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Australian Dental Journal Mar 2021Conservative pulp therapy is an alternative treatment option to tooth removal and root canal treatment in the management of deep caries, traumatic pulp exposures and... (Review)
Review
Conservative pulp therapy is an alternative treatment option to tooth removal and root canal treatment in the management of deep caries, traumatic pulp exposures and developmental anomalies. Pulp tissue preservation can extend the long-term survival of teeth through relatively simple restorative procedures. This article aims to update clinicians on the current state of research in materials, techniques and outcomes of vital pulp therapies and provide practical guidelines for their implementation into daily practice.
Topics: Dental Caries; Dental Pulp; Dental Pulp Capping; Humans; Pulpitis; Pulpotomy
PubMed: 33818812
DOI: 10.1111/adj.12841 -
Journal (Canadian Dental Association) 2013
Topics: Acetaminophen; Anti-Inflammatory Agents, Non-Steroidal; Dental Restoration, Permanent; Humans; Ibuprofen; Pulpectomy; Pulpitis
PubMed: 24059490
DOI: No ID Found -
Journal of Dental Research May 2023Rodent animal models for vital pulp therapy are commonly used in dental research because their tooth anatomy and cellular processes are similar to the anatomy and...
Rodent animal models for vital pulp therapy are commonly used in dental research because their tooth anatomy and cellular processes are similar to the anatomy and processes in humans. However, most studies have been conducted using uninfected sound teeth, which makes it difficult to adequately assess the inflammatory shift after vital pulp therapy. In the present study, we aimed to establish a caries-induced pulpitis model based on the conventional rat caries model and then evaluate inflammatory changes during the wound-healing process after pulp capping in a model of reversible pulpitis induced by carious infection. To establish the caries-induced pulpitis model, the pulpal inflammatory status was investigated at different stages of caries progression by immunostaining targeted to specific inflammatory biomarkers. Immunohistochemical staining revealed that both Toll-like receptor 2 and proliferating cell nuclear antigen were expressed in moderate and severe caries-stimulated pulp, indicating that an immune reaction occurred at both stages of caries progression. M2 macrophages were predominant in moderate caries-stimulated pulp, whereas M1 macrophages were predominant in the severe caries-stimulated pulp. Pulp capping in teeth with moderate caries (i.e., teeth with reversible pulpitis) led to complete tertiary dentin formation within 28 d after treatment. Impaired wound healing was observed in teeth with severe caries (i.e., teeth with irreversible pulpitis). During the wound-healing process in reversible pulpitis after pulp capping, M2 macrophages were predominant at all time points; their proliferative capacity was upregulated in the early stage of wound healing compared with healthy pulp. In conclusion, we successfully established a caries-induced pulpitis model for studies of vital pulp therapy. M2 macrophages have an important role in the early stages of the wound-healing process in reversible pulpitis.
Topics: Humans; Rats; Animals; Pulpitis; Dental Caries Susceptibility; Dental Pulp; Dentin, Secondary; Dental Caries; Dental Pulp Capping
PubMed: 36913545
DOI: 10.1177/00220345221150383 -
International Endodontic Journal Sep 2017
Topics: Endodontics; Humans; Minimally Invasive Surgical Procedures; Pulpitis; Severity of Illness Index
PubMed: 28776717
DOI: 10.1111/iej.12793 -
Journal of Dentistry Sep 2019Management of carious teeth with signs and symptoms indicative of irreversible pulpitis is traditionally invasive, but emerging evidence suggests successful treatment...
OBJECTIVES
Management of carious teeth with signs and symptoms indicative of irreversible pulpitis is traditionally invasive, but emerging evidence suggests successful treatment outcomes with less invasive vital pulp treatment such as coronal pulpotomy. The objective of this systematic review is to determine whether coronal pulpotomy is clinically effective in treating carious teeth with signs and symptoms indicative of irreversible pulpitis.
SOURCES
MEDLINE; PubMed; Embase, Web of Science, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform and ClinicalTrials.gov were searched until December 2018.
STUDY SELECTION
Prospective, retrospective and randomised clinical trials investigating coronal pulpotomy or comparing pulpotomy to root canal treatment in permanent mature carious teeth with signs and symptoms indicative of irreversible pulpitis were included. Studies were independently assessed for risk of bias using Cochrane Systematic Reviews of intervention criteria and modified Downs and Black quality assessment checklist.
DATA
Eight articles were selected for analysis. The average success rate for coronal pulpotomy was 97.4% clinical and 95.4% radiographic at 12 month follow-up. This was reduced to 93.97% clinical and 88.39% radiographic success at 36 months follow-up. Results from the only comparative clinical trial showed pulpotomy to have comparable success to root canal treatment at 12, 24 and 60 month follow-up.
CONCLUSIONS
The evidence suggests high success for pulpotomy for teeth with signs and symptoms of irreversible pulpitis, however, results are based on heterogeneous studies with high risk of bias. Well-designed, adequately powered randomised controlled trials are required for evidence to change clinical practice.
CLINICAL SIGNIFICANCE
Management of carious teeth with irreversible pulpitis is traditionally invasive, but emerging evidence suggests potentially successful treatment outcomes with less invasive therapies such as coronal pulpotomy.
Topics: Calcium Compounds; Dental Pulp Capping; Dental Pulp Exposure; Humans; Pulp Capping and Pulpectomy Agents; Pulpitis; Pulpotomy; Root Canal Therapy; Silicates
PubMed: 31229496
DOI: 10.1016/j.jdent.2019.06.005 -
British Dental Journal Apr 2022
Topics: Humans; Molar; Pulpitis; Pulpotomy; Treatment Outcome
PubMed: 35396428
DOI: 10.1038/s41415-022-4164-3 -
The Journal of Physiology May 2006
Review
Topics: Dental Pulp; Humans; Models, Biological; Pulpitis
PubMed: 16581853
DOI: 10.1113/jphysiol.2006.110049 -
British Dental Journal Jul 2020
Topics: Dexamethasone; Humans; Mandibular Nerve; Pulpitis
PubMed: 32651493
DOI: 10.1038/s41415-020-1907-x -
Journal of Endodontics Jun 2023Vital pulp therapy is increasingly practiced as an alternative treatment to root canal therapy (RCT) in teeth with carious pulp exposure. The aim of this study was to... (Randomized Controlled Trial)
Randomized Controlled Trial
A Randomized Controlled Clinical Trial of Pulpotomy versus Root Canal Therapy in Mature Teeth with Irreversible Pulpitis: Outcome, Quality of Life, and Patients' Satisfaction.
INTRODUCTION
Vital pulp therapy is increasingly practiced as an alternative treatment to root canal therapy (RCT) in teeth with carious pulp exposure. The aim of this study was to compare the outcome, quality of life (QOL), and patients' satisfaction after full pulpotomy and RCT in mature teeth with irreversible pulpitis.
METHODS
Sixty mature permanent molar teeth with carious pulp exposure and a diagnosis of irreversible pulpitis were randomly divided into 2 groups (n = 30). The first group was treated with full pulpotomy using Biodentine (Septodont, Saint Maur des Fosses, France), and the second group was treated with RCT. The pain level was recorded preoperatively and at 1, 2, 3, 5, and 7 days. Clinical and radiographic assessments were performed at the 6- and 12-month follow-ups; 1 case in each group did not attend. Based on the Oral Health Impact Profile questionnaire and 7 semantic differential scales, QOL, and patients' satisfaction were evaluated and compared statistically.
RESULTS
Pulpotomy and RCT had comparable success rates (27/29, 93%). Pain levels at day 1 after pulpotomy were significantly lower than after RCT (P = .037), less patients required analgesics (P = .028), and pulpotomy provided pain relief in a shorter time compared with RCT. Both treatments improved the Oral Health Impact Profile QOL of patients without significant differences (60.29, 64.1% at 1 year). Patients' satisfaction with pulpotomy was higher than RCT in terms of the time involved, intraoperative pain, pleasantness, and cost (P < .05).
CONCLUSIONS
Full pulpotomy could be an alternative treatment to RCT in mature teeth with carious pulp exposure and symptomatic irreversible pulpitis based on the clinical and radiographic success rates and patients' satisfaction.
Topics: Humans; Pulpotomy; Pulpitis; Patient Satisfaction; Root Canal Therapy; Calcium Compounds; Silicates; Quality of Life; Treatment Outcome
PubMed: 37080387
DOI: 10.1016/j.joen.2023.04.001 -
International Endodontic Journal Mar 2023The aim of this study was to assess and compare the clinical and radiographic outcome of partial pulpotomy and full pulpotomy using Biodentine in cariously exposed... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The aim of this study was to assess and compare the clinical and radiographic outcome of partial pulpotomy and full pulpotomy using Biodentine in cariously exposed mature molar teeth with symptoms indicative of irreversible pulpitis.
METHODOLOGY
This study is an unicentric, double-arm, randomized superiority clinical trial with parallel experimental groups, registered under CTRI (CTRI/2019/12/022559). Fifty mature permanent molar teeth with carious exposures with symptoms indicative of irreversible pulpitis were randomly allocated equally into two groups. Partial pulpotomy (PP) and full pulpotomy (FP) were performed in the first and second group, respectively, following standardized protocols. Exposed pulp tissue was removed up to a depth of 2-3 mm for partial pulpotomy, whereas complete coronal pulp tissue was removed up to the level of root orifices for full pulpotomy. Haemostasis was achieved with placement of 2.5% sodium hypochlorite-moistened cotton pellets placed on amputated pulp tissue for a maximum of 10 min. Biodentine was used as the pulp capping material. Pain scores were evaluated using 11-point Visual Analogue Scale (VAS) preoperatively, at 24 h, 48 h and 7th day after the intervention(s). Clinical and radiographic evaluation was done at 3 months, 6 months and 1 year. The data were statistically analysed using chi-squared test, Mann-Whitney U-test, Friedman's test and Wilcoxon signed-rank test. The significance level was pre-determined at p < .05. Cumulative survival probabilities were assessed at 12 months using Kaplan-Meier analysis.
RESULTS
Intra-group analysis of pain scores revealed significant reduction in pain scores preoperatively and at 24 h, 48 h and 7th day in both the groups. However, the difference in the pain score(s) reduction between both the groups was not statistically significant at any time interval (p > .05). At 1-year follow-up, the success rate was 88% (22/25) and 91.6% (22/24) for PP and FP respectively (p > .05).
CONCLUSIONS
Partial pulpotomy showed comparable results to full pulpotomy in terms of clinical/radiographic treatment outcome. If the long-term results remain the same, partial pulpotomy can be proposed as an alternative treatment modality for mature teeth with cariously exposed pulp tissue presenting with signs of symptomatic irreversible pulpitis.
Topics: Humans; Pulpotomy; Pulpitis; Calcium Compounds; Molar; Silicates; Treatment Outcome; Pain; Oxides; Drug Combinations; Aluminum Compounds
PubMed: 36403208
DOI: 10.1111/iej.13872