Pulpotomy Group Research Articles

Appraise the anesthetic efficacy in emergency pulpotomy versus complete pulp extirpation during endodontic treatment: a randomized clinical trial

Background and objectives. Symptomatic irreversible pulpitis (SIP) is one of the main reasons people seek emergency dental care, an extremely painful inflammatory condition of the dental pulp. In endodontics, efficient pain management is a sign of superior clinical practice. An appropriate local anesthesia combined with adequate emergency intervention is mandatory. The aim of the present study was to compare local anesthetic success during pulp extirpation versus emergency pulpotomy in endodontic treatment of mandibular molars teeth with symptomatic irreversible pulpitis. Materials and methods. Seventy-eight patients with mandibular molar having vital pulps with symptomatic irreversible pulpitis were included in the study. After confirming the diagnosis clinically and radiographically, patients were randomly assigned into two groups (n=39) for each group. The control group treated by complete pulp extirpation and the intervention group treated by emergency pulpotomy. Every patient received 4% artiacine as inferior alveolar nerve block (IANB). Endodontic access was initiated after 10 minutes of anesthesia, lip numbness and electric pulp tester (EPT) reading. Pain during endodontic access cavity preparation for both groups and during pulp extirpation or pulpotomy according to each group was recorded by verbal rating scale (VRS). When patients needed, they received buccal infiltration or intraligamentary or intra-pulpal anesthesia of the same anesthetic solution as supplemental. Data were collected through verbal rating scales (VRS) during the intervention to assess the anesthetic success. The second visit was scheduled after one week to complete the treatment for both groups. All the data were collected and tabulated. Statistical analysis was performed by mean, standard deviation for each group, Kolmogorov-Smirnov, Shapiro-Wilk tests, Independent-sample t-test, Mann Whitney test. and the significance level was set to (P≤0.05). Results. There was no statistically significant difference between pulp extirpation group and pulpotomy group (p=0.795) in success of pain control during access cavity preparation and during pulp extirpation or pulpotomy according to each group. 49% of patients in the control group and 43.5% of patients in the intervention group required supplemental anesthesia to effectively complete the treatment without pain. Conclusion. The present study demonstrated that pulpotomy was highly effective as pulp extirpation in rate of anesthetic success upon emergency treatment for mandibular molars with symptomatic irreversible pulpitis. Clinical significance: pulpotomy offers more effective care in less time and with less discomfort than complete pulp extraction.

Effectiveness of pulpotomy in managing carious exposure in mature permanent teeth: A systematic review and meta-analysis

ObjectivesThis quantitative systematic review evaluated whether pulpotomy performed with hydraulic calcium silicate cements may be used as an alternative to root canal treatment (RCT) in mature permanent teeth with carious pulp exposure. Data sourcesA comprehensive search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library. No language restrictions were applied. The search included randomised controlled trials that compared pulpotomy to root canal treatment for managing carious exposure in mature permanent teeth. Study selectionStudies were selected based on predetermined inclusion criteria: randomised controlled trials involving mature permanent teeth with carious pulp exposure, using hydraulic calcium silicate cements for pulpotomy. Non-comparative studies, case reports, and trials involving primary or immature permanent teeth were excluded. DataData were extracted on success rates, clinical outcomes, follow-up periods, pain profiles, and potential complications. A meta-analysis was performed, revealing no statistically significant differences in success rates between pulpotomy and RCT. Both interventions demonstrated success rates exceeding 90 % at one-year and two-year follow-up periods. Pain profiles consistently showed lower post-operative pain intensity in the pulpotomy group compared to the RCT group during the first week. Potential complications, such as non-responsive pulp and difficulties in determining pulp vitality, were reported more frequently in the pulpotomy group. ConclusionsPulpotomy with bioactive hydraulic calcium silicate cements shows comparable success rates to RCT in managing carious pulp exposure in mature permanent teeth. The results suggest pulpotomy as a viable, less invasive alternative to RCT, particularly in cases where preservation of pulp vitality is paramount. Clinical significanceThis systematic review highlights pulpotomy as a less invasive and cost-effective alternative to root canal treatment in mature permanent teeth. With comparable success rates and lower post-operative pain, pulpotomy offers a promising approach to managing carious exposure and preserving tooth vitality.

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.

The effectiveness of partial pulpotomy compared with full pulpotomy in managing deep caries in vital permanent teeth with a diagnosis of non-traumatic pulpitis.

Pulpitis may be pain free or alternatively characterized by mild to severe pain and associated symptoms. Evidence has recently emerged that patients presenting with carious pulp exposure range of symptoms can be treated effectively with pulpotomy. The current systematic review aimed to answer the following research question: "In patients with deep caries lesions in permanent teeth associated with no symptoms, reversible pulpitis or signs and symptoms indicative of irreversible pulpitis (P), is partial pulpotomy (I) as effective as full pulpotomy (C), in terms of a combination of patient and clinical reported outcomes (O), with "tooth survival" as the most critical outcome? The systematic literature search was conducted in the following electronic databases: OVID, Scopus, PubMed (Including MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL) supplemented with Grey literature and hand searching of relevant journals. The English language clinical trials comparing the patient and clinical reported outcomes between partial and full/complete were included. After a structured literature search, two authors independently performed study selection, extracted data and performed a risk of bias assessment; a third reviewer resolved disagreements. As there were only two studies with different exclusion criteria, no meta-analysis was performed and the quality of evidence was assessed by the GRADE approach. After study selection a total of two randomised clinical trials with a total of 156 teeth were included both for the management of teeth with irreversible pulpitis. There were no studies for asymptomatic teeth or teeth with reversible pulpitis. A "Low" risk of bias was noted for both studies with a high level of overall evidence. A meta-analysis was not carried out due to differences in inclusion criteria between the studies related principally to caries depth. Both studies reported a high rate of clinical success for pulpotomy with a pooled unadjusted success rate for full pulpotomy of 90% and 83% partial pulpotomy of at 1-year; however, no significant difference between the treatments was noted in either study. There was significantly reduced postoperative pain reported in the full pulpotomy group over 1-week compared with the partial pulpotomy in one but not in the other study. Pulpotomy as a definitive treatment modality is as effective in managing teeth exhibiting signs and symptoms indicative of irreversible pulpitis and challenges the established protocols to manage this condition. Although based on only two RCTs with a limited number of patients, no difference was shown in terms of clinical or radiographic outcome or postoperative pain between groups. Further well designed randomised clinical trials of longer duration are required in this area to improve the evidence available. There is no consistent difference in patient-reported pain between partial and full pulpotomy at day 7 postoperatively and the clinical success rate was similar after 1 year for both treatment modalities.

Novel cryotherapy technique for pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis- a randomized controlled trial.

To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic irreversible pulpitis. The study included sixty mature permanent mandibular molar teeth with symptomatic irreversible pulpitis and no periapical rarefaction. After coronal pulp tissue amputation, teeth were randomly allocated to one of two groups (n = 30 each). In group I (conventional pulpotomy), a sterile cotton pellet moistened with 2.5% NaOCl was used for haemostasis. In group II (cryotherapy), the pulp chamber was continuously lavaged with 2.50C normal saline solution for haemostasis using an indigenous portable cryotherapy irrigation unit. Following haemostasis, the pulp was capped with mineral trioxide aggregate and the tooth was restored with resin composite. The time taken to achieve haemostasis was recorded. Preoperative and 24, 48 and 72h postoperative pain was measured using the Numerical Rating Scale. The pulpotomy outcome was assessed at the 12-month follow-up. Data were analyzed using Fischer's exact test, two-sample t-test, two-sample Wilcoxon rank-sum test, Friedman Test, and Wilcoxon Signed Rank Test. The cryotherapy group achieved haemostasis in less time (p < 0.05). There was a significant pain reduction at 24 and 48h in the cryotherapy group when compared with the conventional pulpotomy group (P < 0.005). The overall success rate of pulpotomy after 12 months was 88% (n = 22) in both study groups(p < 0.05). Cryotherapy application reduces postoperative pain and has no adverse effect on the outcome of pulpotomy in permanent teeth with symptomatic irreversible pulpitis. The cryotherapy can be incorporated in pulpotomy protocol as an adjunct to minimize post-operative pain.

Outcome and Prognostic Factors for Partial and Full Pulpotomy in the Management of Spontaneous Symptomatic Pulpitis in Carious Mature Permanent Teeth: A Randomized Clinical Trial

IntroductionThe aim of this study was to compare the outcome and prognostic factors for partial and full pulpotomy in the management of mature teeth with spontaneous symptomatic pulpitis. MethodsThe study was a parallel double-blind randomized clinical trial; 200 carious mature permanent teeth with spontaneous symptomatic pulpitis were randomized using a block randomization technique to either partial pulpotomy (n = 99) or full pulpotomy (n = 101). Intraoperative assessment of the pulp under magnification was performed, hemostasis was achieved with a 2.5% sodium hypochlorite moist pellet, and NeoPUTTY (Avalon Biomed, Bradenton, FL) was the pulpotomy material. Preoperative pain levels were recorded and re-evaluated after 1 week. Clinical and radiographic evaluation was performed after 6 and 12 months. Data were analyzed using the chi-square test, the Wilcoxon rank test, and regression analysis. ResultsAt 1 week, immediate failure occurred in 4 cases in partial pulpotomy, and 196 of 200 subjects reported pain relief and were satisfied with the treatment with no significant difference. At 6 months, 6 teeth failed in the partial pulpotomy group and 1 tooth in the full pulpotomy group, with a higher success rate for full pulpotomy (98.96 vs 89.69, P = .003). At 12 months, the recall rate was 98% (96/200). Full pulpotomy was more successful than partial pulpotomy (98.98% [98/99] vs 84.53% [82/97], P < .001). Multivariate analysis revealed that the odds of success for full pulpotomy were 13.6 times higher than partial pulpotomy. Increased age and higher time to hemostasis were significantly associated with decreased odds of success. ConclusionsFull pulpotomy has a higher success rate than partial pulpotomy in the management of spontaneous symptomatic pulpitis. Hemostasis within 4 minutes in partial pulpotomy can be set as the cutoff point beyond which further tissue removal is indicated.

Treatment outcome of coronal pulpotomy and indirect pulp capping in mature permanent molars with symptoms of moderate pulpitis: A randomized clinical trial.

This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars with moderate pulpitis over a 12-month period. A total of 108 vital mature permanent molars with moderate pulpitis were randomly allocated to the IPC (n = 54) or coronal pulpotomy group (n = 54). Dycal and Biodentine were used as pulp-capping materials, followed by composite restoration. The absence of periapical infection and asymptomatic teeth that positively responded to the cold pulp sensitivity test (only in IPC) was considered posttreatment success at 12 months. Data from the study were analyzed using the Chi-square test and Kaplan-Meier survival analysis. There was a statistically significant difference between preoperative symptoms and the cold pulp sensibility test response (P = 0.000), indicating an association between symptoms and pulp sensibility. The average remaining dentine thickness (RDT) value was 0.48 ± 0.5 mm, with no statistically significant difference found between the location of caries and RDT (P = 0.084, P > 0.05). Compared to the IPC group, the pulpotomy group had a greater number of patients at 12 months after treatment that required no intervention. The Kaplan-Meier survival analysis revealed that the mean survival duration for pulpotomy was 48 weeks, and for IPC, it was 42.3 ± 2.35 weeks. Coronal pulpotomy with Biodentine proved more effective in reducing symptoms, achieving radiographic success, and ensuring tooth survival compared to IPC with calcium hydroxide.

Comparative Evaluation of Success of NeoPutty Mineral Trioxide Aggregate ® with Formocresol as Pulpotomy Medicaments in Primary Molars: A Clinical Study.

This clinical study was aimed to investigate the clinical and radiographic outcomes of NeoPutty MTA ® (Nusmile), a novel mineral trioxide aggregate (MTA) pulpotomy material, in primary teeth of children aged 4-6 years. An in vivo study was done in children aged 4-6 years old. A total of 50 primary second molar teeth were included in the study, with 25 of them undergoing treatment with formocresol (FC) and 25 receiving treatment with NeoPutty MTA ® . The subjects were divided into two groups for treatment: the first group received a treatment involving a 1:5 dilution of Buckley's FC. The second group, however, underwent treatment with NeoPutty MTA ® . This study employs a meticulous approach to evaluate the impact of different treatments on a significant number of molar teeth, using FC and NeoPutty MTA ® as the respective treatment methods. The demographics of the subject pool are well-documented, comprising a balance of male and female participants. The technique employed for pulp removal and the subsequent management of bleeding are outlined, underscoring the thoroughness of the process. At 12 months, the NeoPutty MTA ® pulpotomy group showed a significantly higher success rate clinically (96%) compared to the FC group (72%) ( P < 0.05), but radiographically although NeoPutty MTA ® was better (92%) than FC (82%), it was not statistically significant. NeoPutty ® -treated teeth exhibited no signs of pain or discomfort and demonstrated better pulp vitality compared to the FC group. NeoPutty MTA ® demonstrated superior clinical success rates and better radiographic outcomes compared to traditional FC pulpotomy.

Comparing Patient Outcomes for Teeth Treated with Traditional Root Canal Therapy Versus Pulpotomy: A Randomized Controlled Trial

ABSTRACT Background: Root canal therapy (RCT) and pulpotomy are two common treatment modalities for managing dental pulp infections, but their comparative effectiveness in terms of patient outcomes remains unclear. This root canal therapy (RCT) aimed to assess and compare patient outcomes between teeth treated with traditional RCT and pulpotomy Materials and Methods: In this single-center RCT, a total of 120 patients presenting with symptomatic dental pulp infections were randomly assigned to either the RCT group or the pulpotomy group. The RCT group received conventional root canal treatment, which involved complete removal of infected pulp and obturation of the root canals. The pulpotomy group underwent a procedure where only the coronal pulp tissue was removed, followed by the placement of a medicament. Pain levels, infection resolution, and tooth survival were assessed at 6 months and 1 year posttreatment. Results: At the 6-month follow-up, patients in the RCT group reported significantly lower pain scores (2.5 ± 0.8) compared with the pulpotomy group (4.3 ± 1.2, P &lt; 0.001). Infection resolution was also higher in the RCT group (92%) compared with the pulpotomy group (78%) at 6 months. Tooth survival rates at 1 year were significantly higher in the RCT group (95%) compared with the pulpotomy group (81%, P &lt; 0.05) Conclusion: This RCT demonstrates that traditional RCT is superior to pulpotomy in terms of pain reduction, infection resolution, and tooth survival. Patients who underwent RCT experienced less pain, faster infection resolution, and better tooth survival rates compared with those who received pulpotomy. These findings support the use of RCT as the preferred treatment modality for dental pulp infections.

The use of medicaments in the management of symptomatic irreversible pulpitis: A community-based cohort study.

To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom. All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre-operatively, data regarding patients' numerical ratings scale (NRS), pain score (0-10), analgesic use, oral-health impact profile-14 (OHIP-14) and need for time away from work were collected. For 7 days post-operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed-effects model with post hoc Tukey's multiple comparisons test for continuous data and chi-squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel-Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre- and post-operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2-points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work. Eighty-five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p = .645), although patients self-reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p = .015). This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue.

Comparison of Anesthetic Efficacy between 2% Lignocaine and 2% Mepivacaine in Inferior Alveolar Nerve Blocks during Extractions and Pulpotomies of Primary Molars in Children

ABSTRACT Context: There are few studies reported in children comparing local anesthetic agents for their efficacy during extraction and pulpotomy procedures, as well as how they affect the patient’s comfort, pain management, and postoperative outcomes. The current study was planned to assess the local anesthetic effectiveness of 2% lignocaine and 2% mepivacaine in inferior alveolar nerve blocks (IANBs) during pediatric primary molar extractions and pulpotomies. Subjects and Methods: A randomized, double-blind clinical trial was carried out among 60 healthy children between the ages of 6 and 12 years who needed pulpotomies or tooth extractions of their mandibular primary molars. Traditional IANBs were performed either using 2% lignocaine or 2% mepivacaine, both with 1:100,000 epinephrine. The efficacy of local anesthesia was determined by an independent, trained operator after the procedures of local anesthesia, pulpotomy, and extraction. The pain experienced and the behavior of the child were recorded. The parameters, such as the onset and duration of anesthesia, between the groups were compared using an unpaired t-test. The pain rating by the child and the behavior rating by the operator were analyzed by an independent t-test and a Mann–Whitney U-test, respectively. The associated discomfort due to local anesthesia among groups was analyzed by the Fisher’s exact test and the Spearman’s correlation coefficient test. A value of P &lt; 0.05 was considered to be statistically significant. Results: The onset of anesthesia was significantly earlier for the lignocaine group (104.93 s) than the mepivacaine group (138.13 s) while performing pulpotomy (P &lt; 0.001) and extraction (P &lt; 0.001) procedures. The duration of action of lignocaine (173.06 min) was longer than that of mepivacaine (139.96 min). However, this comparison was statistically significant only for the extraction group (P = 0.015) but not for the pulpotomy group (P = 0.057). There was no statistically significant difference in the pain rating, their behavior, or the incidence of self-inflicted injury or discomfort between the anesthetic groups. Conclusions: The time taken for the onset of soft-tissue anesthesia was significantly shorter, and its duration was longer for 2% lignocaine when compared to 2% mepivacaine, when both the agents were given along with 1:100,000 adrenaline. Both agents were similarly effective for pulpotomy and extraction of primary molar teeth with respect to pain control and the behavior displayed by the child, which resulted in similar minor postoperative complications.

One-year outcome of selective caries removal versus pulpotomy treatment of deep caries: A pilot randomized controlled trial.

This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine. This two-armed, parallel-group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer-generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post-treatment. Using a significance level of p < .05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively. In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p < .05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period. Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long-term follow-up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR.

Comparative Evaluation of Low-level Diode Laser and Electrosurgical Pulpotomy in Primary Molars.

Considering the advantages of the nonpharmacotherapeutic techniques over the disadvantages of the pharmacotherapeutic agents, there is a need to evaluate clinically as well as radiographically various nonpharmacotherapeutic techniques to fortify them as replacements to the traditional pulpotomy. This study was conducted to evaluate and compare the clinical and radiographic outcomes of low-level diode laser (LLDL) and electrosurgical pulpotomy in primary molars. Seventy primary molars were allocated to group I (n = 35) and group II (n = 35), which underwent LLDL pulpotomy and electrosurgical pulpotomy, respectively. Clinical and radiographic analysis of all the teeth in the two groups was performed at 1, 3, 6, 9, and 12 months, respectively. Pearson's Chi-squared test was utilized to evaluate the success of both treatment procedures (p < 0.05). During the 12-month follow-up period, the differences between the groups pertaining to clinical and radiographical evaluation were statistically nonsignificant, although enhanced results were seen in the laser pulpotomy group. There was no significant difference in the success rate observed between the LLDL pulpotomy and electrosurgical pulpotomy group at the end of the 12-month follow-up period. The two pulpotomy techniques were found to be successful enough in strengthening the concept of a potent and safe nonpharmacotherapeutic approach in the management of pulpally involved primary molars. This study further establishes nonpharmacological pulpotomy techniques as a favorable alternative to traditional pulpotomy methods. Roy S, Garg N, Pathivada L, et al. Comparative Evaluation of Low-level Diode Laser and Electrosurgical Pulpotomy in Primary Molars. Int J Clin Pediatr Dent 2023;16(4):612-618.

Pulpectomy vs. Pulpotomy as Alternative Emergency Treatments for Symptomatic Irreversible Pulpitis-A Multicenter Comparative Randomised Clinical Trial on Patient Perceptions.

There needs to be more general agreement on the most effective treatment for the emergency patient with Symptomatic Irreversible Pulpitis (SIP). This equivalence randomised clinical study compared the clinical efficiency, as an urgent treatment, of pulpotomy (POT) and pulpectomy (PEC) in the permanent teeth with SIP. The primary outcome was pain management, and the secondary outcome was the patient's perception of duration, comfort, and satisfaction. 80 patients were blindly and randomly allocated into two equal parallel groups, the control group treated by PEC and the test group by POT. Data were collected through numerical rating scales (NRS) during the intervention and 6, 24, and 72 h post-op. Non-parametric tests were used to analyse the data. The Brunner-Longer models were adopted for longitudinal data and the analysis of variance (ANOVA)-type statistical was used. The mean preoperative pain levels for the whole sample scored 5.8 ± 2.8 and significantly decreased to 2.1 ± 2.4 at 6 h, 1.5 ± 2.1 at 24 h, and 1.3 ± 2 at 72 h, without any differences between the groups. No significant differences were found in the patient's perception of treatment discomfort or duration between the groups. Three days after the intervention, patient satisfaction was high, with 9.2 ± 1.7 and 9.1 ± 2 in the PEC and POT groups, respectively. Self-reported pain was the only variable penalising the patient's final satisfaction. The current randomised control trial (RCT) showed that both pulpectomy and pulpotomy effectively eliminate pain and achieve high levels of patient satisfaction. Furthermore, the patient's perceptions of the duration and discomfort of the two treatments were similar. Given that pulpotomy is a faster and more straightforward technique, it may be recommended as a viable and pragmatic option for treating emergency patients with symptomatic irreversible pulpitis.

Single visit root canal treatment versus pulpotomy in management of pulpitis

Aim To clinically and radiographically evaluate single visit root canal treatment (RCT) and pulpotomy in management of mature teeth with irreversible pulpitis. Patients and methods Twenty-four patients diagnosed with irreversible pulpitis in their mature permanent mandibular molars, were selected and randomly divided into two equal groups according to the treatment protocol either single visit RCT or pulpotomy. For single visit RCT group, ProTaper NEXT rotary system was used for canal preparation and obturation was done using cold lateral condensation technique. While in pulpotomy group, after coronal pulp amputation and hemostasis, Biodentine was used as the pulpotomy agent. The clinical examination of tested groups was performed immediately after completing the procedure (baseline), 3, 6, 9, and 12 months posttreatment. While the radiographic examination using cone-beam computed tomography was carried out at baseline and 12 months postoperatively. Statistical analysis was performed by χ 2 test for clinical evaluation criteria and t test for radiographic data. Results Single visit RCT had clinical success rate of 91.67%, while pulpotomy group showed 83.33% success rate. Radiographically, both groups showed normal width of periodontal ligament membrane space and normal bone density after follow-up. There was no statistically significant difference between two groups (P &gt; 0.05). Conclusions Single visit RCT and pulpotomy had high success rate in management of mature permanent teeth diagnosed with irreversible pulpitis. Pulpotomy can be considered as an alternative treatment option.

A retrospective study of iRoot BP Plus pulpotomy compared with Vitapex pulpectomy for irreversible pulpitis of primary molars with the presence of coronal pulp tissue.

Pulpotomy has been successfully performed in immature and mature permanent teeth with irreversible pulpitis but rarely in primary teeth. To evaluate the outcomes of iRoot BP Plus pulpotomy and Vitapex pulpectomy in primary molars with irreversible pulpitis. We selected 130 primary molars of 99 patients, aged 3-7 years, diagnosed with irreversible pulpitis with coronal pulp tissue and treated with iRoot BP Plus pulpotomy or Vitapex pulpectomy (median follow-up period: 18 months). They were divided into the pulpotomy (n= 88) and pulpectomy (n= 42) groups according to treatment procedure. The pulpotomy group was further divided into asymptomatic (n= 46) and symptomatic (n= 42) subgroups according to preoperative symptoms. The chi-squared test and Cox regression were performed to analyze the outcomes. Clinical and radiographic success rates were significantly higher in the pulpotomy group (98.9% and 95.5%) than in the pulpectomy group (88.1% and 54.8%) and did not differ significantly between asymptomatic and symptomatic pulpotomy subgroups. Irreversible pulpitis of primary molars with coronal pulp tissue can be successfully treated with iRoot BP Plus pulpotomy. Early intraradicular resorption of materials is the main adverse outcome of Vitapex pulpectomy.

Analgesic intake after pulpotomy and root canal treatment of permanent molars with carious exposure

To compare the patients’ analgesic intake after pulpotomy and root canal treatment and to compare the time span of both endodontic procedures. A total of thirty-four permanent mandibular molars with signs and symptoms of irreversible pulpitis were randomly assigned to a pulpotomy group (n=17) and root canal treatment (RCT) group (n=17). Endodontic procedure duration was recorded for both groups. Analgesic intake for each patient was recorded up to the fourth day post treatment. In management of mature permanent teeth with carious exposure, pulpotomy may be preferred because it is a simple technique requiring less time and patients requires significantly less analgesics postoperatively.

Outcome of partial pulpotomy verses full pulpotomy using biodentine in vital mature permanent molar with clinical symptoms indicative of irreversible pulpitis: A randomized clinical trial.

Aim:The aim of the study is to evaluate and compare the clinical and radiographic outcome of partial pulpotomy and full pulpotomy in mature permanent molars with symptomatic irreversible pulpitis using biodentine.Materials and Methods:A total of 66 vital mature permanent molars with irreversible pulpitis were randomly allocated to a partial pulpotomy (n = 33) and full pulpotomy group (n = 33). Biodentine was used as a pulp capping material which was covered with resin-modified glass ionomer cement (RMGIC) followed by composite restoration. Clinical and radiographic evaluation was done at 3, 6, and 12 months follow-up for tenderness, periapical radiolucency, dentine bridge formation, and root canal calcification. Data from the study were analyzed using a Friedman and Mann–Whitney test and the success rate was analyzed by Chi-square value.Result:No statistically significant difference was found between partial and full pulpotomy (P > 0.05) and the success rate was 80.7% and 92.8%, respectively, at 12 months follow-up period.Conclusion:Both partial and full pulpotomy can be used as a permanent treatment modality in symptomatic irreversible pulpitis of vital mature permanent molars.

Assessment of Clinical and Radiographic Success Rate of Formocresol-based Pulpotomy versus Collagen-based Pulpotomy: An In Vivo Study

The aim of the study is (a) To use collagen as a pulpotomy material in comparison with the gold standard formocresol-based pulpotomy, (b) to assess the clinical and radiographic success rate of formocresol pulpotomy and collagen-based pulpotomy, and (c) to compare the success rate of formocresol-based pulpotomy and collagen-based pulpotomy over a definitive interval of time. Totally 30 primary first or second molars indicated for pulpotomy after confirming with the operative diagnosis were taken as samples for this study. This split-mouth technique consists of two groups: Group 1-formocresol pulpotomy (n = 15), and group 2-collagen-based pulpotomy (n = 15). Both the procedures were done in the same patient on regular appointments. Pre- and postoperative radiographs were taken. The children were recalled for clinical and radiographic follow-up at 2, 4, and 6 months. The success of the procedure was assessed based on clinical signs (pain, tenderness to percussion, abscess, swelling, fistula, and pathologic mobility) and radiographic findings (radicular radiolucency, internal and external root resorption, periodontal ligament (PDL) space widening, and furcation radiolucency). The Chi-square test was used to compare the differences between the groups. The overall success rate for formocresol pulpotomy (n = 15) was 14, 13, and 10 for the second-, fourth-, and sixth-month review period, respectively. For collagen pulpotomy group (n = 15), the overall success rate was 14, 14, and 14 for the second-, fourth-, and sixth-month review period, respectively. The obtained data from the overall success rate were subjected to statistical analysis, and chi-square test was used. The p-value less than 0.1 was considered a statistically significant result. The chi-square value for the fourth- and sixth-month review was 0.37 and 3.33, respectively. Statistically significant value was obtained from the sixth-month review period (p <0.1), which describes that the overall success rate was better for the collagen pulpotomy group when compared with the formocresol pulpotomy group. Collagen had proven to be a very good alternative for formocresol, its biocompatibility, and regenerative efficiency and is a benchmark for a better clinical success rate in dentistry. However, its implication in pulpotomy should be subjected to further comparative research study on mineral trioxide aggregate (MTA), Biodentine, etc. Keywords: Collagen-based pulpotomy, Formocresol-based pulpotomy.

Endodontic procedures produce bacterial droplet contamination - but what about viruses?

Research question The study aims to investigate spread, distance and spatial distribution of aerosolised microorganisms generated through various endodontic procedures.Study design A case-control study carried out at the University of Maryland, US in 2020. The study investigated the aerosolised microorganisms produced during three endodontic treatments: emergency pulpotomy, emergency pulpectomy and non-surgical root canal therapy (NSRCT), with 15 participants in each group (n = 45). Patients diagnosed with symptomatic apical periodontitis were included. The use of settle plates for passive air sampling was employed, in a 4 x 4 m room with closed doors. The number of colony-forming units (CFUs) and composition of bacterial species were analysed. Variables within the study included: distance of plate to patient's mouth (0.5 m or 2 m), positioning of plate (directly in front of or diagonal to the participant's mouth), type of endodontic treatment performed and the duration of treatment. A baseline sample was collected (room at rest) as a control. All dental treatment was carried out under rubber dam, after patients had undergone a pre-operative 0.12% chlorhexidine digluconate mouth rinse for 60 seconds. An extraoral suction system (ADS EOS Dental System Inc; Ontario, CA, USA) was also placed directly in front of the patient's mouth throughout treatment.Results A significantly greater number of CFUs were recorded after endodontic treatments (all treatments), compared to negative control. CFUs were lower in the emergency pulpotomy group compared to the other two groups. There was a significantly lower number of CFUs found at plates situated 0.5 m, compared to 2 m, away from the patient. There was a positive correlation between the procedure duration and CFU count. The main bacterial species detected were Staphylococcus aureus (48.8%), Staphlococcus epidermidis (42.2%) and oral streptococci (33.1%). Pseudomonas aeruginosa and fungi were not detected.Conclusion Emergency pulpectomy and NSRCT created greater microbial contamination than an emergency pulpotomy. Greater numbers of microorganisms were found after longer treatment times and closer to the patient's mouth.