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

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.

Automated summary

This prospective study evaluated the outcome of a combination of NSET and VPT in the management of mature permanent mandibular molar teeth with symptomatic irreversible pulpitis (SIP) and apical periodontitis (AP). The success rates of the NSET and NSET-VPT groups were 90% and 93.3% respectively, with no significant difference between the two groups, indicating that the combination of NSET and VPT is an effective treatment option.