(TC15) An Alternate Pulpotomy Technique Performed in Carious Permanent Mature Mandibular Molar Teeth with Symptoms Indicative of Irreversible Pulpitis: A Case Series

Abstract: For teeth with symptomatic irreversible pulpitis (SIP), there has been a paradigm shift towards full or partial pulpotomy. Partial pulpotomy (PP) has an 88%-92% success rate, which is lower than that of full pulpotomy. The removal of inflamed tissue to the level of healthy, uninflamed pulp is considered critical for healing. However, the insufficient removal of inflamed pulp tissue may account for the lower success rate of PP. Moreover, the removal of 2-3 mm of pulp tissue in PP is arbitrary for the clinician. Hence, an alternate pulpotomy technique is proposed: midi-pulpotomy.

Objective: Evaluate the outcome of midi-pulpotomy in carious mature permanent mandibular molar teeth with SIP. Experimental design: Case series. Materials and methodology: Ten permanent mandibular first molar teeth with SIP were treated. After anesthesia and rubber dam isolation, caries were removed, and access to the pulp chamber was gained. Underneath the cariously exposed pulp horn (mesial/distal), coronal pulp tissue was removed vertically down to the level of the corresponding canal orifice(s). Hemostasis was achieved with 2.5% NaOCl; MTA was placed, and the tooth was restored with GIC and resin composite. The post-operative VAS score was noted. At 6-9 months, the teeth were clinically and radiographically observed.

Results: All patients were clinically and radiographically asymptomatic. The EPT test was positive.

Conclusion: Midi-pulpotomy provides specific landmarks for pulp amputation and is a clinically feasible procedure.