Search

Aim: The study aimed to compare the outcome of complete pulpotomy (CP) and partial pulpotomy (PP) techniques when utilised for the management of mature permanent teeth with carious pulpal exposure and symptomatic irreversible pulpitis (SIP). Methodology: The study protocol was registered with ClinicalTrials.gov (NCT04397315). One hundred and six permanent mandibular molars with carious pulpal exposure and clinical diagnosis of SIP with periapical index ≤2, from patients aged between 18 and 40 years were randomly allocated in equal proportion to either CP or PP group. Allocated procedures were performed using standardised protocols. The allocated procedure was abandoned in cases where pulpal bleeding could not be controlled within 6 min using cotton pellets soaked in 3% sodium hypochlorite. MTA was used as a pulpotomy agent and teeth were restored using a base of glass ionomer followed by composite restoration. The pain was recorded by the patient preoperatively before administration of local anaesthesia and postoperatively every 24 h for 1 week using visual analogue scale. Success was analysed at 12 months based on clinical and radiographic examination. Mann–Whitney U test was used to compare age, pain scores and mean analgesic consumption between the groups. Categorical data were analysed using chi‐square test. Fisher's exact test was used to assess the clinical and radiographic success and incidence of pain. Kaplan–Meier analysis was used to assess the survival of teeth. A p‐value <.05 was considered as statistically significant. Results: One hundred and one patients were analysed at follow up. Higher success was observed in CP (89.8%) in comparison to PP group (80.8%), but the difference was non‐significant statistically (p =.202). Although no significant difference was observed in pain incidence between the groups at 24 h (p =.496), a significant difference in pain intensities was observed between groups at all the tested time intervals, with lower values reported in CP group (p <.05). Conclusions: Both CP and PP resulted in favourable outcomes in the management of cariously exposed permanent teeth with signs indicative of SIP. Given the more conservative nature of PP, it may be attempted first before proceeding to CP in such cases. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: To investigate the correlation between the concentration of active‐matrix metalloproteinases‐9 (aMMP‐9) in pulpal blood and the outcome of pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis (SIP). Methodology: Forty permanent molar teeth with a clinical diagnosis of SIP and normal apical tissues with periapical index (PAI) score ≤ 2 and ten permanent teeth (8 molars and two premolars) with a diagnosis of normal pulp that required root canal treatment for prosthetic reasons from patients between the ages of 15–35 years were recruited. All clinical procedures were performed under local anaesthesia and rubber dam isolation. After access opening, the coronal pulp tissue was amputated up to the canal orifice. A 100 μL volume of the pulpal blood was collected using a micropipette and transported to the laboratory. Sodium hypochlorite (2.5 %) was used as a haemostatic agent, and mineral trioxide aggregate (MTA) was used as the pulp capping material. The tooth was restored with composite at the same visit. Teeth with normal pulps were treated with single‐visit root canal treatment. Patients with pulpotomy were recalled at 6 and 12 months. Outcome assessment of teeth with pulpotomy was carried out at 12 months and was categorized as success (asymptomatic patients with PAI score ≤ 2) or failure (symptomatic patients or PAI score ≥ 3). Quantification of aMMP‐9 in pulpal blood was achieved using a fluorometric assay. The following statistical analyses were performed to assess the data: t‐test, Fisher's exact test, kappa coefficient, non‐parametric test, Wilcoxon rank‐sum test, Spearman rank correlation test and receiver operating characteristic curve (ROC). Result: The success rate of pulpotomy was 88 % at 12‐months. There was a significant difference between the median concentrations of aMMP‐9 in pulpal blood of teeth with normal pulps (52 (12–96) ng mL−1:) and SIP (193.3 (25.8–607.7) ng mL−1:) (P = 0.0003) and successful (132.3 (25.8–548.3) ng mL−1:) and failed cases (512.4 (334.8–607.7 ng mL−1:) (P = 0.0015) of MTA pulpotomy. A significant association was established between aMMP‐9 concentration and outcome of pulpotomy. The area under the receiver operating characteristics curve (0.9484, 95%CI) suggested excellent discriminatory power of aMMP‐9 concentration in pulpal blood to predict the pulpotomy outcome. Conclusion: The pulpal blood concentration of aMMP‐9 was significantly associated with the outcome of pulpotomy in teeth with symptomatic irreversible pulpitis, where it may be used as a potential prognostic biomarker. [ABSTRACT FROM AUTHOR]

Aim To assess the outcome of mineral trioxide aggregate ( MTA) complete pulpotomy in permanent teeth with carious exposures. Methodology Fifty-two permanent molar teeth with fully developed roots and vital pulps in 43 patients aged 11-51 years were included. Preoperative pulpal and periapical diagnosis was established. After informed consent, each tooth was anaesthetized, isolated with dental dam and disinfected with 5% Na OCl before caries excavation; subsequently, a full pulpotomy was performed. Haemostasis was achieved, and Grey MTA (Angelus, Londrina, Brazil) was placed as the pulpotomy agent; a moist cotton pellet was placed, and the tooth was temporized with the intermediate restorative material ( IRM). Permanent restorations were placed 1 week later if the tooth was asymptomatic, and a postoperative periapical radiograph was taken. Clinical and radiographic evaluation was completed at 3 months, 6 months, 1 year and 3 years postoperatively. Results Clinical signs and symptoms suggestive of irreversible pulpitis were established in 44/52 teeth, and periapical rarefaction was present in 14 teeth. Immediate failure occurred in one tooth. The recall rate ranged from 92% at 3 months to 80.3% at 3 years, with an overall 100% clinical and 97.5% radiographic success during the first year, and 92.7% success at 3 years. All cases with periapical rarefaction were associated with improvement in the periapical index ( PAI) score. Two cases had new periapical rarefaction associated with dislodgment of the permanent restoration. A hard tissue barrier was detected radiographically in 5 cases and canal narrowing in 7 cases. Conclusion MTA full pulpotomy was a successful treatment option for cariously exposed pulps in mature permanent molar teeth. [ABSTRACT FROM AUTHOR]