Comparative evaluation of coronal pulpotomy and partial radicular pulpotomy in vital mature permanent molars with irreversible pulpitis and/or apical periodontitis using chitosan and prf(platelet rich fibrin)-A Randomized controlled trial

Permanent teeth diagnosed with “irreversible pulpitis” have long been implied to have an irreversibly damaged dental pulp that is beyond repair and warranting root canal treatment. However, newer clinical approaches such as pulpotomy, a minimally invasive and biologically based procedure have re-emerged to manage teeth with pulpitis. Recent position statements from the American Association of Endodontists and the European Society of Endodontology (ESE) have concluded that ‘pre-treatment diagnosis of irreversible pulpitis is not necessarily an indication for pulpectomy’, heralding a new era for minimally invasive VPT in mature permanent teeth. In cases with irreversible pulpitis, the morphological changes indicating inflammation or necrosis were principally occurring in the coronal pulp whilst the radicular pulp was viable. This suggests that the radicular pulp could potentially be retained when a pulpotomy procedure is performed, thus preventing the need for a pulpectomy. This less invasive treatment approach called the Endolight concept was used by W.J. Wolters to propose a new classification for clinical pulp diagnosis.

According to this new classification, in cases of severe pulpitis (severe spontaneous pain and clear pain reaction to warmth and cold stimuli, often, sharp to dull throbbing pain, sensitive to touch and percussion) the treatment opted is full pulpotomy, If there is no pro-longed bleeding of pulp stumps in the orifices of the canals and if one or more of the pulp stumps keeps bleeding after rinsing with 2 mL 2% NaOCl, a superficial pulpotomy can be carried out, whereby more inflamed tissue is removed from the canal up to 3–4 mm from the radiographic apex (also known as radicular pulpotomy). Thus, indicating the need to disregard the closely held belief that a vital mature permanent tooth diagnosed with irreversible pulpitis will require root canal treatment for long-term preservation of the tooth rather than the less invasive vital pulp therapy (VPT).

Here in this study we would be using CHITOSAN and PRF as scaffold.

Scaffolds are three-dimensional (3D) porous solid biomaterials which Provide a spatially correct position of cell location which helps in tissue regeneration.

PLATELET RICH FIBRIN (PRF) is second-generation platelet concentrate named as Choukroun’s PRF after its inventor. PRF is biological and Ideal biomaterial for pulp-dentin complex regeneration. The procedure consists of drawing blood which is collected into test tubes without any anticoagulant and is centrifuged instantaneously. A tabletop centrifuge can be used for 10 min at 3000 rpm or for 12 min at 2700 rpm. It contains multitude of growth factors such as PDGF, TGF β1, and IGF. It prevents the early encroachment of undesired cells, thereby acts as a viable barrier between desired and undesired cells and accelerates wound closure with mucosal healing due to fibrin bandage and growth factor release.

CHITOSAN is synthetic biomaterial.  It is produced commercially by deacetylation of chitin, which is the structural element in the exoskeleton of crustaceans (such as crabs and shrimp) and cell walls of fungi. It is nontoxic, easily bioabsorbable, shows antibacterial activity, has gel forming ability, increases alkaline phosphatase activity, shows fibroblast and odontoblastic proliferation. It is a porous scaffold that can be molded into any shape and its hydrophilic property enhances cell attachment and proliferation.

 Therefore, based on this data ,A study has been planned  comparing “ CORONAL PULPOTOMY AND PARTIAL RADICULAR PULPOTOMY IN VITAL MATURE PERMANENT MOLAR WITH IRREVERSIBLE PULPITIS AND/OR APICAL PERIODONTITIS USING CHITOSAN AND PRF”- A RANDOMISED CONTROLLED TRIAL.