Long-term Pulpal and Restorative Outcomes of Pulpotomy in Mature Permanent Teeth

Introduction: Pulpotomy in mature permanent cariously exposed teeth preserves the remaining pulp tissues, but long-term outcomes of the pulp and the restoration are unknown. This prospective study examined the immediate and long-term status of the pulp and the restored tooth and identified potential predictors of early and late failures in teeth that were asymptomatic or experiencing only mild symptoms at the time of treatment. Methods: Pulpotomy was performed using the aseptic technique and a tricalcium silicate cement under local anesthesia. Teeth were assessed for up to 5 years for pulpal and apical signs and symptoms, restorative marginal integrity, and periodontal health. Results: Fifty-two patients (61 teeth) with a median age of 40 years (range, 21-75 years) were included in this study; 17 (32.7%) men and 35 (67.3%) women were treated and reviewed. Overall pulp survival was 90.2% (95% confidence interval, 79.8%-96.3%); 6 teeth developed irreversible pulpitis or pulp necrosis when the restoration was intact. Preoperative pain was a potential predictor (P < .05) for early failure. Eleven late failures occurred between 2 and 4 years: 1 tooth with intact coronal restoration had pulp necrosis and asymptomatic apical periodontitis, 4 had recurrent caries resulting in asymptomatic apical periodontitis, 4 remained vital and only needed new restorations, 1 was unrestorable, and 1 was extracted for periodontal reasons. The type of definitive restoration was a potential predictor for late failure (P < .05). Conclusions: Carious pulp exposures in asymptomatic mature permanent teeth can be predictably managed by pulpotomy using a tricalcium silicate cement. Short-term failures were few and managed by pulpectomy. Appropriate coronal restoration is critical to long-term success.