Outcome Following Complete and Partial Pulpotomy in Managing Cariously Exposed Mature Permanent Molars With Symptomatic Irreversible Pulpitis: A 5-Year Follow-Up of a Randomised Clinical Trial.

Abstract

Introduction: Numerous studies have reported favourable outcomes following complete pulpotomy (CP) and partial pulpotomy (PP) in cariously exposed mature permanent teeth with symptomatic irreversible pulpitis (SIP) at 1-year follow-up. However, literature on long-term outcomes is sparse. The European Society of Endodontology and the American Association of Endodontists emphasised the need for long-term evidence before establishing pulpotomy as a definitive treatment. This prospective follow-up study aimed to compare 5-year outcomes of CP and PP performed in such teeth.

Methodology: This prospective study followed participants from a previously published superiority randomised trial on CP and PP for managing cariously exposed mature permanent teeth with SIP. The original trial was registered at ClinicalTrials.gov (NCT04397315). Ninety-three participants (CP-49, PP-44) received the allocated intervention. Of these, 88 (CP-45, PP-43) participants who attended the 1-year follow-up were recalled for the 5-year follow-up. The primary outcome was combined clinical and radiographic success. Secondary outcome measures included hard tissue barrier (HTB) formation and pulp canal obliteration (PCO). Cases were analysed for restoration integrity, secondary caries, periodontal status and pulp sensibility responses. The impact of various prognostic factors on 5-year success was analysed. Outcome measures at 5-year were compared with 1-year outcomes. Statistical tests included the Mann-Whitney U test, chi-squared test, Fisher's exact test, McNemar's test, intention-to-treat analysis and binary logistic regression, with significance set at p < 0.05.

Results: At 5 years, 59 of 88 participants (CP-28, PP-31) were available for follow-up. The overall success was 83.05%, with no significant difference between groups (p = 0.494, RR = 1.10, 95% CI = 0.88-1.40). While both groups showed comparable evidence of HTB (p = 0.581, RR = 1.06, 95% CI = 0.91-1.23), PCO was significantly more evident in the CP group (p = 0.003, RR = 0.22, 95% CI = 0.07-0.70). The PP group elicited significantly more sensibility responses to cold test (p = 0.015, RR = 2.35, 95% CI = 1.09-7.43). Secondary caries was a significant prognostic factor influencing overall success at 5 years (p < 0.05). No significant differences in success, HTB, or PCO were observed between the 1 and 5 years outcomes in either group (p > 0.05).

Conclusions: CP and PP demonstrated comparable success at 5 years. PP may be preferred given its conservative approach, reduced risk of PCO, and more reliable pulp sensibility reoptimizing responses. Adequate restorative seal is crucial for long-term success.

Trial registration: ClinicalTrials.gov identifier: NCT04397315.