One-year Clinical Effect Observation Of Pulpotomy On 32 Permanent Teeth With Cariously Exposed

The root canal therapy was widely used in clinical doctors for the large extent of the caries,which was more than 0.5mm in diameter.The method was considered to be the gold standard for the treatment of the teeth.In recent years,some scholars reported that the failure rate of root canal therapy after 5 years was up to 21.8%.Moreover,root canal therapy has more disadvantages during and after surgery.On the other hand,pulpotomy is technically less complicated,less time-consuming,and less expensive than RCT and could be indicated in difficult endodontic cases,or else these teeth was extracted in economically underdeveloped areas.Morever,extracting these teeth broke the idea of preserving the tooth and living pulp.Pulpotomy is a way to preserve the living pulp.It is often used in deciduous teeth and young permanent teeth.It is not recommended for mature permanent teeth in the domestic.However,foreign scholar Asgary S et al carried out the pulpotomy for 205 mature permanent teeth.The success rate was 78.1%in 5 years,and compared with the root canal treatment,the success rate of the two treatment methods was not statistically significant.Therefore,it can be applied to mature permanent teeth,which has been proved to have a certain success rate abroad.However,the technology is less studied in China.In order to apply this technology in domestic,this study apply MTA on 32 permanent teeth and observe its 1-month、3-month、6-month、12-month success rate and clinical effect and provides some theoretical basis for its application in clinic.Objective To observe the one year clinical effect of 32 permanent teeth with cariously exposed.Methods Collect 32 permanent teeth with cariously exposed.The tooth was isolated with rubber dam after completely local anesthesia.If there is microleakage,it should be sealed with a sealant.The clinical crown was first disinfected with 5%sodium hypochlorite or 3%hydrogen peroxide.Carious lesions were excavated using a large round diamond bur in a high-speed handpiece with water coolant and spoon excavators.Using fresh sterile round bur,the pulp chamber was deroofed and the opening was refined with sterile tapered diamond bur(EndoAccess Bur;Dentsply Maillefer,Tulsa,OK).During pulpotomy,coronal pulp tissue was excised using a spoon excavator until the canal orifice,and hemorrhage was controlled using a cotton pellet moistened with 2.5%sodium hypochlorite(NaOC1;Prevest Denpro Ltd,Jammu,India)applied for 4 to 5 minutes.After hemorrhage control,the chamber was cleaned using 5 mL 2.5%NaOCl,and a freshly mixed paste of white mineral trioxide aggregate(MTA)(Pro-Root MTA White;Dentsply Maillefer)was placed over the chamber floor covering the canal orifices.MTA was then condensed lightly with moistened cotton pellet to attain adequate thickness of 2 to 4 mm confirmed radiographically.A damped cotton pellet.was placed over the condensed MTA and the cavity was sealed with Ketac Molar glass-ionomer filling(3M/ESPE,Seefeld,Germany)as interim restoration.At the second appointment,scheduled after 24 hours,symptoms were evaluated,the interim restoration was removed,and the hardness of MTA was evaluated.Ketac Molar was placed as a base over MTA in sufficient thickness until the cavity was 3 to 4 mm deep and the remaining cavity was restored with composite restoration(Tetric-E-Ceram;Ivoclar-Vivadent,Schaan,Liechtenstein).Occlusal adjustments of restorations were made,finished,and polished.Postoperative radiographs were taken respectively at 1,3,6,12 months for future comparisons.Results One-month and three month retention rate was 100%,6-month retention rate was 96.8%,12-month retention rate was 90.6%.Conclusion Pulpomy could apply on permanent teeth with cariously exposed and can achieve high success rate in one year.We can do more cases in clinic and have long-term follow-up.