Partial pulpotomy without age restriction: a retrospective assessment of permanent teeth with carious pulp exposure

Abstract

Objectives: This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure.

Materials and methods: Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan-Meier statistics. The level of significance was set at α = 0.05.

Results: Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18-85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged < 30 years, between 30 and 40 years, and > 40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively.

Conclusions: Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure.

Clinical relevance: Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients' age.

Keywords: Dental caries; Mineral trioxide aggregate; Pulpitis; Pulpotomy; Vital pulp therapy.

Fig. 1

Representative photographs taken during partial pulpotomy procedure with either MTA (a–f) or Ca(OH)₂ (g–k). a, g Exposed pulp after nonselective carious tissue removal to firm dentin; b, h pulpotomized area with bleeding control achieved; pulp capping with either c MTA or i Ca(OH)₂ after partial pulpotomy; d, j light cured Ca(OH)₂ cavity liner applied to cover the pulp capping material; e, k radiograph taken immediately after partial pulpotomy and the placement of a direct resin-based composite restoration; f periapical radiograph at follow-up after 2 years. No follow-up radiograph is available for the Ca(OH)₂ case since this tooth ended in a failure after 22 days with signs of irreversible pulpitis and root canal treatment was performed

Fig. 2

Overview of the tooth position and frequency of included partially pulpotomized teeth. a Visualization of all treated cases according to their tooth number of the upper and lower jaw divided into the patients’ right and left side. b Molars and premolars were the teeth most frequently treated, while only 4 canines and 1 central incisor were partially pulpotomized

Fig. 3

Kaplan–Meier survival curves after partial pulpotomy. a Probability of pulp survival in patients < 30 years of age, between 30 and 40 years, and > 40 years of age. Patients’ age at the time of the procedure did not affect the success rate of preserving pulp vitality after partial pulpotomy (p = 0.0225). b Overall probability of pulp survival