Assessment of Pulpotomy Procedure Using NeoMTA Plus in Permanent Teeth With Carious Exposure
Phase: NA
Conditions: Pulpotomy
Sponsor: Jordan University of Science and Technology

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Jordan University of Science and Technology 
Form A1- Research Fund Application (E-Submission) 
    
 
 
DESCRIPTION 
 
 
Title: Assessment of Pulpotomy Procedure Using NeoMTA Plus in Permanent Teeth with Carious 
Exposure 
 
A-I: ABSTRACT  
         
 
A-II: PROJECT GOALS AND OBJECTIVES   
                                                                                                   
The aim of this in vivo study is to clinically and radiographically assess the outcome of full  
pulpotomy in cariously exposed pulps using NeoMTA Plus in permanent  teeth with carious 
exposure. 
 
 
 
 
 
 
 
 
 
 
A 
  Vital pulp therapy is recommended for teeth diagnosed with reversible pulpitis or partially inflamed 
pulps in which the remaining healthy tissue can be conserved and protected by a biologically active 
material to generate a hard tissue barrier that seals and protects the pulp from future microbial insult. 
The aim of this in vivo study is to clinically and radiographically assess the outcome of full  
pulpotomy using a calcium silicate based material (NeoMTA Plus) in permanent  teeth with carious 
exposure.  
Ethics approval will be obtained from the instituitional ethics and research committee, and the 
patients will be informed for the possible complication and informed consent will be obtained. 
Seventy patients meeting the inclusion criteria will be selected for this study and they will be 
subsequently followed up clinically and radiographically after 3 months, 6 months, and 1 year. 
          

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INTRODUCTION 
 
 
 
B-I: REVIEW AND ANALYSIS OF RELATED WORK 
 
 The invading microorganisms in carious lesions are the primary cause of pulpal inflammation. 
Clinical signs and symptoms such as the degree and characteristics of pain do not reflect the actual 
histological status and subsequently the healing potential of the inflamed pulp. Vital pulp therapy is 
recommended for teeth diagnosed with reversible pulpitis or partially inflamed pulps in which the 
remaining healthy tissue can be conserved to generate a hard tissue barrier that seals and protects the 
pulp from future microbial insult.1 
 
 
According to Seltzer and Bender,2,3 pulp capping should be discouraged for carious pulp exposures, 
since microorganisms and inflammation are invariably associated, and it was shown that it has lower 
success rate than in traumatic exposure.4 This perspective has encouraged clinicians to deliver 
alternative treatments, such as pulpotomy or pulpectomy, particularly in immature permanent 
teeth.5,6  
 
Due to better understanding of pulp physiology, caries microbiology, and the inflammatory 
mechanisms responsible for irreversible changes in pulp tissue, teeth with the potential for repair and 
continued vitality can now be more readily identified and predictably treated. 7 
It is recognized that outcomes for vital pulp therapy can vary, depending on the age of the patient, 
extent of bacterial contamination, and degree of pulp inflammation. Perhaps of greater importance 
may be the choice of pulp capping material and the quality of the permanent restoration.8 
Appropriate case selection, through a detailed differential diagnosis using multiple tests paired with 
a careful radiographic interpretation is required. A study done by Aguilar & Linsuwanont concluded 
that vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp 
therapy.9 
 
The dental pulp is a highly vascular and innervated loose connective tissue that has the unusual 
distinction of being enclosed within a rigid envelope composed of enamel, dentin, and cementum. 
10,11  These hard tissues impart mechanical support and offer protection from the oral microbiota.12 
A comparison analysis of gene expression levels reflecting the activity of biologic cell function, 
proliferation, differentiation, and development found them markedly higher in young pulps 
compared to older dental pulps. Analyses of young dental pulps indicated a greater expression level 
in cell and tissue differentiation, proliferation, and development of the lymphatic, hematologic, and 
immune systems compared to older dental pulps where the apoptosis pathway is highly expressed.13 
 
 
Pulpotomy defined as “the removal of the coronal portion of the vital pulp as a mean of preserving 
the vitality of the remaining radicular portion: may be performed as emergency procedure for 
temporary relief of symptoms or as a therapeutic measure.”14 After complete amputation of the 
coronal pulp, a capping material is placed over the pulp. The introduction of new bioactive materials 
makes more teeth with carious exposures viable candidates for innovative pulp therapies designed to 
potentiate and maintain pulp survival.  
B 

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Preliminary investigations with Calcium Silicate Cements have demonstrated physio-chemical and 
bio-inductive properties comparable to those of MTA, indicating the potential future application of 
these materials in vital pulp therapy.15,16 Some of these tricalcium-based materials include 
BioAggregate (Innovative Bioceramix, Vancouver, British Columbia), Biodentine (Septodont, 
Cambridge, Ontario, Canada), MTA-Angelus, MTA Bio, and MTA Branco (MTA-Angelus, 
Londrina PR, Brazil) and NeoMTA plus (Avalon Biomed, Bradenton USA).17,18 Other formulations 
include EndocemMTA (Maruchi, Wonju-si, Gangwon-do, South Korea) and Endosequence root 
repair material (Brasseler USA, Savannah, Georgia). Additional compounds are currently 
undergoing clinical investigations to establish their safety and efficacy.19,20 
 
 
 
NeoMTA Plus (Avalon Biomed Inc. Bradenton. USA), is noncytotoxic, inhibits bacterial growth, 
does not contain resin, washout resistant, no staining potential, and does not require special 
equipment for mixing or placement. Furthermore, the fine particle size powder with the special gel 
creates a material that has superior handling properties. The setting time is less than 10 minutes and 
the manufacturer recommends no waiting time before placement of the permanent filling, which is 
time saving and particularly important for the early achievement of coronal seal.21,22,23 
 
 
 
B-II: SIGNIFICANCE OF WORK 
 
 Until now there are no published data available on the outcome of pulpotomy procedures using 
NeoMTA Plus in human teeth with carious exposure, however animal studies have shown 
favourable response. 24 Therefore; the aim of this study is to explore the clinical and radiographic 
outcome of pulpotomy procedures using NeoMTA plus in permanent teeth with carious exposure. 
 
 
 

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APPROACH AND METHODOLOGY 
 
 
 
C-I: METHODOLOGY 
 
  Ethics approval will be obtained from the instituitional ethics and research committee. One hundred 
and 20  patients meeting the inclusion criteria will be selected for the study.  
 
Inclusion Criteria : 
 
- 
Permanent teeth with mature or immature apices 
- 
Have no significant medical  problems  
- 
The tooth should give positive response to cold test and Electric Pulp Test (EPT) 
- 
Probing pocket depth and  mobillity within normal limits  
- 
No Signs of pulp necrosis including sinus tract or swelling 
- 
Radiographically ; caries either exposing the pulps or reaching more than 2\3 the distance 
from the dentino-enamel junction (DEJ) to the pulp  
- 
The tooth can be restored via direct restoration 
Exclusion criteria : 
- 
Medically compromised patients 
- 
Negative response to cold test 
- 
Mobillity  
- 
Sinus tract  
- 
Swelling  
- 
Non restorable teeth or badly broken teeth 
 
All the patients will be informed for the possible complication and informed consent will be 
obtained. After Clinical and radiographic examination the tooth will be anaesthetised using 
Lidocaine 2 % and adrenaline  1/80000 and subsequently isolated using rubber dam . Then the tooth 
will be wiped with a gauze soaked in  2.5% sodiuom hypochlorite  to disinfect the surface 
 
Cavity will be prepared using high speed fissure bur and the caries will be excavated using large 
C 

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round bur in the slow speed handpiece. The exposed pulpal tissue will be amputated using sterile 
round bur in the high speed hand piece  to the level of canal orifices ( full pulpotomy). A pellet 
soaked with sodium hypochlorite (2.5%) will be placed for 3-5 minutes  over the pulapl wound to 
achieve hemostasis. 
 
NeoMTA Plus (Avalon biomed Inc, USA) will be mixed according to manufacturer instructions, 
then it will be placed over the pulp wound, then permanent restoration will be placed in the same 
visit. The patient will be reviewed after one week to evaluate symptoms. 
The patients will be asked to score the preoperative pain levels using visual analogue scale from 0-
10, 0 equals no pain while 10 is maximum value. The patients will be contacted by phone 2-3 days 
after treatment to score pain levels again. 
 
The patients will be followed up after 3 months, 6 months, and 1 year , all teeth will be examined 
both clinically and radiographically to see if there is any symptoms, tenderness to percussion, 
presence of calcifications, resorption or new apical pathosis. 
 
The outcome will be considered as unfavorable if one or more of the following is present: pain, 
tenderness to percussion, sinus tract, swelling, evidence of new periapical lesion, or persistence of a 
preoperative lesion. In case of failure RCT will be initiated. 
 
 
 
 
C-II: LOCATION AND SAFETY CONSIDERATIONS 
 
 The clinical procedures will be done at the postgraduate clinics at the faculty of dentistry (JUST), 
universal precautions regarding infection control and radiation safety will be followed and respected. 
 
C-III: EXPECTED RESULTS/OUTPUTS 
 
 To maintain the vitality of the teeth and to preserve them in function without any signs and 
symptoms of apical periodontitis.  
NeoMTA plus will be easy to use and manipulate with high clinical and radiographic success in 
patients due to its favourable biological properties. 
 
 
 

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REFERENCES 
 
 
 
 
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D 

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