 462 patients will be included in this trial according to the following criteria: adult patients (18-50years old), pulp exposure during the treatment of deep caries in mature permanent teeth, a diagnosis of reversible or partially irreversible pulpitis without apical translucency on X-ray, without periodontitis or systemic disease. Patients with signed informed consent forms will be enrolled and randomly divided into two groups (VPT and RCT) with a balanced treatment allocation (1:1). Clinical evaluations will be conducted at baseline and at 3, 6, 12, and 24months after treatment, with the potential for extension. The primary outcome measure will be the duration of success. The secondary outcomes will include the success rate at the 1-year follow-up and any adverse reactions. The Kaplan‒Meier method and log-rank test will be used to compare the duration of success of both treatments. For other outcomes, the χ2 test or Fisher's exact test will be used for categorical variables, and the t test or Mann‒Whitney U test will be used for continuous variables to assess the differences between groups. The results of this trial will provide a clinical reference for selecting treatments for carious pulp injuries in permanent teeth. ClinicalTrials.gov ChiCTR2100051369. The study has been registered in the Chinese Clinical Trial Registry (ChiCTR) ( www.chictr.org.cn ). Registered on 21 September 2021.

Full pulpotomy versus root canal therapy in mature teeth with irreversible pulpitis: a randomized controlled trial

BackgroundVital pulp therapy (VPT) is recommended as an alternative treatment to root canal therapy (RCT) for management of teeth with carious pulp exposure. This randomized clinical trial aimed to compare the outcomes and postoperative pain, and to evaluate the time and cost after full pulpotomy (FP) and RCT in mature molar teeth with irreversible pulpitis (IP).MethodsA total of 160 mature molar teeth with IP were randomly divided into two treatment groups. The FP group (test group) was treated with FP using iRoot BP Plus by an endodontist, the RCT group (control group) was treated with RCT using iRoot SP as sealer by the same endodontist. Pain was recorded preoperatively and daily until day 7 postoperatively. The treatment time and cost were recorded. Clinical and radiographic assessments were collected, and pulp sensibility tests were done by electric pulp test (EPT) at 3-, 6-, 12- month postoperatively. Data were analyzed through chi-square test, Mann-Whitney U test, Fisher exact and independent t test.ResultsFP and RCT had comparable success rates (Clinical, 97.3% vs. 98.6%; radiographic, 93.3% vs. 94.6%) (P > 0.05). Pain levels decreased over time from day 1 to day 7 postoperative in both groups, and the FP group had larger reductions in pain intensity than RCT at day 1 (P < 0.05). In the FP group, there were 5, 3 and 3 unresponsive teeth with EPT at 3-, 6- and 12- month follow-ups, respectively. The treatment time and cost in the FP group were significantly lower than in the RCT group (P < 0.05).ConclusionsFP could be an appropriate alternative treatment for management of mature teeth with IP in short follow-up.Trial registrationThe trial was registered in Chinese Clinical Trial Registry (ChiCTR2200063380 at 05/09/2022).

Comparison of oral health-related quality of life among endodontic patients with irreversible pulpitis and pulp necrosis using the oral health-related endodontic patient's quality of life scale.

This prospective cohort study aimed to clarify differences in the longitudinal effects on oral health-related quality of life (OHRQoL) among patients undergoing endodontic treatment for irreversible pulpitis and for pulp necrosis, using a newly developed oral health-related endodontic patient's quality of life (OHQE) scale. This study included 131 patients diagnosed with irreversible pulpitis and pulp necrosis. Comprehensive data regarding the patient's background, medical history, and dental history were collected. The OHQE was administered three times to each patient: before and after endodontic treatment, as well as 2weeks after endodontic treatment as a follow-up. Statistical analysis was performed using a linear mixed model for repeated measurements of changes in the OHQE score over time in cases of irreversible pulpitis and pulp necrosis. The patients consisted of 48 (36.6%) males and 83 (63.4%) females with a mean age of 36.2 (standard deviation, 12.6) years. Of these, 62 (47.3%) had irreversible pulpitis, and 69 (52.7%) had pulp necrosis. Intragroup comparisons showed an improvement in the OHQE scores over time in both groups (p < 0.001). Group comparisons revealed no significant differences at any time point. No interactions or changes over time were observed between the two groups. No difference in the improvement of quality of life after endodontic treatment was seen in the two disease groups, and both groups improved over time. However, patients' expectations of receiving endodontic treatment remained unchanged after treatment. Therefore, dental providers should consider explaining the value of endodontic treatment to patients and address the measures that contribute to patient satisfaction.

Comparative evaluation of various biomaterials as pulpotomy agents in molars with symptomatic irreversible pulpitis: A randomized single-blinded single-center control trial

Abstract Introduction: Untreated tooth decay in mature permanent dentition is a prevalent global issue, affecting 34.1% of people with 2.5 billion cases annually. Extensive decay often leads to irreversible pulpitis, characterized by pulp inflammation and pain. Pulpectomy, the standard treatment, involves complex procedures with potential complications. Modern endodontics favors minimally invasive treatment such as pulpotomy, which preserves pulp vitality. This study aims to compare the clinical as well as radiographic outcomes of different pulpotomy agents: Biodentine, mineral trioxide aggregate (MTA), Bio-C repair, and Endosequence Bio-ceramic root repair material (BCRRM) in mature permanent molars. Methodology: This single-blind, single-center study involved 80 participants randomly assigned to four groups, each receiving one of the biomaterials. Ethical approval was obtained. Participants aged 14–60 years with symptomatic irreversible pulpitis were selected. Pulpotomy procedures were performed, and follow-up evaluations occurred at 24 h, 1 week, 4 weeks, 3, 6, and 12 months. Clinical success was measured by the absence of pain, sensitivity, and tenderness. Radiographic evaluation used the periapical index (PAI) scoring system. Results: Pulpotomy significantly reduced postoperative pain in all groups. Endosequence BCRRM showed the maximum pain reduction at 24 h with a statistically significant difference from all the groups (at 1% probability level), followed by Bio-C repair, Biodentine, and MTA. At 1 week, Bio-C repair led in pain reduction with statistically nonsignificant results. All groups reported no pain at 3, 6, and 12 months. Endosequence BCRRM had the highest improvement in periapical findings at 1 year. Sensitivity to hot and cold improved significantly in all groups, with Endosequence BCRRM performing best. Conclusion: Endosequence BCRRM provided the best overall outcomes, emphasizing the importance of material choice in pulpotomy treatments. Further research on biomaterials’ long-term clinical and radiographic outcomes is needed to enhance treatment efficacy.

Postoperative pain evaluation in patients undergoing endodontic treatment subsequent to working length determination with and without integrated apex locator endomotor: Randomized control trial

Abstract Introduction: Precise working length control during chemomechanical preparation is one of the primary factors for successful endodontic therapy. Aim: The study aims to evaluate the postoperative pain after determining working length with an integrated apex locator-endomotor and a separate apex locator-endomotor. Subjects and Methods: One hundred and twenty subjects with a diagnosis of symptomatic irreversible pulpitis and preoperative pain score Visual Analog Scale (VAS) &gt;50 were allocated into Group I with nonintegrated apex locator and endomotor and Group II with integrated apex locator endomotor, further treated by single endodontist. Postoperative pain was assessed with a VAS chart on days 1, 3, and 7. The necessity of analgesic intake if required was considered as the highest VAS score. Statistical Analysis Used: Pre- and post-operative VAS scores between the groups were compared using the Mann–Whitney and one-way ANCOVA tests. Results: On days 1 and 3, Group II showed significantly lower values of postoperative pain and lesser frequency of rescue medication when compared with Group I (P &lt; 0.05). On day 7, none of the patients reported postoperative pain. Conclusion: Simultaneous working length determination during instrumentation leads to significantly lesser postoperative pain.

Effect of lateral extent of pulp tissue removal on the outcome of partial pulpotomy for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis: A randomized clinical trial.

The aim of this study is to compare the outcomes of restricted partial pulpotomy (R-PP) versus extended partial pulpotomy (E-PP) for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis (SIP). This double-arm, parallel designed randomized clinical trial was registered at clinicaltrials.gov (registration number: NCT05406557). Following random allocation, 43 participants of each group received the designated intervention. In the R-PP group, 2-3 mm of superficial pulp tissue was removed only from the exposure site, while chamber was completely de-roofed and 2-3 mm of superficial pulp tissue from entire chamber was removed in the E-PP group. Haemostasis was achieved using 3% sodium hypochlorite-soaked cotton pellets. Upon haemostasis, ProRoot mineral trioxide aggregate (ProRoot MTA) was placed over the pulpal wound, overlaid with a resin-modified glass ionomer liner, and restored with composite resin in the same visit. Outcome measures included clinical and radiographic success evaluation at 6 and 12 months, and pain assessment using the visual analogue scale pre-operatively and daily for 7 post-operative days. Nonparametric tests were used for variables including patient's age, pain intensities, mean analgesic consumption, and haemostasis time. Categorical variables including gender, caries type, analgesic intake, hard tissue barrier formation, clinical and radiographic success, and pulp sensibility responses were assessed using Chi-square or Fisher's exact test. Tooth survival was analysed using Kaplan-Meier analysis. A total of 81 cases were analysed at 12 months follow-up. Comparable success was observed in both groups (97.6% in E-PP & 97.5% in R-PP; p > .05). The R-PP group reported significantly lower pain scores on the 1st and 2nd post-operative days than E-PP (p < .05) and required significantly less analgesic intake (p < .05). Hard tissue barrier formation was significantly lower in the R-PP group (p < .05). No significant differences were observed between groups regarding haemostasis time, pulp sensibility responses, and tooth survival (p > .05). Both the PP approaches exhibited comparable success for managing cariously exposed mature permanent molars with SIP. Given the conservative nature of R-PP, it may be used as preferred PP approach for managing such cases. Being the first study of this kind, further work is necessary to draw definitive conclusions.

Effect of Ascorbic Acid as A Final Flush on Post Operative Pain After Single Visit Root Canal Treatment for Patients with Symptomatic Irreversible Pulpits Related to Mandibular Molars: Randomized Controlled Trial

Effect of Ascorbic Acid as A Final Flush on Post Operative Pain After Single Visit Root Canal Treatment for Patients with Symptomatic Irreversible Pulpits Related to Mandibular Molars: Randomized Controlled Trial

The short-term postoperative pain and impact upon quality of life of pulpotomy and root canal treatment, in teeth with symptoms of irreversible pulpitis: A randomized controlled clinical trial.

Few studies focus upon patient-reported outcomes in endodontics. To determine whether full pulpotomy offers a less painful, improved health-related quality of life (HRQoL) compared with root canal treatment (RCT) in cases of irreversible pulpitis (IP) in the 7 days after the treatment. One hundred sixty-eight participants presenting with symptoms of IP were randomized to either pulpotomy (n = 86) or RCT (n = 82). Two participants were excluded, 61 participants underwent full pulpotomy with Biodentine (35.7%), 80 had RCT (46.8%), and 25 were randomized to have pulpotomy which progressed to RCT (PRCT) due to uncontrollable bleeding (14.6%). Clinical and radiographic assessments, using CBCT and periapical radiographs, were carried out preoperatively, for the evaluation of the results only CBCT images were used. Pain (VAS) and HRQoL (EQ 5D) assessments were carried out at baseline and Days 1, 3, 5 and 7 post-baseline. Analysis included descriptive and continuous variables, chi-squared, Fisher's exact, and two-sample t-tests. In pulpotomy and RCT groups, VAS pain decreased significantly over the first week (p < .001). The magnitude of reduction was similar in RCT and pulpotomy (p = .804), RCT and PRCT (p = .179), pulpotomy vs. PRCT (p = .144) and in the comparison of combined RCT /PRCT groups (ORCT) with Pulpotomy (0.729). However, the overall level of VAS pain was significantly higher in the PRCT group than in the Pulpotomy (p = .045) and RCT group (p = .049). Using CBCT, significantly more radiolucencies were found in the PRCT group than in the pulpotomy group and overall teeth presenting with CBCT radiolucencies had significantly higher pain scores (p = .015), particularly at Days 1, 3 and 5. There were significant differences in many OHRQoL domains (Questions 1, 6, 11 and 12) between RCT and PRCT groups with higher frequencies of the impact of oral health problems at Day 0 and Day 7 in the PRCT group. In the treatment of IP, pulpotomy is as effective as RCT in reducing post-operative pain, and improving QoL and HRQoL, teeth displaying uncontrollable bleeding and periapical radiolucencies detected using CBCT are associated with more intense postoperative pain and lower QoL.

Outcomes of vital pulp treatment in permanent teeth with carious pulp exposure with signs and symptoms of irreversible pulpitis.

To investigate the outcomes and factors influencing the success of vital pulp treatment (VPT) in permanent teeth with carious pulp exposure and signs and symptoms of irreversible pulpitis (IP). Dental records from 2016 to 2023 of patients who received VPT for carious pulp-exposed permanent teeth with IP symptoms were reviewed. Outcomes were assessed using clinical and radiographic criteria. Univariate and multivariate analyses were performed to identify factors affecting treatment success. The Kaplan-Meier estimator was used to compare survival probabilities. The overall success and survival rates were 88.24% and 97.06%, respectively. Success rates for direct pulp capping, partial pulpotomy, and full pulpotomy were 87.7%, 92.0%, and 87.7%, respectively. Key factors influencing outcomes included the presence of periapical radiographic lesions, type of pulp dressing material, and quality of the final restoration. Full pulpotomy demonstrated the highest survival time, followed by partial pulpotomy and direct pulp capping. VPT in permanent teeth with carious pulp exposure and IP symptoms shows high success rates. Crucial factors include periapical radiographic findings, type of pulp dressing material, and quality of the final restoration. Full pulpotomy exhibited the longest survival time. VPT in teeth with IP symptoms shows promising outcomes, highlighting the importance of certain clinical factors in treatment success.