The aim of this study was to compare the outcome of partial pulpotomies in cariously exposed pulps of young permanent molars using mineral trioxide aggregate (MTA) and calcium hydroxide in a randomized controlled trial.
Eighty-four teeth in 80 patients (aged 7-10yrs) having one or two first permanent molars with deep occlusal carious lesions that resulted in cariously exposed pulps were included. All teeth were diagnosed as having reversible pulpitis and had class I cavities suitable for amalgam restoration. Patients were offered root canal treatment or extraction if indicated during the study period. Using local anaesthesia and under rubber dam cavity preparation took place with high-speed handpiece with water coolant, large round bur in a low-speed handpiece and spoon excavators were used to excavate all of the carious dentine. Exposed pulp tissue was removed to a depth of 2–3 mm and irrigated with 2.5% sodium hypochlorite. Pulp-capping material was randomly allocated 40 patients (44 teeth) received MTA and 40 patients (40 teeth) received calcium hydroxide (CaOH). The pulp cap material was covered with glass ionomer ( 2-3mm) and the remaining cavity restored with amalgam and post operative radiograph taken. Patients were revived at 24hrs for clinical symptoms and reviewed radiographically and clinically after 3-, 6-, 12- and 24-month intervals. Clinical and radiographic reviews were conducted by examiners blinded to the capping materials used. Treatment outcome was considered as unfavourable if one or more of the following were present: pain, swelling, sinus tract, tenderness to percussion, evidence of periradicular or furcation pathosis, root resorption or a lack of continuation of root development in immature teeth.
- There were 4 drop outs from the CaOH group and 2 from the MTA group
- The median survival time for both groups was 24 months
- 2 teeth from the MTA group and 1 tooth from the CaOH group were extracted
- Incidence rates/100 tooth months of unfavourable outcomes for: –
- MTA 0.20 (95% CI: 0.02–0.71)
- CaOH 0.11 (95% CI:0.001–0.60)
- Small pulp exposures (<5 mm2) 0.05 (95% CI: 0.001–0.30)
- Large pulp exposures (>5 mm2) 2.38 (95% CI: 0.29–8.34)
The authors concluded
Partial pulpotomy in teeth of young patients with reversible pulpitis, either using MTA or CaOH, resulted in favourable treatment outcomes for up to 2 years. The incidence of unfavourable outcomes tended to be higher in teeth with pulp exposure areas larger than 5 mm2.
Comment
We have covered a number of studies and reviews over the past two years that have looked at this topic (see Links) and it has been seen for many years as the treatment of choice for managing deep carious lesions with exposed pulps. However, there is increasing interest in using the more conservative approach of stepwise caries removal for the management of these lesions. There have been two reviews that have looked at this approach, one by Schwendicke et al (Dental Elf – 11th Feb 2013) and the more recent Cochrane review by Ricketts et al ( Dental Elf -11th April 2013), although, only included studies are only relatively short term (12 months) so more information is need to see which of the approaches results in the better longer term outcomes.
Links
Chailertvanitkul P, Paphangkorakit J, Sooksantisakoonchai N, Pumas N, Pairojamornyoot W, Leela-Apiradee N, Abbott PV. Randomized control trial comparing calcium hydroxide and mineral trioxide aggregate for partial pulpotomies in cariously exposed pulps of permanent molars. Int Endod J. 2013 Dec 3. doi: 10.1111/iej.12225. [Epub ahead of print] PubMed PMID: 24299006.
Dental Elf – 2nd Nov 2012 -Vital pulp therapy for permanent teeth
