Comparative Effectiveness in the Management of Irreversible Pulpitis

This is an interventional treatment trial for Irreversible Pulpitis focused on measuring Vital Pulp Therapy, Pulpotomy Read More

Inclusion Criteria:

• Maxillary or mandibular first or second mature permanent molars with carious lesions or restorations (excluding crowns), with signs and symptoms of reversible or irreversible pulpitis, requiring treatment, where pulp exposure is detectable upon excavation.
• Tooth is responsive to cold and electrical pulp testing, with or without hyperalgesia
• Patients aged ≥10y for first molars and ≥16y for second molars

Exclusion Criteria:

• Evidence of Pulp Necrosis or Apical Periodontitis, preoperatively or upon inspection of an exposure site
• Absence of a contralateral molar teeth
• Teeth that are badly broken down and/or are not restorable
• Teeth with mechanical allodynia assessed by registering bite force that is at least 50N lower than the contralateral tooth
• Teeth with radiographic evidence of internal, or external cervical, inflammatory or replacement root resorption, or with pulp canal obliteration
• Teeth with no clinical evidence of pulp exposure upon excavation
• Radiographic evidence of PDL space wider than three times normal width on preoperative CBCT
• Clinical evidence of swelling or sinus tract
• Periodontal pocket probing depth ≥5 mm in any site around the tooth
• Clinical evidence of cracks connecting mesial and distal surfaces and/or extending in pulp chamber or associated with periodontal pockets ≥5 mm
• History of taking centrally acting drugs (e.g., tricyclic antidepressants), which interfere with the release of pain mediators and/or modify pain experience, within the previous 6 months.
• Use of medications that affect the host response such as methotrexate; corticosteroids or cyclosporin
• Patients on immunosuppressive agents, chronic corticosteroid use, autoimmune disease, or other immunocompromising diseases or medications
• Patients who require IV sedation or general anesthesia for their dental treatment
• Teeth with full coverage crowns
• Teeth undergoing active orthodontic movement
• Teeth in the VPT group that require intra-pulpal anesthesia for completion of treatment will be considered a treatment failure and treated with RCTx.
• Teeth that require elective RCTx, regardless of pulpal diagnosis, for restorative purposes.
• Teeth in the VPT group in which, following complete pulpotomy, bleeding does not stop after 10 minutes with 3% hypochlorite cotton pellet. These will be considered treatment failure and treated with RCTx.
• Patients who know that they are or may be pregnant at time of treatment. At the 2-year follow up, if they are pregnant the CBCT will be delayed until they have their baby.