Efficacy and radiology evaluation of pulpotomy in mature permanent teeth

  • Xiaoyi ZHAO ,
  • Chang LIU ,
  • Kun QIAN ,
  • Jie PAN
Expand
  • Department of General Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China

Received date: 2023-10-10

  Online published: 2024-02-06

Abstract

Objective: To observe the clinical efficacy of pulpotomy in patients of different ages and to explore the occurrence and characteristics of pulpal calcification. Methods: A total of 77 patients who underwent pulpotomy for mature permanent premolars and molars with caries-derived pulp exposure in the Department of General Dentistry, Peking University School and Hospital of Stomatology from October 2019 to August 2022 were selected. Pulpotomies were performed in a single visit using iRoot BP Plus bioceramic material as pulp capping agent. The patients were divided into three groups according to age: 25 cases in the adolescent group (11-20 years old) with a mean age of (15.88±2.19) years; 27 cases in the middle-aged group (21-50 years old) with a mean age of (34.59±8.67) years; and 25 cases in the elder-aged group (51-83 years old) with a mean age of (63.84±7.40) years. The patients were reviewed 1 year after the operation to evaluate the clinical efficacy and to record the formation of calcified bridge, thickness of calcified bridge, and pulp calcification index (PCI). Results: There was no statistically significant difference between the three groups in terms of gender, dentition, and tooth position (P > 0.05). The 1-year postoperative follow-up rate was 85.71% (66/77), including 88.00% (22/25) in the adolescent group, 85.19% (23/27) in the middle-aged group, and 84.00% (21/25) in the elder-aged group. The 1-year follow-up clinical success rates of the three groups were 95.45% (21/22), 91.30% (21/23), and 95.24% (20/21), respectively, with no statistically significant difference (P>0.05). Among the clinical success cases, calcified bridges appeared in 12 cases (57.14%, 12/21) in the adolescent group, 8 cases (38.10%, 8/21) in the middle-aged group, and 3 cases (15.00%, 3/20) in the elder-aged group, with statistically significant differences (χ2= 7.810, P = 0.020 < 0.05). The difference was statistically significant (F = 4.434, P = 0.020 < 0.05) when comparing the thickness of calcified bridges among the three groups. Calcified bridge thickness was negatively correlated with age (r = -0.516, P < 0.05). The changes in pulpal calcification index ΔPCI were 0.67 ± 0.58, 0.43 ± 0.51, and 0.25 ± 0.52, respectively, with statistically significant differences among the three groups (F = 3.404, P = 0.040 < 0.05). Conclusion: Pulpotomy for caries-derived pulp exposure in elderly patients could also achieve a high success rate. The incidence of calcified bri-dges after pulpotomy and the acceleration of pulpal calcification were age-related. The adolescent group was more likely to form calcified bridges and also showed more pronounced accelerated root canal calcification.

Cite this article

Xiaoyi ZHAO , Chang LIU , Kun QIAN , Jie PAN . Efficacy and radiology evaluation of pulpotomy in mature permanent teeth[J]. Journal of Peking University(Health Sciences), 2024 , 56(1) : 138 -143 . DOI: 10.19723/j.issn.1671-167X.2024.01.021

References

1 Ward J . Vital pulp therapy in cariously exposed permanent teeth and its limitations[J]. Aust Endod J, 2002, 28 (1): 29- 37.
2 何文喜, 余擎. 牙髓炎的活髓保存及再生治疗新进展: 从基础到临床[J]. 中华口腔医学杂志, 2022, 57 (1): 16- 22.
3 张露, 陈智. 生物活性材料在牙髓治疗中的应用[J]. 中华口腔医学杂志, 2022, 57 (1): 31- 37.
4 陈嘉琪, 董艳梅. 龋源性露髓成熟恒牙活髓保存治疗的研究进展[J]. 中华口腔医学杂志, 2022, 57 (1): 95- 100.
5 周学东, 黄定明, 刘建国, 等. 牙髓损伤的活髓保存治疗[J]. 华西口腔医学杂志, 2017, 35 (4): 339- 347.
6 Duncan HF , El-Karim I , Dummer PMH , et al. Factors that influence the outcome of pulpotomy in permanent teeth[J]. Int Endod J, 2023, 56 (Suppl 2): 62- 81.
7 Taha NA , About I , Sedgley CM , et al. Conservative management of mature permanent teeth with carious pulp exposure[J]. J Endod, 2020, 46 (Suppl 9): 33- 41.
8 Santos JM , Marques JA , Diogo P , et al. Influence of preoperative pulp inflammation in the outcome of full pulpotomy using a dog model[J]. J Endod, 2021, 47 (9): 1417- 1426.
9 雍颹, 钱锟, 朱文昊, 等. 成年恒牙牙髓切断后牙髓钙化的X线片评价[J]. 北京大学学报(医学版), 2023, 55 (1): 88- 93.
10 彭楚芳, 赵玉鸣, 杨媛, 等. 三氧化矿物凝聚体牙髓切断术治疗年轻恒牙不可复性牙髓炎的初步研究[J]. 中华口腔医学杂志, 2015, 50 (12): 715- 719.
11 Taha NA , Abdulkhader SZ . Full pulpotomy with biodentine in symptomatic young permanent teeth with carious exposure[J]. J Endod, 2018, 44 (6): 932- 937.
12 Taha NA , Abdelkhader SZ . Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis[J]. Int Endod J, 2018, 51 (8): 819- 828.
13 史瑞棠, 侯本祥. 牙髓钙化的病因、诊断和治疗策略[J]. 中华口腔医学杂志, 2022, 57 (3): 220- 226.
14 刘思毅, 宫玮玉, 刘木清, 等. 成熟恒牙因龋露髓行生物陶瓷材料直接盖髓术的临床疗效观察[J]. 中华口腔医学杂志, 2020, 55 (12): 945- 951.
15 Zanini M , Hennequin M , Cousson PY . A review of criteria for the evaluation of pulpotomy outcomes in mature permanent teeth[J]. J Endod, 2016, 42 (8): 1167- 1174.
16 Vitali FC , Cardoso IV , Mello FW , et al. Association between orthodontic force and dental pulp changes: A Systematic review of clinical and radiographic outcomes[J]. J Endod, 2022, 48 (3): 298- 311.
17 Alak SG , Kele? A , Keskin C , et al. Age-related changes in the morphology of the root canal system of mandibular first molars: A micro-CT study[J]. Clin Oral Investig, 2023, 27 (8): 4667- 4675.
18 郑树国, 王晶, 高岩. 年轻恒前牙冠折活髓切断术的临床及组织学研究[J]. 现代口腔医学杂志, 2005, 19 (1): 89- 91.
19 Taha NA , Ahmad MB , Ghanim A . Assessment of mineral trioxide aggregate pulpotomy in mature permanent teeth with carious exposures[J]. Int Endod J, 2017, 50 (2): 117- 125.
20 Cushley S , Duncan HF , Lappin MJ , et al. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review[J]. J Dent, 2019, 88, 103158.
21 Eggmann F , Gasser TJW , Hecker H , et al. Partial pulpotomy without age restriction: A retrospective assessment of permanent teeth with carious pulp exposure[J]. Clin Oral Investig, 2022, 26 (1): 365- 373.
22 Taha NA , Khazali MA . Partial Pulpotomy in mature permanent teeth with clinical signs indicative of irreversible pulpitis: A randomized clinical trial[J]. J Endod, 2017, 43 (9): 1417- 1421.
23 Awawdeh L , Al-Qudah A , Hamouri H , et al. Outcomes of vital pulp therapy using mineral trioxide aggregate or biodentine: A prospective randomized clinical trial[J]. J Endod, 2018, 44 (11): 1603- 1609.
24 Taha NA , Al-Khatib H . 4-year follow-up of full pulpotomy in symptomatic mature permanent teeth with carious pulp exposure using a stainproof calcium silicate-based material[J]. J Endod, 2022, 48 (1): 87- 95.
25 钱锟, 潘洁, 朱文昊, 等. 两种硅酸钙类材料用于成熟恒牙牙髓切断术的临床效果[J]. 北京大学学报(医学版), 2022, 54 (1): 113- 118.
26 Duncan HF , Galler KM , Tomson PL , et al. European Society of Endodontology position statement: Management of deep caries and the exposed pulp[J]. Int Endod J, 2019, 52 (7): 923- 934.
27 Zaen El-Din AM , Hamama HH , Abo El-Elaa MA , et al. The effect of four materials on direct pulp capping: An animal study[J]. Aust Endod J, 2020, 46 (2): 249- 256.
28 Azimi S , Fazlyab M , Sadri D , et al. Comparison of pulp response to mineral trioxide aggregate and a bioceramic paste in partial pulpotomy of sound human premolars: A randomized controlled trial[J]. Int Endod J, 2014, 47 (9): 873- 881.
29 Couve E , Lovera M , Suzuki K , et al. Schwann cell phenotype changes in aging human dental pulp[J]. J Dent Res, 2018, 97 (3): 347- 355.
30 Couve E , Osorio R , Schmachtenberg O . The amazing odontoblast: Activity, autophagy, and aging[J]. J Dent Res, 2013, 92 (9): 765- 772.
31 Mass E , Zilberman U . Long-term radiologic pulp evaluation after partial pulpotomy in young permanent molars[J]. Quintessence Int, 2011, 42 (7): 547- 554.
32 Qudeimat MA , Alyahya A , Hasan AA . Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: A preliminary study[J]. Int Endod J, 2017, 50 (2): 126- 134.
Outlines

/