Comparative evaluation of non-instrumentation pulp therapy using calcium silicate-based cements versus conventional method for irreversible pulpitis in deciduous molars: a randomized clinical study

American Association of Endodontists (AAE) Consensus Conference Recommended Diagnostic Terminology defines irreversible pulpitis as a clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Pulpitis can be managed with different treatment options such as direct pulp capping, pulpotomy, or root canal treatment. 

The primary goal of pulp therapy is to maintain the integrity and health of the teeth and their supporting tissues while maintaining the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes. A pulpectomy is indicated in a primary tooth with irreversible pulpitis or necrosis or a tooth treatment planned for pulpotomy in which the radicular pulp exhibits clinical signs of irreversible pulpitis (eg, excessive hemorrhage that is not controlled with a damp cotton pellet applied for several minutes) or pulp necrosis (eg, suppration, purulence). The roots should exhibit minimal or no resorption.Pulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis.

A pulpotomy is performed in a primary tooth with extensive caries but without evidence of radicular pathology when caries removal results in a carious or mechanical pulp exposure.The coronal pulp is amputed whereas the remaining vital radicular pulp tissue surface is treated with a long-term clinically successful medicament such as Buckley’s Solution of formocresol or ferric sulfate.

The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. The ribbon-like torturous root canal anatomy in primary molars makes pulpectomy a difficult procedure for general dentists to perform, often requires a child in pain to be referred to a specialist paediatric dentist for definitive treatment. Pulpotomy has gained popularity as an alternative treatment option to pulpectomy due to its advantages, such as reduced chair time, lower cost, and better preservation of tooth structure.

Due to the limited number of studies and clinical trials evaluating pulpotomy for irreversible pulpitis in primary molars, this study will be undertaken to explore its potential as a viable treatment option.

The null hypothesis is that there will be no significant difference in treatment outcomes of the non-instrumentation intervention pulp therapy and conventional pulpectomy treatment for deciduous molar diagnosed with irreversible pulpitis