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Combination of Nonsurgical Endodontic and Vital Pulp Therapy for Management of Mature Permanent Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis and Apical Periodontitis

  • Bhawna Koli
    Affiliations
    Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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  • Amrita Chawla
    Correspondence
    Address requests for reprints to Dr Amrita Chawla, Room No 309, Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India.
    Affiliations
    Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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  • Ajay Logani
    Affiliations
    Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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  • Vijay Kumar
    Affiliations
    Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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  • Sidhartha Sharma
    Affiliations
    Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Published:October 19, 2020DOI:https://doi.org/10.1016/j.joen.2020.10.010

      Abstract

      Introduction

      This prospective study evaluated the outcome of a combination of nonsurgical endodontic (NSET) and vital pulp therapy (VPT) for the management of mature permanent mandibular molar teeth with symptomatic irreversible pulpitis (SIP) and apical periodontitis (AP).

      Methods

      Institutional ethical clearance was obtained. Mandibular molar teeth (N = 60) with a definitive diagnosis of SIP and AP with a radiographic periapical index score (PAI) of ≥3 in either 1 of the roots (mesial or distal) were included. Block randomization was used for allocation. In the NSET group (n = 30), single-visit NSET was performed using a standardized operating protocol. In the NSET-VPT group (n = 30), subsequent to full pulpotomy, at the root orifice where a vital pulp was observed (as determined by the arrest of pulpal bleed upon application of a 2.5% sodium hypochlorite pressure pack), a mineral trioxide aggregate radicular barrier was placed, and it was covered with light-cured resin-modified glass ionomer cement. NSET was performed in the root exhibiting a PAI score ≥3. The tooth was permanently restored. Postoperative pain was assessed at 24, 48, and 72 hours. Teeth were followed up clinically and radiographically at 12 months. The presence/absence of symptoms and the change in PAI scores were noted. The data were statistically analyzed.

      Results

      The success rate was 90% in the NSET group and 93.3% in the NSET-VPT group. According to an intergroup comparison between the proportion of teeth healed and nonhealed (radiographic), there was no significant difference (P > .05).

      Conclusions

      The combination of NSET and VPT is a viable biologically based minimally invasive treatment option for multirooted mandibular teeth with SIP and AP.

      Key Words

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