Root Canal Therapy or Pulpotomy?

doi:10.13701/j.cnki.kqyxyj.2023.01.001

Abstract

Abstract: After hundreds of years of development, root canal therapy (RCT) has been considered as a standard technique in Endodontics. At the meantime, the importance of preserving vital pulp has been realized and the concept of vital pulp therapy (VPT) gradually formed. The continuous emergence of new technologies and bioactive materials has enabled many immature permanent teeth to maintain their pulp vitality. So, could mature permanent teeth also preserve pulp vitality via pulpotomy? More and more clinical trials and evidence-based medicine have demonstrated that pulpotomy have had the same success rate for irreversible pulpitis of mature permanent teeth as RCT. Is it actually possible to utilize pulpotomy as an alternative to root canal treatment for irreversible pulpitis treatment?

Key words: pulpotomy, root cannel therapy, mature permanent teeth, irreversible pulpitis

CHEN Zhi, ZHOU Linfang. Root Canal Therapy or Pulpotomy?[J]. Journal of Oral Science Research, 2023, 39(1): 1-10.

References

[1] 岳林,王嘉德.感染牙髓的治疗思路及方法评价[J].中华口腔医学杂志,2002,37(5):4-6.
[2] Yang J, Yuan G, Chen Z. Pulp regeneration: Current approaches and future challenges[J]. Front Physiol, 2016, 7:58.
[3] Schmalz G, Widbiller M, Galler KM. Clinical perspectives of pulp regeneration [J]. J Endod, 2020, 46(9S):S161-S174.
[4] Duncan HF, Galler KM, Tomson PL, et al. European Society of Endodontology position statement: Management of deep caries and the exposed pulp [J]. Int Endod J, 2019, 52(7):923-934.
[5] AAE position statement on vital pulp therapy [J]. J Endod, 2021, 47(9):1340-1344.
[6] 陈嘉琪,董艳梅.龋源性露髓成熟恒牙活髓保存治疗的研究进展[J].中华口腔医学杂志,2022,57(1):95-100.
[7] 何文喜,余擎.牙髓炎的活髓保存及再生治疗新进展:从基础到临床[J].中华口腔医学杂志,2022,57(1):16-22.
[8] Philip N, Suneja B. Minimally invasive endodontics: a new era for pulpotomy in mature permanent teeth [J]. Brit Dent J, 2022, 233(12): 1035-1041.
[9] Lin LM, Ricucci D, Saoud TM, et al. Vital pulp therapy of mature permanent teeth with irreversible pulpitis from the perspective of pulp biology [J]. Aust Endod J, 2020, 46(1):154-166.
[10] Farges JC, Alliot-Licht B, Renard E, et al. Dental pulp defence and repair mechanisms in dental caries [J]. Mediators Infamm, 2015,2015: 230251.
[11] Nagaoka S, Miyazaki Y, Liu HJ, et al. Bacterial invasion into dentinal tubules of human vital and nonvital teeth [J]. J Endod, 1995, 21(2):70-73.
[12] Caplan DJ, Cai J, Yin G, et al. Root canal filled versus non-root canal filled teeth: a retrospective comparison of survival times [J]. J Public Health Dent, 2005, 65(2):90-96.
[13] Kawahara H, Inoue M, Okura K, et al. Risk factors for tooth loss in patients with ≥25 remaining teeth undergoing mid-long-term maintenance: A retrospective study [J]. Int J Environ Res Public Health, 2021, 18(13):7174.
[14] Tada S, Ikebe K, Matsuda K, et al. Multifactorial risk assessment for survival of abutments of removable partial dentures based on practice-based longitudinal study [J]. J Dent, 2013, 41(12):1175-1180.
[15] Wegner PK, Freitag S, Kern M. Survival rate of endodontically treated teeth with posts after prosthetic restoration [J]. J Endod, 2006, 32(10):928-931.
[16] Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health [J]. Int Endod J, 2011, 44(7):583-609.
[17] zgür B, Uysal S, Güngör HC. Partial pulpotomy in immature permanent molars after carious exposures using different hemorrhage control and capping materials [J]. Pediatr Dent, 2017, 39(5):364-370.
[18] Jeanneau C, Lundy FT, El Karim IA, et al. Potential therapeutic strategy of targeting pulp fibroblasts in dentin-pulp regeneration [J]. J Endod, 2017, 43(9S):S17-S24.
[19] Ricucci D, Siqueira JF, Li Y, et al. Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure [J]. J Dent, 2019, 86:41-52.
[20] Cooper PR, Holder MJ, Smith AJ. Infammation and regeneration in the dentin-pulp complex: a double-edged sword [J]. J Endod, 2014, 40(4 Suppl):S46-S51.
[21] Simon S, Perard M, Zanini M, et al. Should pulp chamber pulpotomy be seen as a permanent treatment? Some preliminary thoughts [J]. Int Endod J, 2013, 46(1):79-87.
[22] Asgary S, Eghbal MJ, Fazlyab M, et al. Five-year results of vital pulp therapy in permanent molars with irreversible pulpitis: a non-inferiority multicenter randomized clinical trial [J]. Clin Oral Investig, 2015, 19(2):335-341.
[23] Asgary S, Eghbal MJ, Shahravan A, et al. Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: a randomized controlled trial [J]. Clin Oral Investig, 2022, 26(3): 3287-3297.
[24] Taha NA, Ahmad MB, Ghanim A. Assessment of mineral trioxide aggregate pulpotomy in mature permanent teeth with carious exposures [J]. Int Endod J, 2017, 50(2):117-125.
[25] Taha NA, Al-Khatib H. 4-year follow-up of full pulpotomy in symptomatic mature permanent teeth with carious pulp exposure using a stainproof calcium silicate-based material [J]. J Endod, 2022, 48(1):87-95.
[26] Taha NA, Khazali MA. Partial pulpotomy in mature permanent teeth with clinical signs indicative of irreversible pulpitis: A randomized clinical trial [J]. J Endod, 2017, 43(9):1417-1421.
[27] Taha NA, Al-Rawash MH, Imran ZA. Outcome of full pulpotomy in mature permanent molars using 3 calcium silicate-based materials: A parallel, double blind, randomized controlled trial [J]. Int Endod J, 2022, 55(5):416-429.
[28] Qian K, Pan J, Zhu WH, et al. Evaluation of bioceramic putty repairmen iRoot and mineral trioxide aggregate in mature permanent teeth pulpotomy [J]. Beijing Da Xue Xue Bao Yi Xue Ban, 2022, 54(1):113-118.
[29] Galani M, Tewari S, Sangwan P, et al. Comparative evaluation of postoperative pain and success rate after pulpotomy and root canal treatment in cariously exposed mature permanent molars: A randomized controlled trial [J]. J Endod, 2017, 43(12):1953-1962.
[30] Eghbal MJ, Haeri A, Shahravan A, et al. Postendodontic pain after pulpotomy or root canal treatment in mature teeth with carious pulp exposure: A multicenter randomized controlled trial [J]. Pain Res Manag, 2020, 2020:5853412.
[31] Asgary S, Hassanizadeh R, Torabzadeh H, et al. Treatment outcomes of 4 vital pulp therapies in mature molars [J]. J Endod, 2018, 44(4):529-535.
[32] Ramani A, Sangwan P, Tewari S, et al. Comparative evaluation of complete and partial pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis: A randomized clinical trial [J]. Int Endod J, 2022, 55(5):430-440.
[33] Asgary S, Eghbal MJ, Ghoddusi J, et al. One-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicentre, randomized, non-inferiority clinical trial [J]. Clin Oral Investig, 2013, 17(2):431-439.
[34] Asgary S, Eghbal MJ, Ghoddusi J. Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicentre randomized clinical trial [J]. Clin Oral Investig, 2014, 18:635-641.
[35] Alqaderi HE, Al-Mutawa SA, Qudeimat MA. MTA pulpotomy as an alternative to root canal treatment in children's permanent teeth in a dental public health setting [J]. J Dent, 2014, 42(11): 1390-1395.
[36] Asgary S, Eghbal MJ, Bagheban AA. Long-term outcomes of pulpotomy in permanent teeth with irreversible pulpitis: a multi-centre randomized controlled trial [J]. Am J Dent, 2017, 30(3): 151-155.
[37] Linsuwanont P, Wimonsutthikul K, Pothimoke U, et al. Treatment outcomes of mineral trioxide aggregate pulpotomy in vital permanent teeth with carious pulp exposure: The retrospective study [J]. J Endod, 2017, 43(2): 225-230.
[38] Kang CM, Sun Y, Song JS, et al. A randomized controlled trial of various MTA materials for partial pulpotomy in permanent teeth [J]. J Dent, 2017, 60:8-13.
[39] Taha NA, Abdelkhader SZ. Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis [J]. Int Endod J, 2018, 51(8):819-828.
[40] Tan SY, Yu VSH, Lim KC et al. Long-term Pulpal and restorative outcomes of pulpotomy in mature permanent teeth [J]. J Endod, 2020, 46(3):383-390.
[41] Sharma R, Kumar V, Logani A, et al. Association between concentration of active MMP-9 in pulpal blood and pulpotomy outcome in permanent mature teeth with irreversible pulpitis-a preliminary study [J]. Int Endod J, 2021, 54(4):479-489.
[42] Careddu R, Duncan HF. A prospective clinical study investigating the effectiveness of partial pulpotomy after relating preoperative symptoms to a new and established classification of pulpitis [J]. Int Endod J, 2021, 54(12):2156-2172.
[43] Zhang M, Xiong Y, Wang X, et al. Factors affecting the outcome of full pulpotomy in permanent posterior teeth diagnosed with reversible or irreversible pulpitis [J]. Sci Rep, 2022, 12(1):20280.
[44] Jassal A, Nawal RR, Yadav S, et al. Outcome of partial and full pulpotomy in cariously exposed mature molars with symptoms indicative of irreversible pulpitis: A randomized controlled trial [J]. Int Endod J, 2022.
[45] Zanini M, Hennequin M, Cousson P. A review of criteria for the evaluation of pulpotomy outcomes in mature permanent teeth [J]. J Endod, 2016, 42(8):1167-1174.
[46] Duncan HF, El-Karim I, Dummer PMH, et al. Factors that influence the outcome of pulpotomy in permanent teeth [J]. Int Endod J, 2022.
[47] Alqaderi H, Lee CT, Borzangy S, et al. Coronal pulpotomy for cariously exposed permanent posterior teeth with closed apices: A systematic review and meta-analysis [J]. J Dent, 2016, 44:1-7.
[48] Li Y, Sui B, Dahl C, et al. Pulpotomy for carious pulp exposures in permanent teeth: A systematic review and meta-analysis [J]. J Dent, 2019, 84:1-8.
[49] Cushley S, Duncan HF, Lappin MJ, et al. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review [J]. J Dent, 2019, 88:103158.
[50] Elmsmari F, Ruiz XF, Miro Q, et al. Outcome of partial pulpotomy in cariously exposed posterior permanent teeth: A systematic review and Meta-analysis [J]. J Endod, 2019, 45(11):1296-1306.
[51] Santos JM, Pereira JF, Marques A, et al. Vital pulp therapy in permanent mature posterior teeth with symptomatic irreversible pulpitis: A systematic review of treatment outcomes [J]. Medicina (Kaunas), 2021, 57(6):573.
[52] Lin GSS, Hisham ARB, Cher CIY, et al. Success rates of coronal and partial pulpotomies in mature permanent molars: a systematic review and single-arm meta-analysis[J]. Quintessence Int, 2021, 52:196-208.
[53] Skitioui M, Seck A, Niang SO, et al. The treatment of mature permanent teeth with irreversible pulpitis by cervical pulpotomy: A systematic review[J]. Aust Endod J, 2022.
[54] Leong DJX, Yap AU. Vital pulp therapy in carious pulp-exposed permanent teeth: an umbrella review[J]. Clin Oral Investig, 2021, 25(12):6743-6756.
[55] Linsuwanont P, Wimonsutthikul K, Pothimoke U, et al. Treatment outcomes of mineral trioxide aggregate pulpotomy in vital permanent teeth with carious pulp exposure: The retrospective study [J]. J Endod, 2017, 43(2): 225-230.
[56] 张露,陈智.生物活性材料在牙髓治疗中的应用[J].中华口腔医学杂志,2022,57(1):31-37.
[57] Mainkar A, Kim SG. Diagnostic accuracy of 5 dental pulp tests: A systematic review and Meta-analysis [J]. J Endod, 2018, 44(5):694-702.
[58] Ricucci D, Loghin S, Siqueira JF. Correlation between clinical and histologic pulp diagnoses [J]. J Endod, 2014, 40(12):1932-1939.
[59] Wolters WJ, Duncan HF, Tomson PL, et al. Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs [J]. Int Endod J, 2017, 50(9):825-829.
[60] Careddu R, Duncan HF. A prospective clinical study investigating the effectiveness of partial pulpotomy after relating preoperative symptoms to a new and established classification of pulpitis[J]. Int Endod J, 2021, 54(12):2156-2172.
[61] Yong D, Cathro P. Conservative pulp therapy in the management of reversible and irreversible pulpitis [J]. Aust Dent J, 2021, 66(S1):S4-S14.