Clinical and Radiographic Evaluation of Potassium Nitrate in Polycarboxylate Versus Mineral Trioxide Aggregate in Vital Pulpotomy in Primary Molars: a Randomized Clinical Trial

Introduction:

Dental caries continues to be a significant health issue, with a very high prevalence in children worldwide. For a variety of reasons (lack of proper dental education, lack of access to dental care, "silent symptomatology," etc.), treatment is frequently initiated once the progression degree has reached a deep, cavitated stage, often with pulp involvement. The primary purpose of pulp therapy in deciduous dentition is to promote the health of the teeth and their supporting tissues in order to maintain the proper functions of the oro-facial complex (mastication, speech, aesthetics), and ultimately to retain the teeth in their position to preserve arch length. Primary teeth are referred to as "the best space maintainers" as they effectively preserve space for their successors.

Carious primary teeth with normal pulp or reversible pulpitis should be treated with vital pulp procedures. Currently, three vital pulp therapy (VPT) options exist for treating deep dentin caries lesions approximating the pulp in vital primary teeth: indirect pulp treatment (IPT), direct pulp cap (DPC), and pulpotomy.

VPT is primarily recommended to be performed in young patients because of the high healing capacity of pulp tissue compared to older patients. An adequate blood supply is required to maintain the pulp's vitality. Furthermore, the presence of a healthy periodontium is required for VPT to be effective, as teeth with moderate to severe periodontal disease are not candidates for treatment. In cases with an inadequate coronal seal and subsequent bacterial microleakage, the prognosis for VPT is significantly reduced.

Pulpotomy is a conservative clinical procedure performed on pediatric patients, and most recently on adult patients too, that involves the removal of the coronal pulp while preserving the radicular pulp. The rationale is based on the healing capacity of the remaining pulp tissue following surgical amputation of the affected or infected coronal pulp. Following hemostasis, the exposed pulp is covered with either a pulp-capping agent that promotes healing or an agent to fix the underlying tissue.