Combination of Non-Surgical Endodontic and Vital Pulp Therapy for Management of Mature Permanent Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis and Apical Periodontitis

 Journal of Endodontics

Published:October 19, 2020DOI:https://doi.org/10.1016/j.joen.2020.10.010

Abstract

Introduction

This prospective study evaluated the outcome of a combination of non-surgical endodontic (NSET) and vital pulp therapy (VPT) for the management of mature permanent mandibular molar tooth with symptomatic irreversible pulpitis (SIP) and apical periodontitis (AP).

Method

Institutional ethical clearance was obtained. Mandibular molar teeth (n= 60) with a definitive diagnosis of SIP and AP with a radiographic periapical index score (PAI) of ≥3 in either one of the roots (mesial or distal) were included. Block randomization was used for allocation. In the NSET group (n=30), single visit NSET was performed using a standardized operating protocol. In NSET-VPT group (n=30), subsequent to full pulpotomy, the root orifice where a vital pulp was observed (as determined by the arrest of pulpal bleed on application of 2.5% sodium hypochlorite pressure pack), an MTA radicular barrier was placed, and it was covered with light-cured RMGIC. NSET was performed in the root exhibiting PAI score ≥3. The tooth was permanently restored. Postoperative pain was assessed at 24, 48 and 72- hours. Teeth were followed up clinically and radiographically at 12-months. Presence/absence of symptoms and change in PAI scores were noted. The data was statistically analyzed.

Results

The success rate was 90% in the NSET group and 93.3% in the NSET-VPT group. On an inter-group comparison between the proportion of teeth healed and non-healed (radiographic), there was no significant difference (p>0.05).

Conclusion

The combination of NSET and VPT is a viable biologically based minimally invasive treatment option for multi-rooted mandibular teeth with SIP and AP.