Vital Pulp Therapy in Permanent Teeth with Irreversible Pulpitis Caused by Caries: A Prospective Cohort Study

Xiaoxu Guan, Yi Zhou, Qingxia Yang, Tianer Zhu, Xuepeng Chen, Shuli Deng, Denghui Zhang, Xiaoxu Guan, Yi Zhou, Qingxia Yang, Tianer Zhu, Xuepeng Chen, Shuli Deng, Denghui Zhang

Abstract

Background: When a tooth is diagnosed with irreversible pulpitis, root canal therapy (RCT) is generally performed to completely remove pulp tissue, which might lead to a higher risk of loss of vascularity, and teeth being more prone to fracture. Vital pulp therapy (VPT) is a personalized method of treating irreversible pulpitis, which conforms to the trend of minimally invasive endodontics. The remaining vital pulp could promote the physiological development of the roots of young permanent teeth with incomplete apical foramen. However, clear guidelines for VPT indication are still missing.

Objective: This prospective cohort study evaluated the outcomes of vital pulp therapy (VPT) using iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, BC, Canada) in permanent teeth of 6- to 20-year-old patients with irreversible pulpitis caused by caries and analyzed the preoperative factors affecting VPT prognosis.

Methods: Fifty-nine permanent teeth in 59 patients with irreversible pulpitis caused by caries were treated with VPT using iRoot BP Plus. All patients received VPT under a standardized protocol. After informed consent, teeth were isolated with a dental dam, then operators performed VPT with iRoot BP Plus and restored the teeth with composite resin or stainless steel crown. Patients were postoperatively recalled after 3, 6 and 12 months and then recalled annually. Successful cases were defined as successful in both clinical and radiographic evaluations. A statistical analysis was performed using the Fisher exact test, and the level of significant difference was p < 0.05.

Results: After 6-36 months of follow-up, a total of 57 teeth from 57 patients were accessible for evaluation. The mean age of subjects was 11.75 ± 3.81 years. The overall clinical and radiographic success rate of VPT was 91.2% (52/57). With an observation time of one year or more, the success rate was 90.5% (38/42). All the symptoms and physical examination findings showed no significant effect on VPT prognosis (p > 0.05) using a binary logistic regression model.

Conclusions: Permanent teeth in 6- to 20-year-old patients diagnosed as irreversible pulpitis caused by caries can be successfully treated with VPT using iRoot BP Plus.

Keywords: caries; iRoot BP Plus; irreversible pulpitis; personalized treatment; vital pulp therapy.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A schematic diagram of the VPT protocol in this clinical study. The number (n) of patients participating in each stage is given. In general, after anesthetizing and isolating the tooth before caries excavation and pulp exposure, pulp bleeding was assessed, and the pulp status was evaluated under microscope. If pulp hemostasis was achieved by direct contact with a cotton pellet moistened with 1% NaOCl within 5 min, DPC was performed. If the hemostasis was more than 5 min, approximately 2–3 mm or more of affected pulpal tissue underneath the exposure site was removed using a sterile high-speed diamond. After this, if the hemostasis was less than 5 min, PP was performed. Otherwise, the full crown pulp was removed to the level of the root canal orifices. Hereafter, if the hemostasis was less than 5 min, FP was performed. Otherwise, the treated tooth was excluded from the study and further treated with RCT or revascularization according to the root development.
Figure 2
Figure 2
(A) The preoperative periapical radiograph of the upper-right second premolar in an 18-year-old male patient with irreversible pulpitis, clinical symptoms and mature roots. (B) The postoperative periapical radiograph after direct pulp-capping (DPC) with iRoot BP Plus. (C) The 12-month follow-up. (D) The 24-month follow-up (E) The preoperative periapical radiograph of the upper left first molar in a 13-year-old male patient with irreversible pulpitis of clinical symptoms and mature roots. (F) The postoperative periapical radiograph after partial pulpotomy (PP) with iRoot BP Plus. (G) The 6-month follow-up. (H) The 12-month follow-up. (I) The preoperative periapical radiograph of the lower right first molar in a 9-year-old female patient with irreversible pulpitis of clinical symptoms and immature roots. (J) The postoperative periapical radiograph after full pulpotomy (FP) with iRoot BP Plus. (K) The 12-month follow-up. (L) The 24-month follow-up showing continued root development.

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