Radiological and clinical assessment of pulpotomy on mature permanent molars with irreversible pulpitis: literature review

Introduction: Endodontic treatment has long been considered the only conservative therapeutic option for teeth with irreversible acute pulpitis. Histological studies have shown that the inflammation is confined to a limited surface of the pulp, near the decaying lesion, and it is not uncommon to find normal histology in the coronary pulp away from decayed surfaces as well as in roots. In dentistry, it is universally accepted that the vital pulp tissue should be preserved if possible. Aim: The objective of this study is to review the literature on the clinical and radiographic assessment criteria for coronary pulpotomy therapeutics on mature permanent teeth with irreversible acute pulpitis. Materials and Methods: To find relevant articles on this therapy, an electronic search strategy on PubMed, Cochran Library and Science Direct databases using the combination pulpotomy and pulpitis and permanent tooth, for indexed studies from January 2008 to April 2018. Results: Results of this study indicated favorable success rates for this therapy. A 2018 study reported 98.4% of clinical and radiographic successes at six months. At one year, it reported 100% clinical success and 98.4% radiographic success with the use of Biodentine. Furthermore, it reported 100% clinical success and 97.5% of radiographic success rate with the use of mineral trioxide aggregate (MTA) in the first year, and 92.7% of radiograph success after three years. In 2014, a publication reported 98.19% clinical success rate with cement-enriched mixture (CEM) over a 27 month period. However, the X-ray success rates were 86.7%. Conclusion:This treatment can be a realistic alternative for mature permanent human molars with irreversible pulpitis symptoms. But other large-scale multicentered clinical trials are strongly encouraged to substantiate this hypothesis.