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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (1): 88-93. doi: 10.19723/j.issn.1671-167X.2023.01.013

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X-ray evaluation of pulp calcification in adult permanent teeth after pulpotomy

Wei YONG*(),Kun QIAN,Wen-hao ZHU,Xiao-yi ZHAO,Chang LIU,Jie PAN   

  1. Department of General Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2022-09-19 Online:2023-02-18 Published:2023-01-31
  • Contact: Wei YONG E-mail:yongwei1004@sina.com
  • Supported by:
    the New Clinical Technology Program of Peking University School and Hospital of Stomatology(PKUSSNCT-17A14)

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Abstract:

Objective: To compare the clinical effects of pulpotomy with two kinds of calcium silicate materials, and to evaluate the formation of dentin bridge and pulp calcification after pulpotomy of adult permanent teeth. Methods: Patients who visited the General Department of Peking University School and Hospital of Stomatology from November 2017 to September 2019 and planned for pulpotomy on permanent premolars and molars with carious exposed pulp were selected. They were randomly divided into two groups. Bioceramic putty material iRoot BP (iRoot group, n=22) and mineral trioxide aggregate MTA (MTA group, n=21) were used as pulp capping agents, respectively. The patients were recalled after one year and two years. The clinical efficacy, dentin bridge index (DBI) and pulp calcification index (PCI) were recorded. Blinding method was used for the patients and evaluators. Results: There was no significant difference in gender, mean age, dentition and tooth position between the two groups (P>0.05). Seven cases were lost during the first year (4 cases in iRoot group and 3 cases in MTA group). In the iRoot group, 1 case had transient sensitivity at the time of 1-year follow-up. The cure rate of the two groups was 100% at the time of 2-year follow-up. The proportion of dentin bridge formation was 38.9% one year after operation, 55.6% two years after operation. The proportion of partial or even complete disappearance of root canal image was 5.6% before operation, 38.9% and 55.6% one and two years after operation, respectively. The difference was statistically significant by rank sum test (P < 0.05). There was no significant difference in dentin bridge formation and pulp calcification between the two groups (P < 0.05). DBI and PCI after operation was as the same as those before operation (44.4% cases of DBI and 25% cases of PCI) or gradually increased (55.6% cases of DBI and 75% cases of PCI). Spearman's nonparametric correlation analysis showed that age was positively correlated with preoperative pulp calcification index (PCI0, P < 0.05), but not with the dentin bridge index (DBI1, DBI2), pulp calcification index (PCI1, PCI2) and the degree of change (DBI2 vs. DBI1, PCI1 vs. PCI0, PCI2 vs. PCI0) 1-year and 2-year after operation (P>0.05). Conclusion: According to this study, good clinical effects were obtained within 2-year after pulpotomy of adult permanent teeth with MTA and iRoot. In some cases, the root canal system had a tendency of calcification aggravation, and there was no statistical difference in the development of this trend between the two groups.

Key words: Pulpotomy, Adult permanent teeth, Bioceramic material, Dentin bridge, Pulp calcification

CLC Number: 

  • R781.05

Table 1

Descriptive data of enrolled cases"

Items Group iRoot
(n=22)		 Group MTA
(n=21)		 t/χ2 P
Gender, n 0.187 0.665
    Male 6 7
    Female 16 14
Average age/years, M (Min, Max) 30.7 (16, 59) 30.4 (21, 55) 0.093 0.926
Jaw, n 1.149 0.284
    Upper 16 12
    Lower 6 9
Tooth position, n 0.72 0.396
    Premolar 9 6
    Molar 13 15

Table 2

Percentage of dentin bridge index (DBI) from Level 1 to 3 before pulpotomy operation, 1-year and 2-year follow up"

Level of DBI Before operation (DBI0) 1-year follow-up (DBI1) 2-year follow-up (DBI2)
Cases Percentage Cases Percentage Cases Percentage
1 No dentin bridge 36 100 22 61.1* 16 44.4*
2 Thickness of dentin bridge < 1 mm 0 0 12 33.3* 13 36.1*
3 Thickness of dentinal bridge >1 mm 0 0 2 5.6* 7 19.4*

Table 3

Percentage of pulp calcification index (PCI) from level 1 to 3 before pulpotomy operation, 1-year and 2-year follow up"

Level of PCI Before operation (PCI0) 1-year follow-up (PCI1) 2-year follow-up (PCI2)
Cases Percentage Cases Percentage Cases Percentage
1 No calcification 12 33.3 0 0% 0 0
2 The root canal images become thinner but all of them exist 22 61.1 22 61.1* 16 44.4*
3 Part of the root canal images disappear 2 5.6 13 36.1* 18 50.0*
4 All of the root canal images disappear 0 0 1 2.8* 2 5.6*

Figure 1

Calcification of root canal before and after pulpotomy of the left upper second premolar A, before pulpotomy operation, PCI0=level 1, DBI0=level 1; B, 1-year follow-up, PCI1=level 2, DBI1=level 2; C, 2-year follow-up, PCI2=level 2, DBI2=level 3."

Figure 2

Calcification of root canal before and after pulpotomy of the right lower second molar A, before pulpotomy operation, PCI0=level 3, DBI0=level 1; B, 1-year follow-up, PCI1=level 3, DBI1=level 3; C, 2-year follow-up, PCI2=level 4, DBI2=level 3."

Table 4

The types of dentin bridge index (DBI0, DBI1, DBI2) variation trend and number of distributed cases"

Type Before operation
(DBI0)		 1-year follow-up
(DBI1)		 2-year follow-up
(DBI2)		 Cases
(n=36)
1 1 1 1 16
2 1 2 2 8
3 1 1 2 5
4 1 2 3 4
5 1 3 3 2
6 1 1 3 1

Table 5

The types of pulp calcification index (PCI0, PCI1, PCI2) variation trend and number of distributed cases"

Type Before operation
(CPI0)		 1-year
(CPI1)		 2-year follow-up
(CPI2)		 Cases
(n=36)
1 1 2 2 10
2 2 3 3 9
3 2 2 3 7
4 2 2 2 4
5 3 3 3 2
6 2 4 4 1
7 2 3 4 1
8 1 2 3 1
9 1 3 3 1
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