Full Pulpotomy Bests Partial Pulpotomy for Managing Spontaneous Symptomatic Pulpitis

A study published in the Journal of Endodontics suggests that full pulpotomy is more effective than partial pulpotomy for managing spontaneous symptomatic pulpitis.

Study Aim

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.

Methodology

Two hundred 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 done, hemostasis was achieved with 2.5% NaOCl moist pellet, and NeoPUTTY was the pulpotomy material. Preoperative pain levels were recorded and reevaluated after 1 week. Clinical and radiographic evaluation was done after 6 and 12 months. Data were analyzed using Chi-square, Wilcoxon rank tests, and regression analysis.

Results

• At 1 week, immediate failure occurred in 4 cases in partial pulpotomy, and 196/200 subjects reported pain relief and were satisfied with the treatment with no significant difference.
• At 6 months, 6 teeth failed in partial pulpotomy and 1 tooth in full pulpotomy, with a higher success rate for full pulpotomy (98.96% vs 89.69%, p=0.003).
• At 12 months, the recall rate was 98% (196/200). Full pulpotomy was more successful than partial pulpotomy (98.98% (98/99) vs 84.53% (82/97), p<0.001).
• 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 a cutoff point beyond which further tissue removal is indicated.

Reference

Taha NA, Albakri SW. Outcome and prognostic factors for partial and full pulpotomy in the management of spontaneous symptomatic pulpitis in carious mature permanent teeth: A randomized clinical trial. J Endod. 2024 Apr 5:S0099-2399(24)00224-3. doi: 10.1016/j.joen.2024.03.012. Epub ahead of print. PMID: 38583758.