Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: a randomized controlled trial

Saeed Asgary, Mohammad Jafar Eghbal, Arash Shahravan, Eshaghali Saberi, Alireza Akbarzadeh Baghban, Ardavan Parhizkar, Saeed Asgary, Mohammad Jafar Eghbal, Arash Shahravan, Eshaghali Saberi, Alireza Akbarzadeh Baghban, Ardavan Parhizkar

Abstract

Objective: The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth.

Materials and methods: A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal-Wallis.

Results: At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544).

Conclusion: In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results.

Clinical relevance: Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.

Keywords: CEM cement; Calcium-enriched mixture; Endodontic; Irreversible pulpitis; Mineral trioxide aggregate; Pulp regeneration; Pulpotomy; Tricalcium silicate; Vital pulp therapy.

Conflict of interest statement

Dr. Asgary is the inventor of CEM cement (Endodontic Filling Material; USA, 7,942,961, 2011 May 17). All other authors declare that there are no conflict of interest regarding the publication of this paper.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram of patients through each stage of randomized controlled trial

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