Feasibility of Pulpotomy as Definitive Treatment for Carious-exposed Permanent Teeth

Objective: To describe the profile of an initial cohort presenting with carious pulp exposure in permanent teeth and study the feasibility of pulpotomy for pain control and maintaining tooth function. Method: Ethics approval was obtained. Patients were recruited with informed consent at a teaching institution. The procedures were carried out under local anesthesia and rubber-dam isolation. When a carious pulp exposure with bleeding was encountered, a partial pulpotomy was performed, and checked for hemostasis. If pulpal bleeding persisted after 5 minutes, full pulpotomy was performed.  If bleeding persisted beyond 5 minutes after that, the tooth was excluded. A calcium-silicate cement was placed over the exposed pulp after hemostasis, and this also served as an interim restoration. In this initial report of a 3-year prospective clinical trial, clinical and radiographic data including 5-level pain score, pulp sensibility and symptoms, collected before, at 1 week and 6 months after treatment, will be presented. Result: To date, 28 teeth from 26 subjects (age 21-68 years; 17 females, 9 males) were recruited.  Time required for pulpal hemostasis was less than 1 minute for 5 teeth, 2-5 minutes for 17 teeth, and 6-10 minutes for 6 teeth. Partial pulpotomy was done in 24 teeth, and full pulpotomy in 4 teeth. Twenty-three teeth (82.1%) maintained pulp sensibility and remained free of symptoms up to 6 months. Pulpotomy effectively controlled the pain in 8 of 11 teeth (72.7%) with pre-operative pain. Teeth with pre-operative pain required at least 2 minutes for pulpal hemostasis. Conclusion: Within the limitations of this initial report, pulpotomy in carious-exposed permanent teeth showed promise in pain control and maintaining tooth function in the short term. If long-term results continue to be favorable, pulpotomy could be a feasible alternative to traditional pulpectomy in vital permanent teeth with carious pulp exposure.