Influence of occlusal and proximal caries on the outcome of full pulpotomy in permanent mandibular molar teeth with partial irreversible pulpitis: A prospective study

Abstract

Aim To assess the influence of occlusal and proximal deep carious lesions on the outcome of full pulpotomy performed in mandibular teeth with pulpal diagnosis of symptomatic partial irreversible pulpitis. Methodology Eighty deep carious mandibular molar teeth with clinical and radiographic diagnosis of symptomatic partial irreversible pulpitis without periapical rarefaction from patients of either gender between the age of 16–35 years were included. Depending upon the location of deep carious lesion, the teeth were distributed equally into occlusal (n = 40) and proximal caries groups (n = 40). Full pulpotomy was performed under local anaesthesia and aseptic conditions. The pulp tissue was removed until the root canal orifices, and 2.5% sodium hypochlorite (NaOCl) was applied to arrest pulpal bleeding. Mineral trioxide aggregate (MTA) was compacted over the radicular pulp. Teeth were restored with resin‐modified glass ionomer cement (RMGIC) and bulk‐fill composite resin. Pre‐ and post‐operative pain was assessed at 24, 48 and 72 h using a 11‐point Numerical Rating Scale (NRS). Patients were followed at 6 and 12 months for clinical and radiographic evaluation. Asymptomatic teeth without any radiographic evidence of periapical rarefaction were considered successful. The data were analysed using the Shapiro–Wilk W test, two‐sample Wilcoxon rank‐sum test, Pearson chi‐square test, Fisher's exact test and Kappa coefficient. The significance level was predetermined at p < .05. Result An intergroup comparison revealed that the pre‐ and post‐operative pain scores at 24, 48 and 72 h were not significantly different (p > .05). At the end of follow‐up period (12 months), success of full pulpotomy in occlusal and proximal caries group was 95% and 92.5%, respectively (p = .644). For both groups, the combined success rate of full pulpotomy was 93.75%. Conclusion The site of carious lesions (i.e., occlusal or proximal) did not affect the clinical and radiographic outcome of full pulpotomy performed in mature permanent mandibular teeth with symptomatic partial irreversible pulpitis.

Short-Term Pain Evolution and Treatment Success of Pulpotomy as Irreversible Pulpitis Permanent Treatment: A Non-Randomized Clinical Study

“…The incidence (11.4%) of clinical failure observed within the first 12 months following the test procedure is in line with the data available in the literature [4][5][6][7]. The overall clinical success rate was 80% in our work, all clinical failures were related to pain and not to other clinical signs, and lead to re-intervention via standard root-canal treatment.…”

“…One of the limitations of the study is the modest sample size in each group, but it is relatively in the same range as most available studies on the topic of vital pulp therapy of irreversible pulpitis [4][5][6], except one works with a much larger sample size [12]. In terms of follow-up, apart from the latter providing results at five years, the present study provides the longest duration with an average of 25 months.…”

“…However, a trend towards more conservative strategies has been observed in recent years notably the consideration of pulpotomy as a permanent treatment [4][5][6][7]. This evolution is related to improved knowledge in pulp biology and biomaterials.…”