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Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter randomized clinical trial
Authors:Saeed Asgary  Mohammad Jafar Eghbal  Jamileh Ghoddusi
Affiliation:1. Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Evin, 1983963113, Tehran, Iran
2. Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3. Endodontic Department, Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract:

Objectives

Oral healthcare expenses are increasing rapidly as a result of the growth of high-cost health technologies worldwide. In many developing/developed countries, low-cost tooth extraction is the alternative treatment option for a high-cost root canal therapy (RCT) for management of human molars with irreversible pulpitis. Vital pulp therapy with calcium-enriched mixture cement (VPT/CEM) as a new alternative treatment option has demonstrated excellent treatment outcomes up to 1 year; if 2-year radiographic/clinical effectiveness as well as cost-effectiveness of the VPT/CEM is also non-inferior compared with RCT, it can serve as a viable treatment for mature molars with irreversible pulpitis.

Materials and methods

In this prospective, multicenter (n?=?23), non-inferiority clinical trial, 407 patients were randomized to either one-visit RCT (n?=?202) or VPT/CEM (n?=?205) for 27 months. In this part of study, the primary outcome measure was the 2-year clinical and radiographic treatment outcomes. Cost-effectiveness was also analyzed.

Results

Mean follow-up times were 24.62?±?0.72 and 24.61?±?0.69 months in RCT (n?=?166) and VPT/CEM (n?=?166) arms, respectively. Clinical success rates in the two study arms were equal (98.19 %); however, radiographic success rates were 79.5 and 86.7 % in RCT and VPT/CEM arms, respectively, with no statistical difference (P?=?0.053). The treatment time span mean was approximately three times greater in the RCT than in the VPT/CEM arm (94.07 vs. 31.09 min; P?K per molar tooth compared with 44.5K for VPT.

Conclusions

VPT/CEM reduced time and cost spent. When considering clinical as well as cost-effectiveness of VPT/CEM, this treatment option is not only non-inferior but also superior to RCT in mature permanent molar teeth with established irreversible pulpitis.

Clinical relevance

Vital pulp therapy with CEM is a cost-effective and reliable biological technique for endodontic treatment of permanent molar teeth with irreversible pulpitis and can be recommended for general clinical practice.
Keywords:
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