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

Abstract

The objective of this work was to evaluate (1) the short-term evolution of pain and (2) the treatment success of full pulpotomy as permanent treatment of irreversible pulpitis in mature molars. The study consisted of a non-randomized comparison between a test group (n = 44)—full pulpotomy performed by non-specialist junior practitioners, and a control group (n = 40)—root canal treatments performed by specialized endodontists. Short-term pain score (Heft–Parker scale) was recorded pre-operatively, then at 24 hours and 7 days post-operatively. Three outcomes were considered for treatment success: radiographic, clinical and global success. For short-term evolution of pain, a non-parametric Wilcoxon test was performed (significance level = 0.05). For treatment success, a Pearson Chi square or Fisher test were performed (significance level = 0.017–Bonferroni correction). There was no significant difference between test and control groups neither regarding short term evolution of pain at each time point, nor regarding clinical (80% and 90%, respectively) or global success (77% and 67%, respectively). However, a significant difference in radiographic success was observed (94% and 69%, respectively). The present work adds to the existing literature to support that pulpotomy as permanent treatment could be considered as an acceptable and conservative treatment option, potentially applied by a larger population of dentists.

Diagnostic and Prognostic Predictors for the Success of Pulpotomy in Permanent Mature Posterior Teeth with Moderate to Severe Pulpitis: A Scoping Review

“…In addition, pulpotomy preserves other neural functions of the dental pulp dentin complex, including maintenance of the immune defense mechanisms [39,40]. Finally, it is well documented that pulp chamber pulpotomy is an effective treatment for moderate to severe pulpitis, which may have success rates that are similar or even superior to those reported for RCT; Asgary reported an overall success of 98% for RCT versus 99% for CEM or MTA pulpotomy at two years, and Beaquis found pulpotomy had higher success rates than RCT (77% and 67%, respectively) [19,41]. It is important to note that both studies found no significant difference in overall success between the two treatment arms.…”

“…Clinicians and researchers use this classification to categorize periapical health or disease, as well as to recognize healing. Eight studies utilized the PAI scoring system to identify the pre-operative periapical diagnosis and/or the outcome of pulpotomy [41,[46][47][48][49][51][52][53][54]. One study included teeth with and without PARL as defined by the PAI score, but did not provide the number of cases in each classification [53].…”

“…Multiple studies showed that the presence of apical periodontitis, whether radiographic or clinical, does not have a statistically significant impact on the outcome [5,15,46,53]. Two studies included cases with a pre-operative PAI score of 3 [41,46]. Anta et al [51] was the only study included in the review that found that the pre-operative periapical condition affected the outcome.…”

“…The bleeding time has been suggested to be an indicator of the extent of inflammation in the pulp, and therefore a diagnostic factor of pulpitis. Some of the studies did not mention the time taken to achieve hemostasis [5,29,41]. Kumar et al [56] excluded cases where bleeding could not be controlled after "several" minutes, but the specific time period was also not quantified.…”

Evaluation of Bioceramic Putty in Pulpotomy of Immature Permanent Molars With Symptoms of Irreversible Pulpitis

“…Recently, pulpotomy with biocompatible materials has been used as a conservative and simple technique in the management of immature permanent molars affected by irreversible pulpitis relying on the ability of the remaining radicular pulp to recover after the removal of the inflamed coronal tissues where this technique showed a high and acceptable success rate [7][8][9] as studies noted a weak relationship between pulp's histological status and the patient's symptoms [10]. In multiple studies, MTA showed a high success rate in the treatment of immature permanent molars affected by irreversible pulpitis [11,12].…”