Ramani Ankita, Sangwan Pankaj, Tewari Sanjay, Duhan Jigyasa, Mittal Shweta, Kumar Vinay
Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India.
Int Endod J. 2022 May;55(5):430-440. doi: 10.1111/iej.13714. Epub 2022 Mar 10.
The study aimed to compare the outcome of complete pulpotomy (CP) and partial pulpotomy (PP) techniques when utilised for the management of mature permanent teeth with carious pulpal exposure and symptomatic irreversible pulpitis (SIP).
The study protocol was registered with ClinicalTrials.gov (NCT04397315). One hundred and six permanent mandibular molars with carious pulpal exposure and clinical diagnosis of SIP with periapical index ≤2, from patients aged between 18 and 40 years were randomly allocated in equal proportion to either CP or PP group. Allocated procedures were performed using standardised protocols. The allocated procedure was abandoned in cases where pulpal bleeding could not be controlled within 6 min using cotton pellets soaked in 3% sodium hypochlorite. MTA was used as a pulpotomy agent and teeth were restored using a base of glass ionomer followed by composite restoration. The pain was recorded by the patient preoperatively before administration of local anaesthesia and postoperatively every 24 h for 1 week using visual analogue scale. Success was analysed at 12 months based on clinical and radiographic examination. Mann-Whitney U test was used to compare age, pain scores and mean analgesic consumption between the groups. Categorical data were analysed using chi-square test. Fisher's exact test was used to assess the clinical and radiographic success and incidence of pain. Kaplan-Meier analysis was used to assess the survival of teeth. A p-value <.05 was considered as statistically significant.
One hundred and one patients were analysed at follow up. Higher success was observed in CP (89.8%) in comparison to PP group (80.8%), but the difference was non-significant statistically (p = .202). Although no significant difference was observed in pain incidence between the groups at 24 h (p = .496), a significant difference in pain intensities was observed between groups at all the tested time intervals, with lower values reported in CP group (p < .05).
Both CP and PP resulted in favourable outcomes in the management of cariously exposed permanent teeth with signs indicative of SIP. Given the more conservative nature of PP, it may be attempted first before proceeding to CP in such cases.
本研究旨在比较完全牙髓切断术（CP）和部分牙髓切断术（PP）在治疗有龋源性牙髓暴露和症状性不可逆性牙髓炎（SIP）的成熟恒牙时的疗效。
本研究方案已在ClinicalTrials.gov（NCT04397315）注册。将106颗来自18至40岁患者的下颌恒牙，有龋源性牙髓暴露且临床诊断为SIP且根尖指数≤2的恒牙，按等比例随机分配至CP组或PP组。采用标准化方案进行分配的操作。若使用浸有3%次氯酸钠的棉球在6分钟内无法控制牙髓出血，则放弃分配的操作。使用MTA作为牙髓切断剂，并用玻璃离子垫底后进行复合树脂修复。患者在术前局部麻醉给药前以及术后1周内每天记录疼痛情况，采用视觉模拟评分法。在12个月时根据临床和影像学检查分析成功率。采用Mann-Whitney U检验比较两组之间的年龄、疼痛评分和平均镇痛药物消耗量。分类数据采用卡方检验进行分析。采用Fisher精确检验评估临床和影像学成功率及疼痛发生率。采用Kaplan-Meier分析评估牙齿的存留率。p值<.05被认为具有统计学意义。
随访时对101例患者进行了分析。与PP组（80.8%）相比，CP组（89.8%）的成功率更高，但差异无统计学意义（p = .202）。尽管两组在24小时时的疼痛发生率无显著差异（p = .496），但在所有测试时间间隔内，两组之间的疼痛强度存在显著差异，CP组的疼痛强度值较低（p < .05）。
CP和PP在治疗有龋源性暴露且有SIP体征的恒牙时均取得了良好的疗效。鉴于PP的操作更为保守，在这种情况下，可先尝试PP，再考虑CP。
