Carious Pulp Exposure in Mature Teeth With Reversible Pulpitis: A Randomized Clinical Trial of Direct Pulp Capping and Partial Pulpotomy

Introduction

No clear guidelines exist for the selection of vital pulp therapy procedures in carious pulp exposures. This study aimed to compare the outcomes of direct pulp capping and partial pulpotomy in mature permanent teeth with reversible pulpitis.

Methods

The study was a parallel double-blind randomized clinical trial of 140 mature permanent teeth. Teeth were asymptomatic or with symptoms of reversible pulpitis and received direct pulp capping (n = 67) or partial pulpotomy (n = 73). After intraoperative assessment under magnification and hemostasis, NeoPUTTY (Avalon Biomed, Bradenton, FL) was placed as the capping material. Baseline variables were recorded. Patients were scheduled for 6- and 12-month clinical and radiographic follow-up. Results were statistically compared using chi-square tests and regression analysis.

Results

Approximately half of the teeth (74/140) were symptomatic, with no significant difference in the preoperative pain levels between the 2 groups (P = .75), both treatments resulted in significant pain reduction after 1 week (P < .001). After 6 months, 4 cases of partial pulpotomy and 10 cases of direct pulp capping failed; the success rate was 94.4% versus 84.4%, P = .057 respectively. At 1 year, 2 additional failures occurred in each treatment group with success rates of 91.5% for partial pulpotomy and 81.3% for direct pulp capping (P = .08). There were no significant prognostic factors for pulp capping or partial pulpotomy, multivariate analysis did not reveal any significant interactions.

Conclusions

Carious pulp exposure in teeth with reversible pulpitis can be managed successfully by either direct pulp capping or partial pulpotomy depending on the intraoperative assessment of the exposed pulp.