Pulpotomy: An alternative treatment modality to conventional root canal treatment

Authors

DOI:

https://doi.org/10.17159/sadj.v78i06.16948

Keywords:

Apexification, dental pulp, root canal therapy, partial pulpotomy, vital pulp therapy

Abstract

Vital pulp therapy is considered a successful treatment modality in primary and immature permanent teeth. The development of bioactive material has led to vital pulp therapy and pulpotomy treatment becoming a popular treatment modality in permanent teeth. This literature review investigates pulpotomy procedures on permanent teeth as a viable option, as opposed to conventional root canal
treatment, as presented in the case report included.
Aim
The aim of this study is to evaluate literature on the reported success of pulpotomy treatment in mature permanent teeth. For this reason, the study specifically reviewed literature detailing the use of pulpotomies including the materials required for the procedure.
Method
The literature review is focused on studies using MTA and bioactive alternatives as pulpotomy material. An electronic search was done on EBSCOhost to source 58 articles published from 1979 to 2022.
Results
Literature investigated reports that pulpotomy treatment with bioactive materials shows promising results and therefore the possibility exists of it being a suitable treatment option or alternative to conventional root canal treatment.

Downloads

Download data is not yet available.

References

Kratunova E, Silva D. Pulp therapy for primary and immature permanent teeth: An overview. Gen Dent. 2018; 66(6):30-38

Akhlaghi N, Khademi A. Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature. Dent Res J. 2015;12(5):406- 417. doi:10.4103/1735-3327.166187 DOI: https://doi.org/10.4103/1735-3327.166187

Wells C, Dulong C, McCormack S. Vital pulp therapy for endodontic treatment of mature teeth: A review of clinical effectiveness, cost-effectiveness, and guidelines (Internet). Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 https://www.ncbi. nlm.nih.gov/books/NBK546327/

Lopes LB, Calvão C, Vieira FS, Neves JA, Mendes JJ, Machado V, Botelho J. Vital and nonvital pulp therapy in primary dentition: An umbrella review. J. Clin. Med. 2022; 11(1):85. doi.org/10.3390/jcm11010085 DOI: https://doi.org/10.3390/jcm11010085

American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: AAPD; 2021:399-407

Ricucci D, Siqueira JF Jr, Li Y, Tay FR. Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure. J Dent. 2019; 86:41-52. doi:10.1016/j.jdent.2019.05.022 DOI: https://doi.org/10.1016/j.jdent.2019.05.022

American Association of Endodontists (AAE). Guide to clinical endodontics. 4th ed. Chicago: AAE; 2004(4) : 9

Caliskan MK. Pulpotomy of carious vital teeth with periapical involvement. Int Endod J. 1995; 28(3):172-6 DOI: https://doi.org/10.1111/j.1365-2591.1995.tb00293.x

Sadaf D. Success of coronal pulpotomy in permanent teeth with irreversible pulpitis: An evidence-based review. Cureus. 2020; 12(1):e6747. doi:10.7759/cureus.6747 DOI: https://doi.org/10.7759/cureus.6747

Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. J Endod. 1978; 4(8):232-7 DOI: https://doi.org/10.1016/S0099-2399(78)80153-8

Farooq NS, Coll JA, Kuwabara A, Shelton P. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatr Dent. 2000; 22(4):278-86

Elemam RF, Pretty I. Comparison of the success rate of endodontic treatment and implant treatment. ISRN Dent. 2011; 640509. doi:10.5402/2011/6405094 DOI: https://doi.org/10.5402/2011/640509

Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: A systematic review of the literature. Int Endod J. 2010; 43:171-189. doi:10.1111/j.13652591.2009.01671.x DOI: https://doi.org/10.1111/j.1365-2591.2009.01671.x

Caplan DJ, Cai J, Yin G, White BA. Root canal fille versus non-root canal filled teeth: A retrospective comparison of survival times. J Public Health Dent. 2005; 65:90-96. doi:10.1111/j.1752-7325.2005.tb02792.x DOI: https://doi.org/10.1111/j.1752-7325.2005.tb02792.x

Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent. 2016; 10(1):144-147. doi:10.4103/1305-7456.175682 DOI: https://doi.org/10.4103/1305-7456.175682

Ribeiro DM, Henckel MD, Mello FW, Felippe MCS, Felippe WT. Radiographic analysis of the obturation’s quality in root canal treatment performed by a South Brazilian sample of undergraduate students. RGO - Rev Gaúch Odontol. 2019; 67. doi:10.1590/19818637201 90004020180038 DOI: https://doi.org/10.1590/1981-863720190004020180038

Sadaf D, Alsalhy H, Alrothy R, Ahmad M. Prevalence of apical periodontitis in root canal-treated teeth from an urban Saudi female population: influence of root canal fillings and coronal restorations. Int J Oral Health Sci. 2017; 7:82-85. doi:10.4103/ijohs.ijohs_46_17 DOI: https://doi.org/10.4103/ijohs.ijohs_46_17

Kabak Y, Abbott PV. Prevalence of apical periodontitis and the quality of endodontic treatment in an adult Belarusian population. Int Endod J. 2005; 38:238-245. doi:10.1111/j.13652591.2005.00942.x DOI: https://doi.org/10.1111/j.1365-2591.2005.00942.x

Pitt-Ford TR, Harty FJ. Harty’s endodontics in clinical practice. 5th ed. Edinburgh: Wright; 2004(5): 37-49

Kojima K, Inamoto K, Nagamatsu K et al. Hara A, Nakata K, Morita I, Nakagaki H, Nakamura H. The success rate of endodontic treatment of teeth with vital and nonvital pulps. A meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 97:95-99. doi:10.1016/j.tripleo. 2003.07.006

Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: a systematic review of the literature - Part 2. Influence of clinical factors. Int Endod J. 2008; 41:6-31. doi:10.1111/j.1365-2591.2007.01323.x DOI: https://doi.org/10.1111/j.1365-2591.2007.01323.x

Randow K, Glantz PO. On cantilever loading of vital and non-vital teeth. An experimental clinical study. Acta Odontol Scand. 1986; 44:271-277. doi:10.3109/00016358609004733 DOI: https://doi.org/10.3109/00016358609004733

Ou KL, Chang CC, Chang WJ, Lin CT, Chang KJ, Huang HM. Effect of damping properties on fracture resistance of root-filled premolar teeth: a dynamic finite element analysis. Int Endod J. 2009; 42:694-704. doi:10.1111/j.1365-2591.2009.01570.x DOI: https://doi.org/10.1111/j.1365-2591.2009.01570.x

Asgary S, Eghbal MJ, Ehsani S. Periradicular regeneration after endodontic surgery with calcium-enriched mixture cement in dogs. J Endod. 2010; 36:837-841. doi:10.1016/j.joen.2010.03.005 DOI: https://doi.org/10.1016/j.joen.2010.03.005

Nosrat A, Peimani A, Asgary S. A preliminary report on the histological outcome of pulpotomy with endodontic biomaterials vs calcium hydroxide. Restore Dent Endod. 2013; 38:227-233. doi:10.5395/red.2013.38.4.227 DOI: https://doi.org/10.5395/rde.2013.38.4.227

Qudeimat MA, Barrieshi-Nusair KM, Owais AI. Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries. Eur Arch Paediatr Dent. 2007; 8(2):99-104

American Academy of Pediatric Dentistry (AAPD). Guideline on pulp therapy for primary and immature permanent teeth; 2022:415-23 available at http://www.aapd.org/media/policies_guidelines/g_pulp.pdf

Barngkgei IH, Halboub ES, Alboni RS. Pulpotomy of symptomatic permanent teeth with carious exposure using mineral trioxide aggregate. Iran Endod J. 2013; 8(2):65-68

Karabucak B, Li D, Lim J, Iqbal M. Vital pulp therapy with mineral trioxide aggregate. Dent Traumatol. 2005; 21(4):240-3. doi:10.1111/j.1600-9657.2005.00306.x DOI: https://doi.org/10.1111/j.1600-9657.2005.00306.x

Nair PN, Duncan HF, Pitt Ford TR, Luder HU. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial. Int Endod J.2008; 41(2): 128-50. doi: 10.1111/j.1365-2591.2007.01329.x DOI: https://doi.org/10.1111/j.1365-2591.2007.01329.x

Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA. The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study. J Am Dent Assoc. 2006; 137(12):1699-705 DOI: https://doi.org/10.14219/jada.archive.2006.0116

Accorinte MLR, Holland R, Reis A, Bortoluzzi MC, Murata SS, Dezan E, Souza V, Alessandro LD. Evaluation of mineral trioxide aggregate and calcium hydroxide cement as pulp-capping agents in human teeth. J Endod. 2008; 34(1):1-6 DOI: https://doi.org/10.1016/j.joen.2007.09.012

Qudeimat MA, Barrieshi-Nusair KM, Owais AI. Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries. Eur Arch Paediatr Dent. 2007; 8(2):99-104 DOI: https://doi.org/10.1007/BF03262577

Tuna D, Olmez A. Clinical long-term evaluation of MTA as a direct pulp capping material in primary teeth. Int Endod J. 2008; 41(4):273 DOI: https://doi.org/10.1111/j.1365-2591.2007.01339.x

Solomon RV, Faizuddin U, Karunakar P, Deepthi Sarvani G, Sree Soumya S. Coronal pulpotomy technique analysis as an alternative to pulpectomy for preserving the tooth vitality, in the context of tissue regeneration: a correlated clinical study across 4 adult permanent molars. Case Rep Dent. 2015; 2015:12. doi:10.1155/2015/916060 DOI: https://doi.org/10.1155/2015/916060

Asgary S, Eghbal MJ, Fazlyab M, Baghban AA, Ghoddusi J. Five-year results of vital pulp therapy in permanent molars with irreversible pulpitis: a non-inferiority multicenter randomized clinical trial. Clin Oral Investig. 2015; 19:335-341. doi:10.1007/s00784-014-1244-z DOI: https://doi.org/10.1007/s00784-014-1244-z

Asgary S, Eghbal MJ, Ghoddusi J. Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: An ongoing multicenter randomized clinical trial. Clin Oral Investig. 2014; 18:635-641. doi:10.1007/s00784-013-1003-6 DOI: https://doi.org/10.1007/s00784-013-1003-6

Taha NA, Abdelkhader SZ. Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis. Int Endod J. 2018; 51:819-828. doi:10.1111/I.12903 DOI: https://doi.org/10.1111/iej.12903

Kojima K, Inamoto K, Nagamatsu K, Hara A, Nakata K, Morita I, Nakagaki H, Nakamura H. The success rate of endodontic treatment of teeth with vital and nonvital pulps. A meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 97:95-99. doi:10. 1016/j .tripleo.2003.07.006 DOI: https://doi.org/10.1016/j.tripleo.2003.07.006

Eghbal MJ, Asgary S, Baglue RA, Parirokh M, Ghoddusi J. MTA pulpotomy of human permanent molars with irreversible pulpitis. Aust Endod J. 2009; 35:4-8. doi:10.1111/j.17474477.2009.00166.x DOI: https://doi.org/10.1111/j.1747-4477.2009.00166.x

Asgary S. Calcium-enriched mixture pulpotomy of a human permanent molar with irreversible pulpitis and condensing apical periodontitis. J Conserv Dent. 2011; 14:90-93. doi:10.4103/09720707.80733 DOI: https://doi.org/10.4103/0972-0707.80733

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 Dent. 2014; 42:1390-1395. doi:10.1016/j.jdent.2014.06.007 DOI: https://doi.org/10.1016/j.jdent.2014.06.007

Taha NA, Abdulkhader SZ. Full pulpotomy with biodentine in symptomatic young permanent teeth with carious exposure. J Endod. 2018; 44:932-937. doi:10.1016/j.joen.2018.03.003 DOI: https://doi.org/10.1016/j.joen.2018.03.003

Taha NA, Ahmad MB, Ghanim A. Assessment of mineral trioxide aggregate pulpotomy in mature permanent teeth with carious exposures. Int Endod J. 2017; 50:117-125. doi:10.1111/I.12605 DOI: https://doi.org/10.1111/iej.12605

Simon S, Perard M, Zanini M, Smith AJ, Charpentier E, Djole SX, Lumley PJ. Should pulp chamber pulpotomy be seen as a permanent treatment? Some preliminary thoughts. Int Endod J. 2013; 46:79-87. doi:10.1111/j.1365-2591.2012.02113.x DOI: https://doi.org/10.1111/j.1365-2591.2012.02113.x

. Linsuwanont P, Wimonsutthikul K, Pothimoke U, Santiwong B. Treatment outcomes of mineral trioxide aggregate pulpotomy in vital permanent teeth with carious pulp exposure: the retrospective study. J Endod. 2017; 43:225-230. doi:10.1016/j.joen.2016.10.027 DOI: https://doi.org/10.1016/j.joen.2016.10.027

Baranwal HC, Mittal N, Yadav J, Rani P, Naveen Kumar PG. Outcome of partial pulpotomy verses full pulpotomy using biodentine in vital mature permanent molar with clinical symptoms indicative of irreversible pulpitis: A randomized clinical trial. J Conserv Dent. 2022 May-Jun;25(3):317-323

Cushley S, Duncan HF, Lappin MJ, Tomson PL, Lundy FT, Cooper P, Clarke M, El Karim IA. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: a systematic review. J Dent. 2019; 88:103158. doi:10.1016/j.jdent.2019.06.005 DOI: https://doi.org/10.1016/j.jdent.2019.06.005

Li Y, Sui B, Dahl C, Bergeron B, Shipman P, Niu L, Chen J, Tay FR. Pulpotomy for carious pulp exposures in permanent teeth: A systematic review and meta-analysis. J Dent. 2019; 84:1-8. doi:10.1016/j.jdent.2019.03.010 DOI: https://doi.org/10.1016/j.jdent.2019.03.010

Yazdani S, Jadidfard M-P, Tahani B, Kazemian A, Dianat O, Alim Marvasti L. Health technology assessment of CEM pulpotomy in permanent molars with irreversible pulpitis. Iran Endod J. 2014; 9:23-29

Kunert GG, Kunert IR, Da Costa Filho LC, De Figueiredo JAP. Permanent teeth ulpotomy survival analysis: retrospective follow-up. J Dent. 2015; 43:1125-1131. doi:10.1016/j.jdent.2015.06.010 DOI: https://doi.org/10.1016/j.jdent.2015.06.010

Dorn SO, Gartner AH. Case selection and treatment planning. In: Cohen S, Burns RC, editors. Pathways of the pulp. 6th ed. St. Louis: Mosby; 1994.(6) 60-76

Asgary S, Eghbal MJ, Ghoddusi J, Yazdani S. One-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter, randomized, non-inferiority clinical trial. Clin Oral Investig. 2013; 17(2):431-9 DOI: https://doi.org/10.1007/s00784-012-0712-6

Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth with curiously exposed pulp: A systematic review. J Endod. 2011; 37(5):581-74 DOI: https://doi.org/10.1016/j.joen.2010.12.004

Bjørndal L, Reit C, Bruun G, Markvart M, Kjaeldgaard M, Näsman P, Thordrup M, Dige I, Nyvad B, Fransson H, Lager A, Ericson D, Petersson K, Olsson J, Santimano EM, Wennström A, Winkel P, Gluud C. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci. 2010; 118(3):290-7 DOI: https://doi.org/10.1111/j.1600-0722.2010.00731.x

Witherspoon DE. Vital pulp therapy with new materials: new directions and treatment perspectives – permanent teeth. J Endod 2008;30(3):220-4 DOI: 10.1016/j.joen.2008.02.030 DOI: https://doi.org/10.1016/j.joen.2008.02.030

Hafez AA, Cox CF, Tarim B, Otsuki M, Akimoto N. An in vivo evaluation of haemorrhage control using sodium hypochlorite and direct capping with a one- or two-component adhesive system in exposed nonhuman primate pulps. Quintessence Int 2002; 33: 261–272

Bogen G, Kim JS, Bakland LK. Direct pulp capping with mineral trioxide aggregate: an observational study. J Am Dent Assoc 2008; 139: 305–315 DOI: https://doi.org/10.14219/jada.archive.2008.0160

Downloads

Published

2023-10-05

How to Cite

Streit, G., Vorster, M., & van der Vyver, P. J. (2023). Pulpotomy: An alternative treatment modality to conventional root canal treatment. South African Dental Journal, 78(06), 309–313. https://doi.org/10.17159/sadj.v78i06.16948

Most read articles by the same author(s)

1 2 > >>