Complete Pulpotomy or Root Canal Treatment for Managing Irreversible Pulpitis?

Objectives: Dental caries is a frequent reason for adults to seek emergency medical care. Caries is a chronic condition which, if untreated, progresses inducing severe inflammation, termed irreversible pulpitis (IRP) which may be accompanied by severe pain. Traditionally IRP is treated by root canal treatment (RCTx), which although successful, is destructive and often poorly carried out in General Practice. Maintaining vitality is a goal in operative treatment, however, RCTx devitalises the tooth. Complete pulpotomy (Cp) is a re-emerging minimally invasive treatment whereby inflamed coronal tissue is removed and the healthy radicular pulp dressed with a biomaterial promoting healing and repair. Cp may be suitable for some IRP cases and there is evidence that European dentists are gradually embracing this treatment.

Objectives
Measure and compare patient pain experience after RCTx and Cp.
Quantify biomarker (BM) expression in teeth with a clinical diagnosis of symptomatic IRP and correlate with the intensity of postoperative pain.
Methods: In this multi-site exploratory study, 53 patients aged ≥18years were randomised to receive either RCTx(n=25) or Cp(n=28). Patient reported pain intensity data was collected using a numeric rating scale (NRS) questionnaire. Pulp blood samples were collected on sterile paper points, and BMs quantified using a Luminex Human Discovery Assay. Associations between pain experience and time, treatment group and BM expression were analysed with multivariate and χ²statistical tests (p=0.05).
Results: Baseline pain intensity scores were comparable in the 2 groups. The difference in mean post-operative pain scores over time is significant p<0.001. The effect of treatment group on pain intensity across time is not significant p=0.13 (F=2.371). There is a statistically significant association between pain intensity and BM expression.
Conclusions: Cp is as effective as RCTx in managing pain associated with symptomatic IRP and baseline BM expression is associated with pain experience in the postoperative period.