Partial pulpotomy without age restriction: a retrospective assessment of permanent teeth with carious pulp exposure

Abstract

Objectives This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure. Materials and methods Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan–Meier statistics. The level of significance was set at α = 0.05. Results Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18–85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged < 30 years, between 30 and 40 years, and > 40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively. Conclusions Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure. Clinical relevance Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients’ age.

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“…Another long-term study showed that at the end of the follow-up period (12 months), the success of complete pulpotomy in the occlusal and proximal caries group was 95% and 92.5%, respectively (p = 0.644) [31] . Finally, the overall success rate in maintaining pulp vitality in this study was 89.1%, with a tooth survival of 98.4% [32] .…”

Minimally invasive endodontics: a new era for pulpotomy in mature permanent teeth

“…Pulpotomy has traditionally not been part of the treatment considerations for mature permanent teeth diagnosed with irreversible pulpitis. However, there is now increasing evidence from retrospective studies, 54,55,56 prospective cohort studies 40,41,47,57,58,59,60 and randomised controlled trials, 39,42,43,44,45,46,61,62,63,64,65,66,67,68,69,70 showing high success rates for pulpotomy in treating mature permanent teeth with irreversible pulpitis or carious pulp exposures (online Supplementary Table 1). Systematic reviews, meta-analyses and recent umbrella reviews (Table 2) have also concluded that pulpotomy could be a prospective substitute to conventional RCTx in managing vital mature permanent teeth diagnosed with irreversible pulpitis or carious pulp exposure.…”

Pulpotomie beim bleibenden Zahn – Möglichkeiten und Grenzen

“…Früher wurde angenommen, dass vitalerhaltende Maßnahmen bei älteren Patienten, deren Pulpagewebe verglichen mit jenem von jüngeren Patienten weniger zellreich ist, ungünstigere Erfolgsaussichten hätten. Wenngleich das Pulpagewebe im jungen Alter tatsächlich ein höheres Regenerationspotenzial besitzt, weisen Studien darauf hin, dass das Patientenalter keinen signifikanten Einfluss auf die Erfolgswahrscheinlichkeit einer partiellen Pulpotomie hat 15 , 16 . Auch das Stadium des Wurzelwachstums beeinflusst die Prognose nicht wesentlich 15 .…”