Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
J Endod. 2024 Jul;50(7):889-898. doi: 10.1016/j.joen.2024.03.012. Epub 2024 Apr 5.
The aim of this study was to compare the outcome and prognostic factors for partial and full pulpotomy in the management of mature teeth with spontaneous symptomatic pulpitis.
The study was a parallel double-blind randomized clinical trial; 200 carious mature permanent teeth with spontaneous symptomatic pulpitis were randomized using a block randomization technique to either partial pulpotomy (n = 99) or full pulpotomy (n = 101). Intraoperative assessment of the pulp under magnification was performed, hemostasis was achieved with a 2.5% sodium hypochlorite moist pellet, and NeoPUTTY (Avalon Biomed, Bradenton, FL) was the pulpotomy material. Preoperative pain levels were recorded and re-evaluated after 1 week. Clinical and radiographic evaluation was performed after 6 and 12 months. Data were analyzed using the chi-square test, the Wilcoxon rank test, and regression analysis.
At 1 week, immediate failure occurred in 4 cases in partial pulpotomy, and 196 of 200 subjects reported pain relief and were satisfied with the treatment with no significant difference. At 6 months, 6 teeth failed in the partial pulpotomy group and 1 tooth in the full pulpotomy group, with a higher success rate for full pulpotomy (98.96 vs 89.69, P = .003). At 12 months, the recall rate was 98% (96/200). Full pulpotomy was more successful than partial pulpotomy (98.98% [98/99] vs 84.53% [82/97], P < .001). Multivariate analysis revealed that the odds of success for full pulpotomy were 13.6 times higher than partial pulpotomy. Increased age and higher time to hemostasis were significantly associated with decreased odds of success.
Full pulpotomy has a higher success rate than partial pulpotomy in the management of spontaneous symptomatic pulpitis. Hemostasis within 4 minutes in partial pulpotomy can be set as the cutoff point beyond which further tissue removal is indicated.
本研究旨在比较部分活髓切断术和全活髓切断术治疗有自发症状性牙髓炎成熟恒牙的疗效和预后因素。
本研究为平行双盲随机临床试验；采用区组随机化技术，将 200 颗有自发症状性牙髓炎的龋坏成熟恒牙随机分为部分活髓切断术组（n=99）和全活髓切断术组（n=101）。术中在放大条件下对牙髓进行评估，用 2.5%次氯酸钠湿丸止血，使用 NeoPUTTY（Avalon Biomed，Bradenton，FL）作为活髓切断材料。记录术前疼痛程度，并在术后 1 周时进行重新评估。术后 6 个月和 12 个月进行临床和影像学评估。采用卡方检验、Wilcoxon 秩和检验和回归分析进行数据分析。
术后 1 周，部分活髓切断术组有 4 例即刻失败，200 例患者中有 196 例报告疼痛缓解，对治疗满意，差异无统计学意义。术后 6 个月，部分活髓切断术组有 6 颗牙失败，全活髓切断术组有 1 颗牙失败，全活髓切断术成功率更高（98.96% [98/100] vs 89.69% [196/200]，P=0.003）。术后 12 个月的召回率为 98%（96/200）。全活髓切断术的成功率高于部分活髓切断术（98.98% [98/99] vs 84.53% [82/97]，P<0.001）。多变量分析显示，全活髓切断术成功的可能性是部分活髓切断术的 13.6 倍。年龄增加和止血时间延长与成功率降低显著相关。
全活髓切断术治疗有自发症状性牙髓炎的成功率高于部分活髓切断术。部分活髓切断术止血时间在 4 分钟内可作为进一步组织去除的截止点。
