Abstract
Subjects Selection
This randomized clinical trial included 61 patients who were referred to the graduate endodontic clinics for management of deep symptomatic caries during a period of 4 months. The patients had to be aged >= 20 years with permanent molars that had symptomatic deep carious lesions (>2/3 extending into dentin). The teeth had to be restorable, have a positive cold test, normal mobility, and probing depth without signs of pulpal necrosis. Teeth with immature roots, swellings, or sinus tract were excluded. Teeth with uncontrolled bleeding within 6 minutes after pulpotomy or without pulp exposure upon caries removal were excluded as well.
Key Study Factor
This study investigated the success rate of mineral trioxide aggregate (MTA) partial pulpotomy in comparison to calcium hydroxide (CH) in symptomatic mature permanent molars. After clinical and radiographic examination, the teeth were anesthetized and isolated with rubber dam. Between 2 and 3 mm of exposed pulpal tissue was amputated, then cleaned with 2.5% NaOCl for 23 minutes. Once hemostasis is achieved, teeth were randomly allocated to receive white ProRoot MTA (Dentsply, Tulsa, OK) (27 teeth in 11 male and 16 female patients) or CH (23 teeth in 12 male and 11 female patients). In the MTA group, a cotton pellet and interim coronal seal were placed for 1 week. If teeth were asymptomatic and MTA setting was confirmed, a layer of Vitrebond (3M ESPE, St Paul, MN) was placed and the tooth was permanently treated with amalgam or composite. In the CH group, Vitrebond was placed immediately over CH, and the final restoration was placed. Clinical and radiographic evaluations were performed at 6 months, 1 year, and 2 years postoperatively.
Main Outcome Measure
The main outcome of the study was the clinical and radiographic success rate of the partial pulpotomy in both groups (MTA and CH). A clinically successful case was considered when there was no history of spontaneous pain or discomfort at rest or during chewing, a positive cold test, no tenderness to percussion or palpation, normal mobility, and normal soft tissues around the tooth without sinus tract or swelling. A radiographically successful case was considered if there are no signs of intraradicular pathosis, internal resorption, or root resorption, and the periapical index was <3. Radiographic evaluation was checked by a blinded endodontist with high intraobserver reliability (Kappa 5 0.95).
Main Results
MTA pulpotomy was successful in 85% of the cases, whereas 43% of CH cases were successful. Immediate failure occurred in 4 cases (1 in the MTA arm and 3 in the CH arm). After 6 months, 12 cases failed (MTA: 4, CH: 8) with no statistically significant difference between the 2 approaches (P = .1). After 1 year of follow-up, 13 cases failed (MTA: 4, CH: 9) with no statistically significant difference between the approaches (P = .052). At 2 years of follow-up, 17 cases failed, with more CH cases than MTA cases (MTA: 4, CH: 13). This difference was statistically significant (P = .006). There was no statistically significant difference in success rate between MTA and CH by gender (P = .764).
Conclusions
MTA partial pulpotomy can be used for the management of symptomatic mature permanent molars with a success rate of >80% after 2 years of follow-up. However, CH is not a suitable alternative in these cases. A longer duration of follow-up until 5 years after treatment is recommended.