Assessment of Mineral Trioxide Aggregate pulpotomy in mature permanent teeth with carious exposures

Aim To assess the outcome of mineral trioxide aggregate ( MTA) complete pulpotomy in permanent teeth with carious exposures. Methodology Fifty-two permanent molar teeth with fully developed roots and vital pulps in 43 patients aged 11-51 years were included. Preoperative pulpal and periapical diagnosis was established. After informed consent, each tooth was anaesthetized, isolated with dental dam and disinfected with 5% NaOCl before caries excavation; subsequently, a full pulpotomy was performed. Haemostasis was achieved, and Grey MTA ( Angelus, Londrina, Brazil) was placed as the pulpotomy agent; a moist cotton pellet was placed, and the tooth was temporized with the intermediate restorative material ( IRM). Permanent restorations were placed 1 week later if the tooth was asymptomatic, and a postoperative periapical radiograph was taken. Clinical and radiographic evaluation was completed at 3 months, 6 months, 1 year and 3 years postoperatively. Results Clinical signs and symptoms suggestive of irreversible pulpitis were established in 44/52 teeth, and periapical rarefaction was present in 14 teeth. Immediate failure occurred in one tooth. The recall rate ranged from 92% at 3 months to 80.3% at 3 years, with an overall 100% clinical and 97.5% radiographic success during the first year, and 92.7% success at 3 years. All cases with periapical rarefaction were associated with improvement in the periapical index ( PAI) score. Two cases had new periapical rarefaction associated with dislodgment of the permanent restoration. A hard tissue barrier was detected radiographically in 5 cases and canal narrowing in 7 cases. Conclusion MTA full pulpotomy was a successful treatment option for cariously exposed pulps in mature permanent molar teeth.