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Aim: The aim of this study is to compare the outcomes of restricted partial pulpotomy (R‐PP) versus extended partial pulpotomy (E‐PP) for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis (SIP). Methodology: This double‐arm, parallel designed randomized clinical trial was registered at clinicaltrials.gov (registration number: NCT05406557). Following random allocation, 43 participants of each group received the designated intervention. In the R‐PP group, 2–3 mm of superficial pulp tissue was removed only from the exposure site, while chamber was completely de‐roofed and 2–3 mm of superficial pulp tissue from entire chamber was removed in the E‐PP group. Haemostasis was achieved using 3% sodium hypochlorite‐soaked cotton pellets. Upon haemostasis, ProRoot mineral trioxide aggregate (ProRoot MTA) was placed over the pulpal wound, overlaid with a resin‐modified glass ionomer liner, and restored with composite resin in the same visit. Outcome measures included clinical and radiographic success evaluation at 6 and 12 months, and pain assessment using the visual analogue scale pre‐operatively and daily for 7 post‐operative days. Nonparametric tests were used for variables including patient's age, pain intensities, mean analgesic consumption, and haemostasis time. Categorical variables including gender, caries type, analgesic intake, hard tissue barrier formation, clinical and radiographic success, and pulp sensibility responses were assessed using Chi‐square or Fisher's exact test. Tooth survival was analysed using Kaplan–Meier analysis. Results: A total of 81 cases were analysed at 12 months follow‐up. Comparable success was observed in both groups (97.6% in E‐PP & 97.5% in R‐PP; p >.05). The R‐PP group reported significantly lower pain scores on the 1st and 2nd post‐operative days than E‐PP (p <.05) and required significantly less analgesic intake (p <.05). Hard tissue barrier formation was significantly lower in the R‐PP group (p <.05). No significant differences were observed between groups regarding haemostasis time, pulp sensibility responses, and tooth survival (p >.05). Conclusions: Both the PP approaches exhibited comparable success for managing cariously exposed mature permanent molars with SIP. Given the conservative nature of R‐PP, it may be used as preferred PP approach for managing such cases. Being the first study of this kind, further work is necessary to draw definitive conclusions. [ABSTRACT FROM AUTHOR]

Background: Pulpitis may be pain free or alternatively characterized by mild to severe pain and associated symptoms. Evidence has recently emerged that patients presenting with carious pulp exposure range of symptoms can be treated effectively with pulpotomy. Objective: The current systematic review aimed to answer the following research question: "In patients with deep caries lesions in permanent teeth associated with no symptoms, reversible pulpitis or signs and symptoms indicative of irreversible pulpitis (P), is partial pulpotomy (I) as effective as full pulpotomy (C), in terms of a combination of patient and clinical reported outcomes (O), with "tooth survival" as the most critical outcome? Methods: The systematic literature search was conducted in the following electronic databases: OVID, Scopus, PubMed (Including MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL) supplemented with Grey literature and hand searching of relevant journals. The English language clinical trials comparing the patient and clinical reported outcomes between partial and full/complete were included. After a structured literature search, two authors independently performed study selection, extracted data and performed a risk of bias assessment; a third reviewer resolved disagreements. As there were only two studies with different exclusion criteria, no meta‐analysis was performed and the quality of evidence was assessed by the GRADE approach. Results: After study selection a total of two randomised clinical trials with a total of 156 teeth were included both for the management of teeth with irreversible pulpitis. There were no studies for asymptomatic teeth or teeth with reversible pulpitis. A "Low" risk of bias was noted for both studies with a high level of overall evidence. A meta‐analysis was not carried out due to differences in inclusion criteria between the studies related principally to caries depth. Both studies reported a high rate of clinical success for pulpotomy with a pooled unadjusted success rate for full pulpotomy of 90% and 83% partial pulpotomy of at 1‐year; however, no significant difference between the treatments was noted in either study. There was significantly reduced postoperative pain reported in the full pulpotomy group over 1‐week compared with the partial pulpotomy in one but not in the other study. Discussion: Pulpotomy as a definitive treatment modality is as effective in managing teeth exhibiting signs and symptoms indicative of irreversible pulpitis and challenges the established protocols to manage this condition. Although based on only two RCTs with a limited number of patients, no difference was shown in terms of clinical or radiographic outcome or postoperative pain between groups. Further well designed randomised clinical trials of longer duration are required in this area to improve the evidence available. Conclusion: There is no consistent difference in patient‐reported pain between partial and full pulpotomy at day 7 postoperatively and the clinical success rate was similar after 1 year for both treatment modalities. [ABSTRACT FROM AUTHOR]

Background: Few studies focus upon patient‐reported outcomes in endodontics. Aim: To determine whether full pulpotomy offers a less painful, improved health‐related quality of life (HRQoL) compared with root canal treatment (RCT) in cases of irreversible pulpitis (IP) in the 7 days after the treatment. Methodology: One hundred sixty‐eight participants presenting with symptoms of IP were randomized to either pulpotomy (n = 86) or RCT (n = 82). Two participants were excluded, 61 participants underwent full pulpotomy with Biodentine (35.7%), 80 had RCT (46.8%), and 25 were randomized to have pulpotomy which progressed to RCT (PRCT) due to uncontrollable bleeding (14.6%). Clinical and radiographic assessments, using CBCT and periapical radiographs, were carried out preoperatively, for the evaluation of the results only CBCT images were used. Pain (VAS) and HRQoL (EQ 5D) assessments were carried out at baseline and Days 1, 3, 5 and 7 post‐baseline. Analysis included descriptive and continuous variables, chi‐squared, Fisher's exact, and two‐sample t‐tests. Results: In pulpotomy and RCT groups, VAS pain decreased significantly over the first week (p <.001). The magnitude of reduction was similar in RCT and pulpotomy (p =.804), RCT and PRCT (p =.179), pulpotomy vs. PRCT (p =.144) and in the comparison of combined RCT /PRCT groups (ORCT) with Pulpotomy (0.729). However, the overall level of VAS pain was significantly higher in the PRCT group than in the Pulpotomy (p =.045) and RCT group (p =.049). Using CBCT, significantly more radiolucencies were found in the PRCT group than in the pulpotomy group and overall teeth presenting with CBCT radiolucencies had significantly higher pain scores (p =.015), particularly at Days 1, 3 and 5. There were significant differences in many OHRQoL domains (Questions 1, 6, 11 and 12) between RCT and PRCT groups with higher frequencies of the impact of oral health problems at Day 0 and Day 7 in the PRCT group. Conclusion: In the treatment of IP, pulpotomy is as effective as RCT in reducing post‐operative pain, and improving QoL and HRQoL, teeth displaying uncontrollable bleeding and periapical radiolucencies detected using CBCT are associated with more intense postoperative pain and lower QoL. [ABSTRACT FROM AUTHOR]

Background: Indirect pulp capping (IPC) represents a pivotal therapeutic intervention directed toward preservation of pulp vitality, achieved through the placement of a biocompatible, bioactive material over the affected dentin to protect the pulp from further insult and encourage healing. Aim: This study aimed to evaluate the clinical and radiographical success rates of Biodentin versus light-cured mineral trioxide aggregate (MTA) when used as an IPC agents. Evaluation was done on the basis of prognosis of the treatment after a period of 1 year. Methodology: This randomized controlled clinical trial was based on a cohort of 20 individuals with deep carious lesions being subsequently divided into two experimental groups of ten cases each. Group I - Biodentin and Group II - Light cured-MTA as pulp capping agents, respectively. Clinical and radiographical assessment was done at baseline, 1, 2, 3, 6 months, and 1 year. Results: Statistical analysis with the Chi-square test showed no statistically significant difference between the groups. The overall success rate of 1-year follow-up for both Biodentine group and Light-cured MTA group was 93.33%. Conclusion: The results of this randomized controlled clinical trial support promising success of IPC independent of the pulp capping material used as the findings underscore a significant decrease in postoperative pain levels compared to preoperative states across all cases. However, more studies with long-term follow-ups are required. [ABSTRACT FROM AUTHOR]

Hyaluronic acid (HA), known for diverse properties, was investigated for its potential in dental pulp therapy. This study investigated the potential of HA in dental pulp therapy by examining the physical properties and effects of zinc oxide eugenol (ZOE) pulpotomy materials containing varying HA concentrations on rat molar teeth. In vitro tests assessed compressive strength and hardness of ZOE materials blended with HA (0.5%, 1%, 3%) and HA gels (0.54%, 0.8%). 120 samples, encompassing the control group, underwent compressive strength testing, while 60 samples were designated for hardness assessment. In vivo experiments on rat molars studied histological effects of HA-containing ZOE on dental pulp over 1 week and 1 month. Gels with HA concentrations of 0.5%, 1%, and 0.54% were used in pulpotomy on 22 rats. Each rat underwent the procedure on four teeth, with one tooth serving as a control, totaling 88 teeth subjected to the intervention. In the analyses, SPSS 22.0 was used and the significance level was set at P = 0.05. Findings showed that HA at 0.5% maintained compressive strength, but higher concentrations decreased mechanical properties significantly (P = 0.001). Histological assessments indicated better outcomes with lower HA concentrations in terms of odontoblast layer continuity (P = 0.005 at 1 month) and pulp vitality (P = 0.001 at 1 week and P = 0.018 at 1 month). The study suggests HA holds promise for pulpotomy and regenerative endodontic treatments, but further research is needed to understand long-term clinical implications. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the histological success of pulpotomy in primary molars using white mineral trioxide aggregate (WMTA) mixed with 2.25% sodium hypochlorite (NaOCl) gel and to evaluate in vitro its physical and chemical properties. The study had a clinical stage and an in-vitro stage. The clinical study was conducted with 24 patients aged 8–10 years. It was a randomized controlled trial to perform a histologic evaluation of pulp response following pulpotomy. Primary first molars were randomly assigned in split mouth model to control group—WMTA + distilled water (DW) or experimental group – WMTA + NaOCl gel. Teeth were extracted after 7, 30 or 90 days and submitted to histological analysis. The second stage was an in-vitro study to evaluate the physical and chemical properties of the two materials tested. SEM and EDX analyses and pH level evaluations were performed after 24 h and 28 days. The histological findings revealed that while WMTA + NaOCl gel group showed better odontoblastic integrity (P < 0.05), WMTA + DW group had more favorable outcomes in dentin bridge formation and pulp calcification (P < 0.05). Pulp tissue hemorrhage and pulp fibrosis were similar between them (P > 0.05). Regarding materials' in vitro evaluation, the pH level indicated a higher initial pH for the WMTA + NaOCl gel group, which equalized after 28 days. SEM analysis initially showed a less homogeneous surface for WMTA + NaOCl gel, but it became similar after 28 days. EDX analysis indicated higher calcium and silicon percentages in the WMTA + NaOCl gel group initially, which increased in both groups after 28 days. Adding 2.25% NaOCl gel to WMTA enhanced odontoblastic integrity in both the short and medium term. In addition, it had a similar chemical composition, surface morphology, and alkalinity when compared to WMTA + DW mixture. [ABSTRACT FROM AUTHOR]

Background: Toothache is a debilitating condition, often with mild to excruciating pain, swelling, eating difficulties and insomnia. This study aims to delineate the profiles of patients seeking emergency dental care, focusing on the diagnosis, treatment, and outcomes following non-surgical root canal treatment. Methods: This prospective cohort study was conducted from 2012 to 2021 at the Section for Endodontics, Department of Clinical Dentistry, University of Bergen, Norway. A total of 281 emergency patient forms were analyzed. Data registered included patient demographics, dental history, chief complaints, medications used, diagnostic results, treatments provided and outcome. Results: A total of 272 patients (272 teeth) were included in the study. Pain was the predominant complaint (98.5%), where only 57.4% of the patients managed to localize pain to a specific tooth. The mean age of patients was 51.2 years with no significant gender differences. The maxillary right first molar (15.4%) was the most frequent tooth needing treatment. The majority of the patients had experienced pain for three days before they attended the emergency appointment. The most frequently used drug for pain management was paracetamol which was stated to have little effect. Teeth that needed endodontic treatment often had restorations rather than caries. The most frequent diagnoses were pulpitis (26.8%) followed by necrotic pulp (25.4%) and previously root filled teeth (22.8%). Root canal treatment was performed on 60% of the teeth and a success rate of 95% was registered at one-year recall. Conclusions: There was no singular diagnostic cause leading patients to seek an emergency appointment, highlighting the necessity of a thorough diagnostic procedure. Over the counter pain medications have little effect on alleviating dental pain, often resulting in desperate measures of self-medication. 60% of the teeth needing emergency treatment had previous coronal restorations such as fillings or crowns, indicating that conservative treatment does not appear to fully protect against future pulpal disease. The good prognosis of root canal treatment for teeth with acute symptoms supports recommending dentists to attempt root canal treatment rather than opting for tooth extraction. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion To assess the clinical, radiographic and patient‐reported outcome measures, and the success of screw‐retained one‐piece monolithic zirconia implant‐supported restorations in the posterior region during a 1‐year follow‐up.In a prospective case series, 50 single molar sites in the posterior region of 41 patients with a minimum age of 18 years and sufficient bone volume for placing an implant (≥ 8 mm) and space for an anatomical restoration were included. Following prosthetic‐driven digital three‐dimensional treatment planning, a tissue‐level implant with an internal connection was inserted during a one‐stage surgical procedure. Three months later, the implant was restored with a screw‐retained one‐piece monolithic zirconia restoration. Clinical, radiographic and patient‐reported outcome measures, and restoration survival and success according to the modified USPHS criteria were assessed at baseline prior to and immediately after implant placement, and 1‐month and 1‐year after definitive restoration placement.At the 1‐year follow‐up, 1 implant had been lost (implant survival rate 98%) hence, 49 restorations were evaluated. The restoration survival and success rates were 100% and 98%, respectively. Plaque, calculus, bleeding and suppuration on probing and peri‐implant inflammation were absent in most cases. The mean (SD) marginal bone level change between implant placement and the 1‐year follow‐up was −0.14 mm (0.27) on the mesial and −0.25 mm (0.31) on the distal side. The mean (SD) patient satisfaction (0–10) was 9.2 (0.8) at the 1‐year evaluation.One‐piece monolithic zirconia implant‐supported restorations exhibited favourable outcomes over 1 year in situ.Trial Registration: Registered in the National Trial Register (NL9059) [ABSTRACT FROM AUTHOR]

Background: A Partial pulpotomy technique is an alternative choice of treatment for immature permanent teeth with exposed vital pulps. This study aimed to compare the histopathological pulpal response of the primary teeth of puppies after partial pulpotomy and full pulpotomy using mineral trioxide aggregate (MTA). Materials and methods: 72 primary premolars from experimental puppies aged 6–8 weeks were equally divided into test and control groups, as MTA partial pulpotomy (MTA-PP) and MTA full pulpotomy (MTA-FP). After 60 days, the teeth were extracted and examined histologically. The specimens were assessing the extent and intensity of inflammatory response (acute or chronic), necrosis, fibrosis, calcific bridge (presence or absence), pulp calcification, and pathological root resorption. Results: The Inflammation intensity was lower (2.8%) in MTA-PP than in MTA-FP (16.7%) (P = 0.004). MTA-FP also had a significantly higher percentage of localized (27.8%) and diffuse (11.1%) necrosis (P = 0.014), whereas both groups (P = 0.290) had an equal fibrosis degree. A calcific bridge was observed in 72.2% of cases. Meanwhile, pathological internal root resorption was more evident in MTA-FP (63.9%) than in MTA-PP (19.4%) (P <0.0001). Conclusion: Partial MTA pulpotomy procedure demonstrated promising histological findings that can be applied to vital-pulp therapy in primary teeth. [ABSTRACT FROM AUTHOR]

Background: Dental caries is one of the most prevalent dental illnesses in children. Untreated severe caries can damage teeth, requiring pulpotomy to save them. Objective: To evaluate the clinical success rate of treatments involving pulpotomies + IRM (Intermediate Restorative Material, composed of reinforced zinc oxide–eugenol polymers) + preformed metal crowns (PMCs) in primary teeth of children treated at a public university in Mexico. Materials and Methods: A cross-sectional ambispective study was conducted on children aged 10 years or younger, treated at a public university in Mexico. A total of 1281 medical records from February 2018 to June 2023 were reviewed, yielding a sample of 199 children treated with pulpotomy + IRM + PMC. Information was collected via telephone interviews with parents/caregivers to inquire about any symptoms following the pulpotomy and metal crown treatments. Success was defined as the absence of pain, inflammation, or infection. Results: During the study period, the number of teeth treated with pulpotomy + IRM + PMC was 414, with follow-ups ranging from 6 to 69 months. Most participants were girls (54.3%), while 45.7% were boys. Out of the 167 pulpotomy + IRM + PMC treatments included in the study, the clinical success rate was 98.2%. Conclusions: The clinical success rate of primary teeth treated with pulpotomy + IRM + PMCs was high, close to 100%, based on evidence and symptom reports from parents/caregivers. It would be beneficial to implement its use in public health institutions in countries such as Mexico. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Success of pulpotomy of primary teeth depends on biological and cytotoxic effects of pulp capping agents. Mineral trioxide aggregate (MTA), Biodentine, calcium enriched mixture (CEM) cement, and ferric sulfate (FS) are among the commonly used pulp capping agents (PCAs) for pulpotomy, and their successful application has been previously evaluated. Purpose: This study aimed to compare the cytotoxicity of PCAs against mesenchymal stem cells isolated from human exfoliated deciduous teeth (SHEDs). Materials and Method: In this in vitro study, SHEDs were exposed to MTA, Biodentine, CEM cement, and FS for 24 and 72 hours. The methyl thiazolyl tetrazolium (MTT) assay was performed for five different concentrations of PCAs after 24 and 72 hours of exposure. Data were analyzed by ANOVA. Results: Generally, the biocompatibility increased by reduction in concentration. All tested concentrations showed higher biocompatibility at 72 hours compared with 24 hours (p< 0.0001). Comparison of cytotoxicity of different biomaterials revealed no significant difference at any time point (p> 0.05). Conclusion: In general, the cytotoxicity of MTA, Biodentine, CEM cement, and FS was comparable, with no significant difference. Cytotoxicity decreased over time and by a reduction in concentration of biomaterials. MTA and Biodentine showed maximum biocompatibility followed by FS, and CEM cement. [ABSTRACT FROM AUTHOR]

The present study aimed to compare the clinical and radiographic success rates of Formocresol (FC), Portland Cement (PC), and NeoMTA Plus in primary molar pulpotomy. Ninety-six primary molars in ninety-six children aged 3‒9 years were randomly assigned to FC, PC, and NeoMTA Plus groups. Radiographic and clinical follow-up evaluations were performed at six and twelve months. After six and twelve months, clinical success rates were 100% in the three groups. The radiographic success rates in the 6-month follow-up were 96.7 and 96.7% in the FC and PC groups and 100% in the NeoMTA Plus group. At 12 months, radiographic success rate was 93.8, and 93.8% in the FC and PC groups and 96.9% in the NeoMTA Plus group. There were no significant differences between the three groups at all follow-up evaluations. NeoMTA Plus showed highest success rate, clinically and radiographically. PC and NeoMTA Plus can be considered as an alternative to FC. [ABSTRACT FROM AUTHOR]

Background: Children with hearing impairment (HI) face communication challenges during dental procedures due to hearing loss. Studies suggest that distraction techniques, like virtual reality (VR), can effectively divert their focus from stressful stimuli, resulting in a more comfortable dental experience. The present study aims to assess the effectiveness of distracting children with moderate to severe (HI) with virtual reality glasses that show cartoons in sign language during pulpotomy treatment compared to conventional management techniques. Methods: Forty children aged five to seven participated in a randomized controlled parallel two-arm clinical trial—the type of behavioral management employed determined which two groups children were randomly placed into. Group I (Study group) used virtual reality glasses as a diversion, while Group II (Control group) used the conventional behavior management approach. Local anesthesia was administrated, and a pulpotomy procedure was performed on the selected tooth, followed by stainless steel crown restoration (SSC). There were three methods used to assess dental anxiety before and after the procedure: the physiological method, which used heart rate (HR); the objective measure, which used the Venham Clinical Anxiety Scale (VCAS); and the subjective measure, which used the modified Facial Affective Scale (FAS). An independent t-test was employed for HR analysis of the difference between the groups as a continuous variable. The Pearson Chi-square test assessed differences between groups for categorical variables, such as (VCAS) (FAS). Results: No significant differences were found in mean (HR) or (VCAS) between the two groups throughout the procedures: during local anesthesia (p = 0.659, 0.282), pulpotomy (p = 0.482, 0.451), and stainless steel crown preparation (p = 0.090, 0.284). Anxiety levels by (FAS) remained statistically comparable between the two groups before and after the procedures (p = 0.507, 0.749), respectively. Conclusions: The use of VR glasses revealed no significant advantages in managing children with HI during the dental visit compared to the conventional method of child behavior management. Trial registration: The trial was prospectively enrolled on 11/11/2023 under the identification number NCT06153823 on ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this in vitro study was to compare the microleakage of bulk-fill restoratives to the gold standard, preformed metal crowns (PMCs), in pulpotomized primary molars. Methods: Fifty-four extracted primary molars were selected, ensuring three intact walls and at least two-thirds root length. After caries removal and pulpotomy procedures, intermediate restorative material (IRM) was placed in the pulp chambers. Teeth were then randomly divided according to the final restoration into six groups (n equals nine): Group A–Activa™ (glass ionomer liner, etching, bonding); Group B–Tetric® N-Ceram Bulk-Fill composite (liner, etching, bonding); Group C–Cention® N (liner, etching, bonding); Group D–Cention® N (liner); Group E–IRM; and Group F–PMCs (control). Specimens underwent 500 thermocycles and 24-hour immersion in one percent methylene blue dye at 37 degrees Celsius. Microleakage was assessed after mesio-distal sectioning using Kruskal-Wallis and Dunn’s post hoc tests (P<0.05). Results: Group A–Activa™ (mean rank equals 18.28) and Group C–Cention® N, (mean rank equals 20.5) showed significantly lower leakage scores than Group E–IRM (mean rank equals 41.5; P=0.012 and 0.036, respectively). Group A –Activa™ had the highest proportion of leakage-free samples (44.4 percent). Differences between Bulk-Fill materials groups and Group F–PMCs were statistically insignificant. Microleakage trends decreased in order from Group A–Activa™ to –C Cention® N to B–Tetric® N-Ceram Bulk-Fill composite to D– Cention® N (liner) to F–PMCs. Conclusions: These preliminary in vitro findings provide evidence for one aspect of restorative success, suggesting that bulk-fill restoratives, particularly Activa™ and Cention® N with adhesive, may be promising alternatives to preformed metal crowns for restoring pulpotomized primary molars for microleakage resistance. However, further parameter testing and clinical research are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this systematic review and meta-analysis was to assess the success of pulpotomies performed on primary teeth using mineral trioxide aggregate (MTA) and other calcium-silicate-based cements (CSC). Methods: A comprehensive search was conducted in six electronic databases. The selection of studies was guided by PICOS criteria and included only randomized clinical trials that evaluated the success of pulpotomy in primary teeth using MTA, compared with other CSC materials. Risk of bias was assessed using the RoB-2 tool, and meta-analyses were conducted using RevMan© 5.3 software. The GRADE tool was used to determine the certainty of evidence. Results: The initial search retrieved 662 studies, resulting in 27 included studies. Although there was significantly higher radiographic success for MTA after 12 months versus BiodentineTM, the 24-month follow-up showed no significant difference. Also, no significant difference was observed between MTA and Portland cement (24 months) or TheraCal® (12 months). Seventeen studies were classified as having a high risk of bias, and the GRADE assessment revealed an overall low level of evidence. Conclusions: Pulpotomies using mineral trioxide aggregate, BiodentineTM, Portland cement, or TheraCal® are highly effective for managing primary teeth. The certainty of evidence supporting these findings remains low, and future work should focus on conducting better-designed long-term studies. [ABSTRACT FROM AUTHOR]

Background: Pulpotomy is a widely recommended treatment for deep caries and reversible pulpitis in primary teeth. However, there is a significant lack of large-scale clinical studies evaluating the long-term efficacy of pulpotomy in primary molars, especially in studies with follow-up periods extending beyond a two years. Aim: This study aimed to evaluate the long-term efficacy of mineral trioxide aggregate (MTA) and iRoot BP Plus for pulpotomy in primary molars performed under general anesthesia and to investigate factors influencing the success rate. Methods: In this retrospective study, a total of 942 primary molars from 422 children who met the inclusion criteria underwent pulpotomy. Propensity score matching method (PSM) was used to match the MTA and iRoot BP Plus groups in a 1:1 ratio based on covariates. Efficacy was assessed using the Zurn & Seale criteria. Kaplan-Meier survival analysis and Cox proportional hazards model were performed to analyze the outcomes. Results: PSM resulted in 266 pairs of matched teeth from 532 teeth of 291 children (mean age: 4.64 ± 1.07 years, ranging from 2 to 8 years). Long-term clinical and radiographic evaluations revealed higher success rates for iRoot BP Plus (24-month: 99.54%/97.25%; 36-month: 97.22%/95.83%) compared to MTA (24-month: 94.76%/95.29%; 36-month: 92.50%/91.25%). Survival analysis indicated a statistically significant difference between two groups (P = 0.0042). Age, gender, tooth position, and decayed tooth surface showed no significant impact on pulpotomy success, whereas the choice of pulp capping materials significantly influenced the outcome (HR [95% CI]=0.3745[0.1857-0.7552], P = 0.006). Conclusion: Clinical and radiographic evaluations support the use of iRoot BP Plus for pulpotomy in primary molars. [ABSTRACT FROM AUTHOR]

Introduction: Vital pulp therapy (VPT) aims to preserve dental pulp after injury and has gained significant popularity due to advancements in materials and understanding of pulp biology. While bibliometric analyses are common in various fields, none have been conducted specifically for the 100 most-cited articles on VPT. Materials and Methods: This bibliometric study analyzed the 100 most-cited VPT papers using data from Web of Science (WoS-CC), Scopus, and Google Scholar. Articles were manually reviewed to extract key bibliometric data, including titles, citation counts, citation density, authorship, country of origin, publication year, journal, study design, and VPT type. Results: The articles collectively received 19,782 citations, with the oldest from 1966 and the most recent from 2019, having 803 and 104 citations, respectively. Key journals included the Journal of Endodontics , International Endodontic Journal , and Dental Materials. Review articles were the predominant study design, followed by clinical, laboratory, and basic research studies. Eight of the top 20 articles focused on the properties of mineral trioxide aggregate (MTA). Torabinejad and Parirokh were notable contributors before 2010, while Duncan, Bjørndal, and Simon were prominent after 2010. VPT research has increased significantly post-2010, with a notable shift in focus from early studies on calcium hydroxide to more recent studies on MTA's biocompatibility and its use as a pulp capping agent. Conclusion: This analysis provides a comprehensive list of the top 100 cited VPT articles, offering valuable insights for researchers, students, and clinicians. The study highlights key trends and influential contributions in the field of VPT research. [ABSTRACT FROM AUTHOR]

Background: The evidence underpinning caries management for children has progressed dramatically over the past 20 years. Anecdotally, this is not reflected in the teaching provided to undergraduate dental students, with the ongoing teaching of outdated methods within some dental schools. Aim: To capture the current undergraduate teaching provision and clinical treatment experience requirement relative to caries management in paediatric dentistry in UK dental schools. Design: Cross‐sectional analysis of current teaching methods on paediatric caries management was obtained using a piloted online data collection form. Question content included current caries teaching methods, assessment of student exposure and competence. The results were analysed descriptively. Results: Of the 16 UK dental schools, 14 participated. Discrepancy in teaching content was apparent. Many schools (n = 9) taught biological caries management through therapeutic fissure sealants, yet this was not reflected in assessment and clinical requirements. Some schools (n = 4) taught amalgam placement in children, and most (n = 12) operatively taught treatments that would no longer be routinely provided in general dental practice in the UK, including primary tooth pulpotomy. Conclusion: There is substantial variation in the paediatric caries management techniques that are taught across UK dental schools, demonstrating a need for a national consensus to address these disparities. [ABSTRACT FROM AUTHOR]

Background: Prefabricated Zirconia Crowns (PZCs) are increasingly preferred for restoring primary teeth due to their esthetic appeal and retention. However, their rigid, unmodifiable design requires precise tooth preparation, often leading to aggressive reduction and potential pulp exposure. Pulpotomy, a standard treatment for reversible pulpitis and mechanical pulp exposure, is sometimes employed before PZCs. While pulpotomy is not routinely performed, its use raises important considerations about the interplay between restorative procedures and pulp therapy in pediatric dentistry, particularly regarding the long-term restoration outcomes of PZCs. Purpose: This study aimed to investigate the impact of pulpotomy on the success rate of PZCs. Methods: We examined 81 anterior upper primary teeth treated with PZCs in children aged 2–5 years over a two-year period. Cases were divided into groups with and without pulpotomy. Follow-ups occurred at 6-month intervals, assessing clinical and radiographic outcomes. Analyses were performed using SPSS 25.0 software. The statistical significance was p < 0.05. Results: A total of 81 anterior primary teeth were included. Chi-square analysis showed no association between pulp therapy and PZC success (χ2 = 0.051, p = 0.822). The Kaplan–Meier survival analysis revealed comparable survival curves and the log-rank test showed no statistically significant difference in survival time between pulpotomy-treated and untreated groups (χ2 = 0.051, p = 0.821). Conclusions: Pulpotomy did not significantly affect the success rate of PZCs within 2 years. [ABSTRACT FROM AUTHOR]

Abstract This study aimed to evaluate the histological success of pulpotomy in primary molars using white mineral trioxide aggregate (WMTA) mixed with 2.25% sodium hypochlorite (NaOCl) gel and to evaluate in vitro its physical and chemical properties. The study had a clinical stage and an in-vitro stage. The clinical study was conducted with 24 patients aged 8–10 years. It was a randomized controlled trial to perform a histologic evaluation of pulp response following pulpotomy. Primary first molars were randomly assigned in split mouth model to control group—WMTA + distilled water (DW) or experimental group – WMTA + NaOCl gel. Teeth were extracted after 7, 30 or 90 days and submitted to histological analysis. The second stage was an in-vitro study to evaluate the physical and chemical properties of the two materials tested. SEM and EDX analyses and pH level evaluations were performed after 24 h and 28 days. The histological findings revealed that while WMTA + NaOCl gel group showed better odontoblastic integrity (P 0.05). Regarding materials’ in vitro evaluation, the pH level indicated a higher initial pH for the WMTA + NaOCl gel group, which equalized after 28 days. SEM analysis initially showed a less homogeneous surface for WMTA + NaOCl gel, but it became similar after 28 days. EDX analysis indicated higher calcium and silicon percentages in the WMTA + NaOCl gel group initially, which increased in both groups after 28 days. Adding 2.25% NaOCl gel to WMTA enhanced odontoblastic integrity in both the short and medium term. In addition, it had a similar chemical composition, surface morphology, and alkalinity when compared to WMTA + DW mixture.

Abstract Background Toothache is a debilitating condition, often with mild to excruciating pain, swelling, eating difficulties and insomnia. This study aims to delineate the profiles of patients seeking emergency dental care, focusing on the diagnosis, treatment, and outcomes following non-surgical root canal treatment. Methods This prospective cohort study was conducted from 2012 to 2021 at the Section for Endodontics, Department of Clinical Dentistry, University of Bergen, Norway. A total of 281 emergency patient forms were analyzed. Data registered included patient demographics, dental history, chief complaints, medications used, diagnostic results, treatments provided and outcome. Results A total of 272 patients (272 teeth) were included in the study. Pain was the predominant complaint (98.5%), where only 57.4% of the patients managed to localize pain to a specific tooth. The mean age of patients was 51.2 years with no significant gender differences. The maxillary right first molar (15.4%) was the most frequent tooth needing treatment. The majority of the patients had experienced pain for three days before they attended the emergency appointment. The most frequently used drug for pain management was paracetamol which was stated to have little effect. Teeth that needed endodontic treatment often had restorations rather than caries. The most frequent diagnoses were pulpitis (26.8%) followed by necrotic pulp (25.4%) and previously root filled teeth (22.8%). Root canal treatment was performed on 60% of the teeth and a success rate of 95% was registered at one-year recall. Conclusions There was no singular diagnostic cause leading patients to seek an emergency appointment, highlighting the necessity of a thorough diagnostic procedure. Over the counter pain medications have little effect on alleviating dental pain, often resulting in desperate measures of self-medication. 60% of the teeth needing emergency treatment had previous coronal restorations such as fillings or crowns, indicating that conservative treatment does not appear to fully protect against future pulpal disease. The good prognosis of root canal treatment for teeth with acute symptoms supports recommending dentists to attempt root canal treatment rather than opting for tooth extraction.

Abstract Introduction Both pulpotomy and pulpectomy are indicated in deciduous teeth with carious pulp exposure. Pulpotomy is recommended for treating carious pulp exposure in primary molars with the development of dental biomaterials. However, it is difficult to determine the severity of pulpitis as children frequently have difficulty communicating their clinical symptoms and there is no objective diagnostic method to assess pulpal status. Thus, therapeutic interventions for deciduous teeth with carious pulp involvement are controversial in clinical applications. This study compared the clinical and radiographic survival time of iRoot BP Plus pulpotomy and Vitapex pulpectomy in treating extremely deep caries with carious pulp exposure in deciduous molars under general anaesthesia. Methods The 876 deciduous teeth in patients aged 3 to 6 years diagnosed with extremely deep caries were categorised into Group A (iRoot BP Plus pulpotomy) and Group B (Vitapex pulpectomy) based on treatment methods in this retrospective cohort study. The Kaplan-Meier survival curves were used to compare the survival rates and time between the groups. The Cox proportional hazards model was used to evaluate the factors associated with success. Results 876 primary molars were collected, including Group A (504) and Group B (372). The clinical and radiographic survival time in Group A (54.394 ± 1.388(months) and 48.978 ± 1.413(months)) were significantly higher than that in Group B (47.867 ± 0.956 (months) and 38.834 ± 0.981 (months)) (P

Objectives: Treatment of carious primary molars is always indicated, especially on young children; however, there are no clear guidelines that precisely explain the best treatment approach for Class II carious molars with marginal breakdown (International Caries Detection and Assessment System [IC-DAS] 5). The objective of this prospective observational clinical study was to assess the efficacy of three restorative techniques in treating ICDAS 5 Class II lesions in primary molars: compomerfillings (CF), preformed metal crowns (PMC), and pulpotomy and conventional preformed metal crowns (PMC+P). The secondary goal was to evaluate the impact of some cofactors on the course of treatment. Method and materials: Overall, 92 children (female, n = 50, 54.3%; male, n = 42, 45.7%) aged 2 to 9 years old (mean age = 5.9 ± 1.9 years) with 166 treated teeth were included. The average number of decayed, missing, or filled teeth (d3mft) of the whole sample was 8.0 ± 3.4. The distribution of the sample according to type of treatment was CF = 53 (31.9%), PMC = 64 (38.6%), and PMC+P = 49 (29.5%). Paired ttest, nonparametric Friedman ANOVA test, and decision tree analysis were used as the basis for the statistics. Results: After 12 months, data from 75.8% (72/95) treated patients, corresponding to 62.0% (103/166) of the treated teeth (CF = 42/53, 79.2%; PMC = 38/64,59.4%; PMC+P = 23/49,46.9%) were available for analysis. The mean patients age was 6.8 ± 1.8years; 32 (47.1%) boys and 36 (52.9%) girls. The mean d3mft of the remaining sample was 7.8±3.35. PMC and PMC+P arms showed the highest success rates (> 91%) as compared to the CF arm, which showed the lowest success rates (61.9%), with 9/42 teeth of the CF group (21.4%) presenting with minor failures, and 7/42 teeth (16.7%) with major failures (P< .0001). Conclusion: Accordingtothe decision tree analysis, PMC and PMC+P had a success rate of 99%, whereas CF had a success rate of only 69%. Some cofactors (treatment decision, Approximal Plaque Index, and tooth number) had a higher impact on the decision tree analysis than others (age, dmfs, and dmft values), especially when the treatment selection was CF. In future studies it is necessary to examine the impact of other cofactors on the outcomes of conventional fillings using a larger sample size. [ABSTRACT FROM AUTHOR]

Objectives: Although minimally and noninvasive caries management are advocated in pediatric dentistry, extensive caries progression often requires endodontic treatment followed by crowning of the tooth. Thus, the aim of this study was to evaluate the success of esthetic preformed zirconia crowns (PZCs) compared to the standard preformed metal crowns (PMCs) after pulpotomy in primary molars retrospectively. Method and materials: Patients' digital records in a specialized pediatric clinic in Germany were analyzed to include 2- to 9-year-olds, who had received one or more PMCs or PZCs after a pulpotomy between 2016 and 2020. The main outcomes were success, minorfailure (restoration loss, wear, or fracture), or major failure (need for extraction or pulpectomy). Results: In total, 151 patients with 249 teeth (PMC, n = 149; PZC, n = 100) were included. The mean follow-up time was (19.9 months), with 90.4% of the crowns fol-lowed for at least 18 months. The majority of the crowns were considered successful (94.4%). The differences in the success rates between PMCs (96%) and PZCs (92%) did not reach the level of statistical significance (P = .182). All minor failures (1.6%) were in the PZC group and located in the maxilla. Independent of crown type, especially first primary molars were prone to failure (7.9%; second primary molars, 3.3%). Conclusion: PMCs and PZCs both show high clinical success rates as restorations of primary teeth after a pulpotomy. However, there was a tendency of greater minor or major failure in the PZC group. [ABSTRACT FROM AUTHOR]

Objective To explore the long-term clinical effect of Theracal LC on complicated crown fracture of immature permanent teeth. Methods A total of 33 teeth (13 males,15 teeth; 16 females, 18 teeth) from 29 adolescent patients with complicated crown fracture were collected. In this randomized clinical trial, all the samples were divided into two groups depending on the different pulp capping materials: the experimental group-Theracal LC(n=17) and the control group-MTA(n=16), with the same contralateral or adjacent teeth as blank control group. The treated teeth were evaluated clinically and radiographically at 3, 6, 12, 24, 36, 48 months. Results During the 4-year follow-up, clinical symptoms of all the treated teeth in both groups improved and disappeared. At 6 months, the clinical success rate of both groups was 100%. The clinical success rate was 93.7% at 12 months in the MTA group. The clinical success rates of Theracal LC group at 12 months and 24 months were 94.1% and 88.2%, respectively. There was no statistical difference between the groups in clinical efficacy(P>0.05). The samples of MTA group went black, while Theracal LC group had no discoloration. The formation rate of early-formed dentine bridge in Theracal LC group was relatively faster than that in MTA group. The dentine bridge could be seen in all samples of both groups in the long term. The dentine bridges in Theracal LC group had complex morphology, while the linear uniform was mostly seen in MTA group. Conclusion As a pulp capping agent, Theracal LC has good clinical efficacy and biosafety,and can be used as one of the substitutes for MTA.

Objective This clinical study was aimed to investigate the clinical and radiographic outcomes of NeoPutty MTA® (Nusmile), a novel mineral trioxide aggregate (MTA) pulpotomy material, in primary teeth of children aged 4–6 years. Methods An in vivo study was done in children aged 4–6 years old. A total of 50 primary second molar teeth were included in the study, with 25 of them undergoing treatment with formocresol (FC) and 25 receiving treatment with NeoPutty MTA®. The subjects were divided into two groups for treatment: the first group received a treatment involving a 1:5 dilution of Buckley’s FC. The second group, however, underwent treatment with NeoPutty MTA®. This study employs a meticulous approach to evaluate the impact of different treatments on a significant number of molar teeth, using FC and NeoPutty MTA® as the respective treatment methods. The demographics of the subject pool are well-documented, comprising a balance of male and female participants. The technique employed for pulp removal and the subsequent management of bleeding are outlined, underscoring the thoroughness of the process. Results At 12 months, the NeoPutty MTA® pulpotomy group showed a significantly higher success rate clinically (96%) compared to the FC group (72%) (P < 0.05), but radiographically although NeoPutty MTA® was better (92%) than FC (82%), it was not statistically significant. NeoPutty®-treated teeth exhibited no signs of pain or discomfort and demonstrated better pulp vitality compared to the FC group. Conclusion NeoPutty MTA® demonstrated superior clinical success rates and better radiographic outcomes compared to traditional FC pulpotomy.

Abstract Background The aim of this study was to compare postoperative pain following total pulpotomy (TP) and root canal treatment (RCT) in mature molar teeth with irreversible pulpitis. To compare the traditional pulpitis classification system with the Wolters system in evaluating postoperative pain. Methods Eighty mandibular molars with irreversible pulpitis were included and classified according to the Wolters (moderate/severe pulpitis). The teeth were randomly assigned to two groups (RCT or TP). RCT was performed following standardized protocols. TP was performed to the level of the canal orifices, and hemostasis was achieved with 2.5% sodium hypochlorite. A 3 mm layer of MTA was placed as the pulpotomy material. The teeth were restored with glass ionomer cement followed by composite. Pain scores were recorded preoperatively and, at 6, 12, 24, 48, and 72 h and 7 days after the interventions. The data were statistically analyzed using the Mann-Whitney U test, the Friedman test, the Wilcoxon signed-rank test, and the Spearman’s correlation test. The significance level was set at 0.05. Results Sixty-four patients were analyzed at the one-week follow-up and all were diagnosed as irreversible pulpitis according to the AAE; 22 teeth were classified as moderate and 42 teeth were classified as severe pulpitis according to Wolters. There was no significant difference between TP and RCT in pain scores in moderate pulpitis patients (p > 0.05). There was a significant difference between TP and RCT at 24 and 72 h of severe pulpitis; higher pain scores were observed in the RCT (p

Abstract This review aims to comprehensively explore calcium-enriched mixture (CEM) cement as a crucial biomaterial in dentistry/endodontics. With its growing clinical relevance, there is a need to evaluate its composition, chemical/physical/biological properties, clinical applications, and future perspectives to provide clinicians/researchers with a detailed understanding of its potential in endodontic procedures. Through systematic analysis of available evidence, we assess the advantages/limitations of CEM cement, offering valuable insights for informed decision-making in dental/endodontic practice. Our findings highlight the commendable chemical/physical properties of CEM cement, including handling characteristics, alkalinity, color stability, bioactivity, biocompatibility, sealing ability, and antimicrobial properties. Importantly, CEM cement has shown the potential in promoting regenerative processes, such as dentinogenesis and cementogenesis. It has demonstrated successful outcomes in various clinical applications, including vital pulp therapy techniques, endodontic surgery, open apices management, root resorption/perforation repair, and as an orifice/root canal obturation material. The efficacy and reliability of CEM cement in diverse clinical scenarios underscore its effectiveness in endodontic practice. However, we emphasize the need for well-designed clinical trials with long-term follow-up to further substantiate the full potential of CEM cement. This review serves as a robust reference for researchers/practitioners, offering an in-depth exploration of CEM cement and its multifaceted roles in contemporary dentistry/endodontics.

Abstract Background Pulpotomy is a crucial method to preserve primary teeth until natural exfoliation. This study aimed to evaluate the clinical and radiographic outcomes of pulpotomy with iRoot BP Plus in primary molars and to explore the association between hemostasis time and these outcomes. Methods Primary molars that underwent iRoot BP Plus pulpotomy and were followed for at least 12 months were selected for this study. Clinical and radiographic data were collected, and the success rate was analyzed in relation to factors such as hemostasis time, tooth type, and arch type. The tests of significance used were the chi-square test, Fisher’s exact test, or Kruskal-Wallis test. Statistical significance was set at P 0.05). Conclusions Pulpotomy using iRoot BP Plus in primary molars achieved favorable results. The hemostasis time may not significantly impact the outcomes of pulpotomy using iRoot BP Plus in primary molars.

Abstract This study aims to investigate the effect of Mineral Trioxide Aggregate (MTA), a bioactive endodontic cement, and Concentrated Growth Factor (CGF), a second-generation autologous growth factor, on pulpotomy-induced pulp inflammation. The study utilized the maxillary anterior central teeth of thirty-six young male Sprague Dawley rats. Forty-eight teeth were randomly assigned to two groups (12 rats/group; 24 teeth/group) based on the capping material (MTA or CGF). Subsequently, two subgroups (MTAG and CGFG) were formed per group (12 teeth/group) based on the time following pulpotomy (2-weeks and 4-weeks). The central teeth of the 12 animals assigned to the control group (CG) were not manipulated in any way, both in the 2-week group and in the 4-week group. Tissue samples extracted from rats at the end of the experiment were stained with H&E for histopathological analysis. For immunohistochemical analysis, primary antibodies for TNF-α and NF-kβ/65 were incubated. Data obtained from semi-quantitative analysis were assessed for normal distribution using Skewness-Kurtosis values, Q-Q plot, Levene’s test, and the Shapiro-Wilk test on statistical software. A P value

Background: Various dressing materials have been evaluated for pulpotomy of primary teeth. However, an ideal pulp dressing material has not been identified yet. This systematic review investigated the effectiveness of TheraCal compared to Formocresol in pulpotomy of primary teeth. Materials and methods: This research was conducted in the form of a secondary study, with a systematic search of texts until 2023 in Scopus, Web of Science, PubMed and Google Scholar databases. The articles were selected based on the inclusion and exclusion criteria and, finally the search results were reported in the PRISMA chart. The quality of the studies was evaluated based on the NIH checklist. The extracted information was entered into Stata17 software. Heterogeneity was evaluated using Cochran’s chi-square test and I2 statistics. Egger’s tests were used to detect publication bias. Results: After removing duplicate articles and articles that did not meet the inclusion criteria, 4 studies were selected for qualitative analysis. The odds’ ratio of success rate between Formocresol and TheraCal pulpotomy for absence of the pain, abscess, Mobility, internal root resorption and bone radiolucency was obtained 1.12 (95 % CI: 0.32, 3.85, P = 0.86), 0.47 (95 % CI: 0.1, 2.14, P = 0.33), 0.82 (95 % CI: 0.21, 3.21, P = 0.78), 0.89 (95 % CI: 0.3, 2.67, P = 0.84), and 1.96 (95 % CI: 0.68, 5.62, P = 0.21) respectively. Conclusion: The study results revealed that there was no significant difference in clinical and radiographic success between pulpotomy with TheraCal and Formocresol.

The decision making process for managing irreversible pulpitis in permanent teeth often involves choosing between pulpotomy and root canal treatment, with clinicians exercising discretion. This systematic review and meta-analysis aim to evaluate the efficacy of calcium silicate based pulpotomy in treating symptomatic permanent teeth with irreversible pulpitis. A comprehensive search across PubMed, Google Scholar, and SCOPUS databases yielded 482 articles. From this pool, 169 articles underwent further scrutiny. Following data filtration, presentation, and analysis, a meta-analysis was conducted using RevMan 5 software. Eleven articles were ultimately selected based on predefined inclusion and exclusion criteria. This meta-analysis revealed that calcium silicate based pulpotomy, employed in treating irreversible pulpitis cases, exhibited notable success rates ranging from 75% to 90% over a period of 15 years across most of the included studies. The majority of studies integrated into this systematic review reported successful outcomes for teeth with symptomatic irreversible pulpitis undergoing pulpotomy with the utilization of calcium silicate. Nonetheless, further research is necessary to delineate the precise roles of calcium silicate based pulpotomy in managing this condition.

Aim Methodology Results Conclusions To assess Spanish dentists' management preferences for deep caries removal and exposed pulps in permanent teeth.A web‐based open and anonymous survey was distributed by social media and a specific website for this project amongst dentists practicing in Spain. The questionnaire comprised 40 questions, divided into five sections: (1) demographic data and professional activity; (2) carious tissue removal; (3) decision‐making regarding pulp exposure; (4) direct pulp capping and (5) pulpotomy procedures in permanent teeth. Results were descriptively analysed. Logistic regression (95% CI) analyses and X2 tests were carried out.A total of 538 responses were received. Half the respondents (53.7%) preferred to perform complete caries excavation for shallow and moderate carious dentin lesions, and selective excavation to firm dentin for deep lesions (57.8%). Selective removal to soft dentin and stepwise removal were much less indicated (15.4% and 10.9%, respectively). Exposed pulps in asymptomatic teeth were treated by direct pulp capping (over 80%), decreasing in the presence of reversible pulpitis symptoms (57.1%). If irreversible pulpitis was diagnosed, a pulpectomy would be performed by 53.5% and 89.9% of the respondents in, respectively, immature and mature teeth. Pulpotomy was performed routinely only by 26.4% of the clinicians. Patients' attitudes and priorities were the most relevant criteria when performing direct pulp capping and pulpotomy, together with the history of pain and the presence of bleeding. Regarding the clinical procedure, dry cotton was preferred to obtain haemostasis and Biodentine was the material of election.Caries removal preferences and management of pulp exposure by dentists practicing in Spain deviated from vital pulp treatment guidelines, mainly regarding indications and case selection. Pulp exposure was managed by direct pulp capping in asymptomatic cases, whilst immature permanent molars favoured the indication of pulpotomy when pulpitis was diagnosed. Most clinicians used hydraulic calcium silicate cement, specifically Biodentine, to perform vital pulp treatments. Postgraduate formation and continuing education in caries lesions management and vital pulp treatments were consistently related to more conservative and updated decisions. [ABSTRACT FROM AUTHOR]

Background: Vital pulp therapy (VPT) is recommended as an alternative treatment to root canal therapy (RCT) for management of teeth with carious pulp exposure. This randomized clinical trial aimed to compare the outcomes and postoperative pain, and to evaluate the time and cost after full pulpotomy (FP) and RCT in mature molar teeth with irreversible pulpitis (IP). Methods: A total of 160 mature molar teeth with IP were randomly divided into two treatment groups. The FP group (test group) was treated with FP using iRoot BP Plus by an endodontist, the RCT group (control group) was treated with RCT using iRoot SP as sealer by the same endodontist. Pain was recorded preoperatively and daily until day 7 postoperatively. The treatment time and cost were recorded. Clinical and radiographic assessments were collected, and pulp sensibility tests were done by electric pulp test (EPT) at 3-, 6-, 12- month postoperatively. Data were analyzed through chi-square test, Mann-Whitney U test, Fisher exact and independent t test. Results: FP and RCT had comparable success rates (Clinical, 97.3% vs. 98.6%; radiographic, 93.3% vs. 94.6%) (P > 0.05). Pain levels decreased over time from day 1 to day 7 postoperative in both groups, and the FP group had larger reductions in pain intensity than RCT at day 1 (P < 0.05). In the FP group, there were 5, 3 and 3 unresponsive teeth with EPT at 3-, 6- and 12- month follow-ups, respectively. The treatment time and cost in the FP group were significantly lower than in the RCT group (P < 0.05). Conclusions: FP could be an appropriate alternative treatment for management of mature teeth with IP in short follow-up. Trial registration: The trial was registered in Chinese Clinical Trial Registry (ChiCTR2200063380 at 05/09/2022). [ABSTRACT FROM AUTHOR]

Background: While the effect of biomaterials covering the pulp tissue is considered in the success of pulpotomy treatment, the level of pulpal inflammation is still very important for treatment success. The aim of this study was to compare IL-6 and IL-8 levels, known as good indicators of pulpal inflammation, with a new biomarker, presepsin, and to evaluate the impact of biomarker levels along with the pulp capping agents used in the treatment on the one-year success of pulpotomy treatment. Methods: The study included 120 primary second molar teeth with pulpotomy indications from 75 children. To determine the pulpal inflammation status, pulpal bleeding samples were taken during treatment, and the levels of IL-6, IL-8, and presepsin were measured. During the pulpotomy treatment, MTA, NeoMTA™, and Biodentine™, and ZOE were randomly applied to groups of thirty teeth each. Patients were monitored for a period of 12 months post-treatment. Results: IL-8, IL-6, and presepsin levels were significantly higher in teeth with pathology (p < 0.001). Biomarker levels were found to be higher in the NeoMTA and Biodentine groups, but this did not result in a statistically significant difference. (p > 0.05) Following pulpotomy treatment, the most successful material groups in order were MTA, ZOE, NeoMTA™, and Biodentine™. Conclusion: Presepsin may be a usable indicator in predicting the level of inflammation. At the end of the one-year follow-up of pulpotomy treatment, more pathology was observed in the NeoMTA and Biodentine groups, where biomarker levels were higher, while no pathology was found in the MTA group, where biomarker levels were lower. Trial registration: NCT06398327/ 20,240,503. [ABSTRACT FROM AUTHOR]

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Aim: The European Society of Endodontology outlines best practices for the management of deep caries and the pulp. Despite evidence supporting vital pulp treatments (VPTs) as predictable alternatives to conventional endodontic treatment, studies have shown they are not widely adopted in the UK. This study aimed to explore the barriers to implementation of VPTs by primary care general dental practitioners (GDPs). Methodology: Qualitative one‐to‐one semi‐structured online interviews were conducted with purposively sampled UK GDPs. Interview transcripts were analysed using reflexive thematic analysis. Recurring themes were iteratively refined as additional transcripts were reviewed. Results: Eleven participants were interviewed. A range of barriers to the provision of VPTs were identified, which aligned with two core themes: 'Motivational barriers to service provision' and 'Educational access & opportunities'. Sub‐themes included lack of access to materials and equipment, deficiencies in knowledge of treatment (including protocols, outcomes and prognosis), lack of confidence (in treatment efficacy and clinical ability), time constraints and public dental service funding and remuneration. Conclusions: This study identifies barriers to the widespread adoption of VPTs among primary care GDPs in public and private settings. Economic constraints, practitioner confidence, time limitations and educational gaps are key challenges. Addressing these may require systemic changes such as policy interventions, education and improved resource allocation. [ABSTRACT FROM AUTHOR]

Pulpotomy is the total amputation of coronal pulp tissue and subsequent placement of a pulpotomy agent over the root canal orifices, followed by a coronal seal. The most suitable pulpotomy agent for successful treatment outcomes remains controversial. To evaluate and compare the clinical and radiographic success of calcium hydroxide (CH) and Biodentine (BD) in primary tooth pulpotomy at 6 and 12 months. An automatised search of the PubMed-Medline, Web of Science, and SCOPUS electronic databases was performed to identify scientific articles on primary tooth pulpotomies with either calcium hydroxide (CH) or Biodentine (BD) as a pulpotomy agent, published until January 2024. The software used for meta-analysis was R 4.3.1 (R Core Team, 2023). Of the 594 potentially eligible articles, 14 met the inclusion criteria: seven articles on CH pulpotomy and seven articles on BD pulpotomy with 6- and 12-months of follow-up. The meta-analysis concluded a mean clinical success rate of 91.8 % at 6 months and 79.0 % at 12 months for the CH group, and 99.2 % at 6 months and 98.8 % at 12 months for the BD group. In terms of the mean radiographic success, the CH group achieved 74.2 % at 6 months and 63.7 % at 12 months, whereas the BD group achieved 99.4 % at 6 months and 98.4 % at 12 months. In comparison, the meta-analysis concluded a marginally significant difference in clinical success in favour of the BD group at 6 months (p = 0.091). At 12 months, clinical success was significant in the BD group (p = 0.023). Regarding radiographic success, a significant difference in favour of the BD group was observed at 6 (p = 0.008) and 12 months (p < 0.001). BD showed significantly higher clinical and radiographic success than CH in pulpotomy. [ABSTRACT FROM AUTHOR]

Objectives: Dental caries is the most common chronic disease, with a high incidence rate that affects many children in different countries. Indirect pulp therapy (IPT) is a minimally invasive procedure that depends on the application of a bioactive material to the affected dentin, thus preserving the vitality of the pulp. Aim: The present study was directed to conduct clinical and radiographic evaluation of indirect pulp capping with biodentine and theracal LC in primary molars. Materials and Methods: A randomized clinical trial registered under the NCT06020911 identifier on ClinicalTrials.gov on August 23, 2023, had a sample size of 34 primary molars between the ages of 4 and 7 years, of which 17 teeth were considered, each for group I (theracal LC) and group II (biodentine). Measurements of dentin thickness and density were obtained using cone-beam computed tomography immediately after restoration and after a 9-month follow-up. Results: Both the thickness and density of the dentin showed a statistically significant increase in the theracal LC and the biodentine groups after 9 months postoperatively compared to immediately after restoration (P < 0.001 and 0.001, respectively). However, the density of dentin showed a statistically significant increase in the theracal LC group compared to the biodentine group 9 months postoperatively (P = 0.005). Conclusion: Both biodentine and theracal LC are effective clinically and radiographically as IPT material in primary teeth, with considerable dentin production. IPT provides high success rates as well as the ideal pulp capping material for primary teeth with deep carious lesions. Clinical relevance: For primary molars, IPT is a conservative treatment strategy that can help maintain pulp vitality. In IPT, calcium hydroxide is still widely used, although no alternative material has been developed as of yet. As IPT needs the preferred liner for primary teeth and can serve as a viable alternative to pulpotomy in primary molars, the use of capping materials like biodentine or theracal LC can improve the success rate of IPT. [ABSTRACT FROM AUTHOR]

Background and Aim: This study aims to evaluate the efficacy of different endodontic irrigants employed in the lesion sterilization and tissue repair (LSTR) technique. Methods: Forty children aged 4–8 years having at least one primary molar with irreversible pulpitis/pulpal necrosis indicated for pulpectomy were included. Participants were randomly divided into three test groups (Group A, B, and C) and one control group (Group D). After caries excavation using a spoon excavator, superficial pulp was removed under topical anesthesia in all groups. Following this, pulpal floor was irrigated using different endodontic irrigants in each group: Group A – 20% propolis, Group B – 2% sodium hypochlorite, Group C – 2% chlorhexidine gluconate, and Group D (control) – saline. Alternate 3-Mix (triple antibiotic paste containing metronidazole, ciprofloxacin, and amoxicillin) was then placed over the pulpal floor and the teeth were restored with glass ionomer cement followed by stainless steel crown. Patients were recalled at follow-up periods up to 18 months for clinical and radiographic evaluation. Repeated-measures ANOVA test, Chi-square test, and independent t -test were used for statistical analysis. Results: Clinical success was achieved in all treated teeth, with the results showing statistical significance (P < 0.05). In addition, Group C showed best clinical results. Statistically significant results (P < 0.05) were obtained in reduction in size of furcation radiolucency, with Group B showing the best results compared to other groups. Statistically significant results (P < 0.05) were obtained in terms of rate of root resorption in all teeth, with Group C showing least resorption compared to other groups. Conclusions: The use of endodontic irrigant before the placement of alternate 3-Mix is an effective step for the improved success of LSTR technique in primary teeth, with chlorhexidine showing the best success rate. [ABSTRACT FROM AUTHOR]

Introduction: Untreated tooth decay in mature permanent dentition is a prevalent global issue, affecting 34.1% of people with 2.5 billion cases annually. Extensive decay often leads to irreversible pulpitis, characterized by pulp inflammation and pain. Pulpectomy, the standard treatment, involves complex procedures with potential complications. Modern endodontics favors minimally invasive treatment such as pulpotomy, which preserves pulp vitality. This study aims to compare the clinical as well as radiographic outcomes of different pulpotomy agents: Biodentine, mineral trioxide aggregate (MTA), Bio-C repair, and Endosequence Bio-ceramic root repair material (BCRRM) in mature permanent molars. Methodology: This single-blind, single-center study involved 80 participants randomly assigned to four groups, each receiving one of the biomaterials. Ethical approval was obtained. Participants aged 14–60 years with symptomatic irreversible pulpitis were selected. Pulpotomy procedures were performed, and follow-up evaluations occurred at 24 h, 1 week, 4 weeks, 3, 6, and 12 months. Clinical success was measured by the absence of pain, sensitivity, and tenderness. Radiographic evaluation used the periapical index (PAI) scoring system. Results: Pulpotomy significantly reduced postoperative pain in all groups. Endosequence BCRRM showed the maximum pain reduction at 24 h with a statistically significant difference from all the groups (at 1% probability level), followed by Bio-C repair, Biodentine, and MTA. At 1 week, Bio-C repair led in pain reduction with statistically nonsignificant results. All groups reported no pain at 3, 6, and 12 months. Endosequence BCRRM had the highest improvement in periapical findings at 1 year. Sensitivity to hot and cold improved significantly in all groups, with Endosequence BCRRM performing best. Conclusion: Endosequence BCRRM provided the best overall outcomes, emphasizing the importance of material choice in pulpotomy treatments. Further research on biomaterials' long-term clinical and radiographic outcomes is needed to enhance treatment efficacy. [ABSTRACT FROM AUTHOR]

Introduction: This review evaluates the effectiveness of treatment modalities for immature teeth with pulp necrosis, focusing on calcium hydroxide (CH) and mineral trioxide aggregate (MTA) apexification, as well as regenerative endodontic treatments (RETs). Recent advancements and clinical outcomes are highlighted. Materials and Methods: A comprehensive search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, and grey literature was conducted from inception to July 2024. Systematic reviews and meta-analyses (SR/MAs) assessing apexification and RET outcomes in immature teeth with pulp necrosis were included. Studies were selected based on predefined criteria, and data on study design, interventions, and outcomes were extracted. Methodological quality was evaluated using the AMSTAR-2 tool. Results: 31 SR/MAs were included. The quality ranged from critically low to low, except one rated as high. MTA apexification was more effective than CH for faster apical barrier formation, though overall success rates were similar. MTA is preferred for its efficiency, but standardized protocols are needed, and tooth discoloration was noted as a potential complication. RET generally outperforms apexification in root maturation, with platelet concentrates like platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) showing promising results; PRP was associated with greater root length, while PRF showed superior apical healing. Variability in RET outcomes was noted due to the lack of standardized protocols. Comparative studies of RET versus apexification showed no significant differences in survival or overall success rates. RET often provides better apical closure and root development, though results vary. Both approaches are viable, but more research with standardized protocols and larger samples is needed to establish definitive clinical advantages. Conclusions: MTA apexification and RET are viable alternatives to CH apexification, with RET showing greater potential for root development and apical healing. Future research should focus on developing standardized protocols and uniform RET guidelines, and evaluating long-term outcomes to establish efficacy and safety. [ABSTRACT FROM AUTHOR]

Background: Pulpotomy is a crucial method to preserve primary teeth until natural exfoliation. This study aimed to evaluate the clinical and radiographic outcomes of pulpotomy with iRoot BP Plus in primary molars and to explore the association between hemostasis time and these outcomes. Methods: Primary molars that underwent iRoot BP Plus pulpotomy and were followed for at least 12 months were selected for this study. Clinical and radiographic data were collected, and the success rate was analyzed in relation to factors such as hemostasis time, tooth type, and arch type. The tests of significance used were the chi-square test, Fisher's exact test, or Kruskal-Wallis test. Statistical significance was set at P < 0.05. Results: A total of 183 teeth in 106 patients were included in the analysis. The follow-up period fell into a range of 1–3 years, with a mean of 1.6 years. The clinical and radiographic success rates were 96.7% and 92.9%, respectively. The earliest time to observe the radiographic failures was half a year after the treatment, and the latest time was two years after the treatment. Among all the teeth, 130 were recorded with hemostasis time before the application of iRoot BP Plus. Compared to teeth with a hemostasis time of 5 min or less, teeth with a hemostasis time exceeding 5 min showed no significant differences in clinical and radiographic success (P = 1.000 and 0.879). Additionally, neither arch nor teeth type showed a relationship with the pulpotomy success rate (P > 0.05). Conclusions: Pulpotomy using iRoot BP Plus in primary molars achieved favorable results. The hemostasis time may not significantly impact the outcomes of pulpotomy using iRoot BP Plus in primary molars. [ABSTRACT FROM AUTHOR]

This review aims to comprehensively explore calcium-enriched mixture (CEM) cement as a crucial biomaterial in dentistry/endodontics. With its growing clinical relevance, there is a need to evaluate its composition, chemical/physical/biological properties, clinical applications, and future perspectives to provide clinicians/researchers with a detailed understanding of its potential in endodontic procedures. Through systematic analysis of available evidence, we assess the advantages/limitations of CEM cement, offering valuable insights for informed decision-making in dental/endodontic practice. Our findings highlight the commendable chemical/physical properties of CEM cement, including handling characteristics, alkalinity, color stability, bioactivity, biocompatibility, sealing ability, and antimicrobial properties. Importantly, CEM cement has shown the potential in promoting regenerative processes, such as dentinogenesis and cementogenesis. It has demonstrated successful outcomes in various clinical applications, including vital pulp therapy techniques, endodontic surgery, open apices management, root resorption/perforation repair, and as an orifice/root canal obturation material. The efficacy and reliability of CEM cement in diverse clinical scenarios underscore its effectiveness in endodontic practice. However, we emphasize the need for well-designed clinical trials with long-term follow-up to further substantiate the full potential of CEM cement. This review serves as a robust reference for researchers/practitioners, offering an in-depth exploration of CEM cement and its multifaceted roles in contemporary dentistry/endodontics. [ABSTRACT FROM AUTHOR]

Background: Different materials have been used as wound dressings after vital pulp therapies. Some of them have limitations such as delayed setting, difficult administration, slight degree of cytotoxicity, crown discoloration and high cost. Therefore, to overcome these disadvantages, composite scaffolds have been used in regenerative dentistry. This study aims to construct and characterize the physicochemical behavior of a novel injectable alginate hydrogel loaded with different bioactive glass nanoparticles in various concentrations as a regenerative pulpotomy filling material. Methods: Alginate hydrogels were prepared by dissolving alginate powder in alcoholic distilled water containing mesoporous bioactive glass nanoparticles (MBG NPs) or boron-doped MBG NPs (BMBG NPs) at 10 and 20 wt% concentrations. The mixture was stirred and incubated overnight in a water bath at 50 0 C to ensure complete solubility. A sterile dual-syringe system was used to mix the alginate solution with 20 wt% calcium chloride solution, forming the hydrogel upon extrusion. Then, constructed hydrogel specimens from all groups were characterized by FTIR, SEM, water uptake percentage (WA%), bioactivity and ion release, and cytotoxicity. Statistical analysis was done using One-Way ANOVA test for comparisons between groups, followed by multiple pairwise comparisons using Bonferroni adjusted significance level (p < 0.05). Results: Alginate/BMBG loaded groups exhibited remarkable increase in porosity and pore size diameter [IIB1 (168), IIB2 (183) (µm)]. Similarly, WA% increased (~ 800%) which was statistically significant (p < 0.05). Alginate/BMBG loaded groups exhibited the strongest bioactive capability displaying prominent clusters of hydroxyapatite precipitates on hydrogel surfaces. Ca/P ratio of precipitates in IIA2 and IIB1 (1.6) were like Ca/P ratio for stoichiometric pure hydroxyapatite (1.67). MTT assay data revealed that the cell viability % of human gingival fibroblast cells have declined with increasing the concentration of both powders and hydrogel extracts in all groups after 24 and 48 h but still higher than the accepted cell viability % of (˃70%). Conclusions: The outstanding laboratory performance of the injectable alginate/BMBGNPs (20 wt%) composite hydrogel suggested it as promising candidate for pulpotomy filling material potentially enhancing dentin regeneration in clinical applications. [ABSTRACT FROM AUTHOR]