Appraise the anesthetic efficacy in emergency pulpotomy versus complete pulp extirpation during endodontic treatment: a randomized clinical trial
Authors:   Endodontics Department, Faculty of Dentistry, Cairo University, Cairo, Egypt, Shabaan Nesma Ali , Ibrahim Salsabyl Mohamed ,   Endodontics Department, Faculty of Dentistry, Cairo University, Cairo, Egypt, El-Boghdadi Randa ,   Endodontics Department, Faculty of Dentistry, Cairo University, Cairo, Egypt, El Abbasy Fatma El Zahraa ,   Endodontics Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
Published: December 2024

Background and objectives. Symptomatic irreversible pulpitis (SIP) is one of the main reasons people seek emergency dental care, an extremely painful inflammatory condition of the dental pulp. In endodontics, efficient pain management is a sign of superior clinical practice. An appropriate local anesthesia combined with adequate emergency intervention is mandatory. The aim of the present study was to compare local anesthetic success during pulp extirpation versus emergency pulpotomy in endodontic treatment of mandibular molars teeth with symptomatic irreversible pulpitis. Materials and methods. Seventy-eight patients with mandibular molar having vital pulps with symptomatic irreversible pulpitis were included in the study. After confirming the diagnosis clinically and radiographically, patients were randomly assigned into two groups (n=39) for each group. The control group treated by complete pulp extirpation and the intervention group treated by emergency pulpotomy. Every patient received 4% artiacine as inferior alveolar nerve block (IANB). Endodontic access was initiated after 10 minutes of anesthesia, lip numbness and electric pulp tester (EPT) reading. Pain during endodontic access cavity preparation for both groups and during pulp extirpation or pulpotomy according to each group was recorded by verbal rating scale (VRS). When patients needed, they received buccal infiltration or intraligamentary or intra-pulpal anesthesia of the same anesthetic solution as supplemental. Data were collected through verbal rating scales (VRS) during the intervention to assess the anesthetic success. The second visit was scheduled after one week to complete the treatment for both groups. All the data were collected and tabulated. Statistical analysis was performed by mean, standard deviation for each group, Kolmogorov-Smirnov, Shapiro-Wilk tests, Independent-sample t-test, Mann Whitney test. and the significance level was set to (P≤0.05). Results. There was no statistically significant difference between pulp extirpation group and pulpotomy group (p=0.795) in success of pain control during access cavity preparation and during pulp extirpation or pulpotomy according to each group. 49% of patients in the control group and 43.5% of patients in the intervention group required supplemental anesthesia to effectively complete the treatment without pain. Conclusion. The present study demonstrated that pulpotomy was highly effective as pulp extirpation in rate of anesthetic success upon emergency treatment for mandibular molars with symptomatic irreversible pulpitis. Clinical significance: pulpotomy offers more effective care in less time and with less discomfort than complete pulp extraction.