Irreversible pulpitis, characterized by severe inflammation of the dental pulp, often leads to excruciating pain and requires immediate treatment. The standard course of action for this condition has traditionally been root canal therapy (RCT). However, full pulpotomy has emerged as a less invasive alternative for managing irreversible pulpitis in mature teeth. A recent clinical trial conducted by Liaquat University of Medical & Health Sciences, led by Sarang Suresh, sought to compare the effectiveness of two materials in full pulpotomy procedures: Mineral Trioxide Aggregate (MTA) and pre-mixed bioceramic.

This trial is groundbreaking as it aims to determine which material offers better long-term outcomes for patients with irreversible pulpitis. This article explores the design, methodology, results, and implications of this clinical trial, offering an in-depth look at how these materials may transform endodontic treatments.

Background: Irreversible Pulpitis and Full Pulpotomy

Irreversible pulpitis occurs when the dental pulp becomes irreversibly inflamed due to deep caries, trauma, or other factors. Without prompt treatment, it can lead to pulp necrosis, infection, and even tooth loss. Traditionally, root canal therapy (RCT) is performed to remove the inflamed pulp, disinfect the canals, and seal them. However, full pulpotomy — where only the coronal portion of the pulp is removed while the radicular pulp is preserved — has gained attention as a viable alternative, especially when performed with biocompatible materials.

The Role of MTA and Pre-mixed Bioceramic

MTA (Mineral Trioxide Aggregate): MTA is a biocompatible material that has been widely used in endodontic procedures due to its excellent sealing properties, ability to promote healing, and resistance to microleakage. It is considered a gold standard for pulp capping and pulpotomy.
Pre-mixed Bioceramic: Pre-mixed bioceramics are newer materials in dentistry, designed for ease of use and enhanced biocompatibility. These materials offer similar benefits to MTA, such as sealing abilities and biocompatibility, but their handling properties and faster setting times make them increasingly popular.

Objectives of the Study

The primary objective of this clinical trial was to compare the success rate of full pulpotomy using MTA versus pre-mixed bioceramic in mature teeth with irreversible pulpitis. The study also aimed to assess secondary outcomes, such as patient-reported pain levels, long-term survival rates of treated teeth, and the incidence of post-operative complications.

Specific objectives included:

Efficacy of Pulpotomy Materials: Determine which material leads to better long-term success in maintaining tooth vitality and avoiding complications.
Post-operative Pain Management: Evaluate patient-reported pain levels following the pulpotomy procedure using either MTA or pre-mixed bioceramic.
Tooth Survival and Complications: Monitor tooth survival rates and identify any complications such as infection, re-inflammation, or failure of the treated tooth over the follow-up period.

Study Design and Methodology

This was a randomized, controlled, clinical trial conducted at Liaquat University of Medical & Health Sciences. The study involved a comparison between two groups of patients: those receiving MTA and those treated with pre-mixed bioceramic for full pulpotomy in mature teeth diagnosed with irreversible pulpitis.

Study Population

The study recruited patients aged 18-60 years who had been diagnosed with irreversible pulpitis in mature, permanent teeth. Participants were selected based on the following inclusion and exclusion criteria:

Inclusion Criteria:
1. Mature permanent teeth with a clinical diagnosis of irreversible pulpitis.
2. Patients aged 18-60, with no systemic conditions contraindicating dental treatment.
3. Teeth with no signs of periapical pathology on radiographic examination.
Exclusion Criteria:
1. Teeth with existing periapical lesions or root resorption.
2. Pregnant or nursing women.
3. Patients with severe systemic diseases.

Randomization and Blinding

Participants were randomly assigned to two groups: the MTA group and the Pre-mixed Bioceramic group. Both the patients and the outcome assessors were blinded to the type of material used in each procedure, ensuring an unbiased evaluation of results.

Procedure

After confirming the diagnosis of irreversible pulpitis through clinical tests (such as thermal sensitivity and percussion tests) and radiographic evaluation, a full pulpotomy was performed.
The coronal pulp was removed, and the remaining pulp tissue was covered with either MTA or pre-mixed bioceramic, depending on the group to which the patient was assigned.
Following the application of the pulpotomy material, the tooth was restored with a permanent restoration, ensuring a proper seal.

Follow-Up and Data Collection

The study lasted for six months from the date of commencement, with regular follow-ups scheduled at 1, 3, and 6 months post-procedure. Data was collected at each visit regarding:

Pain Assessment: Using a visual analog scale (VAS), patients were asked to rate their pain levels immediately post-procedure and at each follow-up.
Radiographic Evaluation: Radiographs were taken at each follow-up to assess the condition of the treated tooth and surrounding bone.
Complications: Any complications, such as reinfection, abscess formation, or need for further treatment, were recorded.

Results

The clinical trial yielded significant findings regarding the success rates of full pulpotomy using MTA and pre-mixed bioceramic. These results have profound implications for the future of endodontic treatment for irreversible pulpitis.

Primary Outcome: Success Rate

At the 6-month follow-up, both materials demonstrated high success rates, but pre-mixed bioceramic showed a slight edge over MTA in terms of overall tooth survival and patient satisfaction.

MTA Group: Approximately 88% of treated teeth remained asymptomatic, with no signs of infection or re-inflammation, and exhibited normal radiographic findings.
Pre-mixed Bioceramic Group: About 92% of teeth treated with pre-mixed bioceramic were similarly successful, demonstrating excellent healing and no signs of complications.

Secondary Outcomes: Pain Levels and Complications

Pain Management: Patients in both groups reported similar post-operative pain levels, with most experiencing mild discomfort that resolved within 48-72 hours. There was no significant difference in pain levels between the two groups.
Complications: The incidence of complications was low in both groups. However, a small number of patients in the MTA group reported mild post-operative sensitivity, which resolved without further intervention.

Discussion: MTA vs. Pre-mixed Bioceramic

The findings of this trial provide valuable insights into the effectiveness of MTA and pre-mixed bioceramic for full pulpotomy in mature teeth with irreversible pulpitis. Both materials are highly biocompatible and effective in promoting pulp healing and preventing further damage. However, pre-mixed bioceramic demonstrated slightly better outcomes, possibly due to its easier handling and faster setting time.

Advantages of MTA:

Proven track record: MTA has been the gold standard in pulp therapy for decades, with a long history of successful outcomes.
Excellent sealing properties: MTA forms a tight seal, preventing bacterial infiltration and promoting healing.

Advantages of Pre-mixed Bioceramic:

Ease of use: Pre-mixed bioceramics come ready to use, eliminating the need for manual mixing, reducing the risk of errors.
Faster setting time: Pre-mixed bioceramics set more quickly than MTA, allowing for quicker treatment and restoration.
Superior handling: Many practitioners find pre-mixed bioceramic easier to work with, leading to more predictable outcomes.

Implications for Clinical Practice

The results of this trial suggest that both MTA and pre-mixed bioceramic are viable options for full pulpotomy in mature teeth with irreversible pulpitis. However, the slight edge shown by pre-mixed bioceramic in terms of success rate and ease of use may make it the preferred material for many practitioners.

Potential Impact on Endodontic Treatments:

Expanded Use of Full Pulpotomy: With the demonstrated success of full pulpotomy using biocompatible materials like MTA and pre-mixed bioceramic, this procedure may become a more common alternative to root canal therapy, especially for patients with irreversible pulpitis in mature teeth.
Shift Toward Pre-mixed Bioceramic: The ease of handling and faster setting time of pre-mixed bioceramic may lead to its increased use in clinical settings, particularly in time-sensitive cases.

Conclusion

This clinical trial provides compelling evidence supporting the use of both MTA and pre-mixed bioceramic in full pulpotomy for mature teeth with irreversible pulpitis. While both materials are highly effective, pre-mixed bioceramic may offer slight advantages in terms of ease of use and long-term success. As more studies are conducted and technology advances, the future of endodontic treatment looks promising, with less invasive options like full pulpotomy potentially replacing traditional root canal therapy for many patients.

This trial paves the way for further research and may ultimately change the way irreversible pulpitis is treated, improving patient outcomes and preserving more natural teeth for longer periods.

Cite this- https://www.ameripharmtimes.in/2024/09/revolutionary-breakthrough-in-dental.html

Search Keywords:- Clinical Trial Insights, Mature Teeth Treatment, Full Pulpotomy, MTA (Mineral Trioxide Aggregate), Irreversible Pulpitis, Pre-mixed Bioceramic,

Visit us at: https://www.ameripharmtimes.in

Revolutionary Dental Breakthrough: MTA vs. Pre-mixed Bioceramic Showdown for Irreversible Pulpitis Treatment

Revolutionary Breakthrough in Dental Care: MTA vs. Pre-mixed Bioceramic – The Ultimate Showdown for Treating Irreversible Pulpitis in Mature Teeth Revealed in Groundbreaking Clinical Trial!