Outcomes of partial pulpotomy in permanent molars of children with irreversible pulpitis: A prospective cohort study.

Vital pulp therapy is gaining traction in dental practice, especially for young patients. To evaluate the outcomes of partial pulpotomy in permanent molars of children diagnosed with irreversible pulpitis (IP) using iRoot BP Plus. A total of 94 permanent molars in 88 patients, aged 6-15 years, with symptoms of IP, were treated with partial pulpotomy, using iRoot BP Plus as the pulp capping agent. The treated teeth underwent clinical and radiographic assessments at 1, 6, 12, 18, and 24 months postoperative. The outcomes were determined based on clinical and radiographic criteria by calibrated examiners. The success rates were 98.4% (63/64), 93.2% (41/44), and 89.7% (26/29) at the 6-month, 12-month, and 24-month follow-up. By the end of this study, the median follow-up period was 15.1 months, and the estimated survival rate was 95.2% at 24 months. Gender, root maturity, and number of missing walls had no significant effect on success rates. Six molars were failed, and root canal therapy (RCT) was applied. Partial pulpotomy for permanent molars with IP in young patients using iRoot BP Plus as pulp capping material achieved high success. This method presents a viable alternative to apexification and RCT for treating vital, inflamed molars with IP in children.

Zheng J ，Ding M ，Zhang S ，Ren Y ，Wen Q ... -  《-》

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

Vital 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). A 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. FP 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). FP could be an appropriate alternative treatment for management of mature teeth with IP in short follow-up. The trial was registered in Chinese Clinical Trial Registry (ChiCTR2200063380 at 05/09/2022).

Zhu L ，Liu W ，Deng X ，Chen Z ，Chen J ，Qian W ... -  《BMC Oral Health》

Optimal outcomes of pulpotomy in young patients: Long-term prospects for permanent molars with signs and symptoms indicative of irreversible pulpitis.

Limited literature addresses the long-term success of complete pulpotomy in permanent molars with signs of irreversible pulpitis in young patients. The aim of this observational study was to prospectively evaluate the long-term outcomes of complete pulpotomy using mineral trioxide aggregate (MTA) over an average period exceeding 11 years. Out of 27 molars displaying signs suggestive of irreversible pulpitis which underwent MTA pulpotomy, 24 molars were followed-up for a mean duration of 11.0 ± 2.2 years (range 8.2 to 14.8 years). Clinical and radiographic assessments were periodically conducted, tailored to each patient's specific circumstances. Treatment failure criteria included clinical signs and symptoms and radiographic evidence suggesting a lack of pulpal or periapical healing. 83 % of molars had signs and symptoms of symptomatic irreversible pulpitis, with 83 % displaying apical periodontitis. Clinically and radiographically, all pulpotomies (100 %) were considered successful. A hard tissue barrier was observed in 71 % of teeth, and continued root maturation was evident in all molars with open apices. Complete pulp canal obliteration (PCO) was present in 21 % of the molars. All radiographic apical radiolucencies completely resolved. This study demonstrates a 100 % success rate over an average 11-year follow-up for complete pulpotomy in managing permanent molars with signs and symptoms of irreversible pulpitis in young patients. It offers evidence for its long-term efficacy in promoting healing of pulp and periapical tissues. This study showed high long-term success for complete pulpotomy in young permanent molars with irreversible pulpitis, with clinical and radiographic success over 11 years. Despite initial symptoms of pulpitis and apical periodontitis, the treatment resulted in tissue healing, root maturation, and resolution of periapical radiolucencies, suggesting it as an alternative to root canal therapy.

Alyahya A ，Qudeimat MA 《-》

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.

Ramani A ，Sangwan P ，Duhan J ，Popat S ，Sangwan A ... -  《-》

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.

Louzada LM ，Hildebrand H ，Neuhaus KW ，Duncan HF ... -  《-》