IADR Abstract Archives
A Prospective Clinical Study Investigating the Effectiveness of Partial Pulpotomy After Relating Preoperative Symptoms to a new and Established Pulpitis Classification
Objectives: To prospectively investigate the outcome of partial pulpotomy after one-year, using a hydraulic-calcium-silicate-cement (HCSC) on symptomatic cariously-exposed pulps in adult-teeth. To compare the traditional pulpitis-classification with the recently proposed Wolters-classification system in predicting the likelihood of treatment failure.
Methods: Sixty-two symptomatic adult-teeth with deep/extremely deep carious lesions were classified according to the Wolters (mild/moderate/severe pulpitis) and the traditional pulpitis classification (reversible/irreversible pulpitis). Eleven teeth were excluded intraoperatively. The remaining 51-teeth, regardless of diagnosis, were treated by partial-pulpotomy, followed by HCSC application (BiodentineTM). A permanent restoration was placed 1-2 weeks later. Preoperative tenderness-to-percussion (TTP), bleeding-time and material setting-time were recorded .Review occurred at 12-months. A range of statistical analysis were carried out (p<0.05).
Results: Forty-one teeth reviewed at one-year were classified as either ‘success’, ‘successful but unresponsive to sensibility-testing’ and ‘failed’. This included five-severe, 24-moderate and 22-mild pulpitis according to Wolters-classification or 23 reversible-pulpitis and 18 irreversible-pulpitis cases by the AAE-classification. All failures occurring in the extremely-deep group. Partial-pulpotomy was 90% successful (100%-reversible, 78%-irreversible or 100%-mild, 88%-moderate, 60%-severe pulpitis) with a significant difference in outcome between mild and severe pulpitis groups (p=0.04). Bleeding time (p=0.26) and TTP (p=0.61) did not influence treatment outcome, while BiodentineTM setting time was significantly longer than manufacturers’ claim (p<0.05).
Conclusions: Partial-pulpotomy using BiodentineTM was successful for treating symptomatic carious-pulpal-exposures after one-year. Within the limitations of this study cases with signs and symptoms indicative of irreversible-pulpitis were not less successful; however, Wolters-classification highlighted severe-pulpitis to be less successful than mild-pulpitis thereby providing a potential prognostic benefit in diagnostically subdividing pulpitis. Caries-depth was an indicator of failure, while bleeding-time and preoperative TTP were not.
Methods: Sixty-two symptomatic adult-teeth with deep/extremely deep carious lesions were classified according to the Wolters (mild/moderate/severe pulpitis) and the traditional pulpitis classification (reversible/irreversible pulpitis). Eleven teeth were excluded intraoperatively. The remaining 51-teeth, regardless of diagnosis, were treated by partial-pulpotomy, followed by HCSC application (BiodentineTM). A permanent restoration was placed 1-2 weeks later. Preoperative tenderness-to-percussion (TTP), bleeding-time and material setting-time were recorded .Review occurred at 12-months. A range of statistical analysis were carried out (p<0.05).
Results: Forty-one teeth reviewed at one-year were classified as either ‘success’, ‘successful but unresponsive to sensibility-testing’ and ‘failed’. This included five-severe, 24-moderate and 22-mild pulpitis according to Wolters-classification or 23 reversible-pulpitis and 18 irreversible-pulpitis cases by the AAE-classification. All failures occurring in the extremely-deep group. Partial-pulpotomy was 90% successful (100%-reversible, 78%-irreversible or 100%-mild, 88%-moderate, 60%-severe pulpitis) with a significant difference in outcome between mild and severe pulpitis groups (p=0.04). Bleeding time (p=0.26) and TTP (p=0.61) did not influence treatment outcome, while BiodentineTM setting time was significantly longer than manufacturers’ claim (p<0.05).
Conclusions: Partial-pulpotomy using BiodentineTM was successful for treating symptomatic carious-pulpal-exposures after one-year. Within the limitations of this study cases with signs and symptoms indicative of irreversible-pulpitis were not less successful; however, Wolters-classification highlighted severe-pulpitis to be less successful than mild-pulpitis thereby providing a potential prognostic benefit in diagnostically subdividing pulpitis. Caries-depth was an indicator of failure, while bleeding-time and preoperative TTP were not.