Outcome of Full pulpotomy vs Partial radicular pulpotomy in mature permanent teeth indicative of Irreversible Pulpitis using Biodentine - 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.

Prevention of disease or its termination at the earliest possible stage, along with the preservation of maximum healthy viable tissue is an indispensable element of any treatment modality and forms the fundamental basis of minimally invasive dentistry. Pulpotomy is one such procedure that focuses on the preservation of pulp and its functions like proprioception, innervation and vascularisation. Compared to root canal treatment (RCT), it is less time-consuming and easier to perform technically. Teeth treated with RCT are at risk of structural failure, loss of sensation of environmental changes (potentially leading to more or worse caries), rejection of the foreign material, reinfection, and occurrence of apical periodontitis.

The rationale behind root canal obturation has inclined toward mechanical rather than biological treatment. A recent systematic review has concluded that VPTs, specifically full pulpotomy, have exhibited a high success rate in managing carious pulp exposure of cases with IP and can be a suitable potential substitute for RCT.

Despite the work to date, controversy still persists regarding the optimal level of endodontic therapy. This is partly due to the lack of distinction between pulpal inflammation and  radicular infection. Nicholls and Baume, have shown that the inflamed pulp lends itself to vital apex treatment. Therefore, to overcome the drawbacks of RCT, vital apex treatment and vital pulp therapy have been developed. Vital apex treatment may be defined as radicular pulpotomy or biopulpectomy.