Effect of Pulpal Haemostasis Time on Partial Pulpotomy Outcome in Cariously Exposed Mature Permanent Teeth With Symptomatic Irreversible Pulpitis
Saada Sulaiman, Ruchika Roongta Nawal, Sudha Yadav, Sangeeta Talwar, Seema Yadav, Henry Fergus DuncanABSTRACT
Aim
To correlate the outcome of partial pulpotomy (PP) with the time taken to arrest pulpal bleeding in cariously‐exposed mature permanent teeth with a clinical diagnosis of symptomatic irreversible pulpitis (SIP).
Methodology
This single centre, one‐arm clinical trial was registered in the Clinical Trials Registry—India (CTRI/2023/06/054485). One‐hundred and thirty‐five permanent molar teeth with extremely deep caries presenting with a clinical diagnosis of SIP were recruited. PP was performed following a standardized protocol, by first amputating 2–3 mm of exposed coronal pulp, prior to haemostasis being achieved using 2.5% sodium hypochlorite with pressure up to 15 min. The time taken to arrest bleeding was recorded and categorized into three groups: 1–5 min, 6–10 min and 11–15 min. Biodentine was used as the pulp capping material and the tooth restored. Pain scores were recorded pre‐operatively, at 24 h, 48 h and 7 days post‐operatively using a visual analogue scale (VAS). Clinical and radiographic evaluations were carried out at 6 and 12 months. Statistical analysis included: Friedman test, Kruskal‐Wallis, t ‐test, Mann Whitney U test, Cramer's V coefficient ( V ) and Spearman correlation (rho). The significance level was p < 0.05.
Results
Of the 135 cases, 123 cases were evaluated at 12‐months reflecting a recall rate of 91.1% (123/135). The overall success rate of PP at 12 months was 91.9%. No statistically significant association was shown between the treatment outcome and time taken to achieve haemostasis across the three categories. However, a weak correlation was demonstrated between bleeding time and pre‐operative pain intensity (rho = 0.262; p = 0.002). A moderate association was evident between patient age and treatment outcome ( V = 0.38; p = 0.001). Other variables, such as gender, tooth type, site of caries, pre‐operative VAS score, pain on percussion and periapical index score did not significantly influence the outcome ( p > 0.05).
Conclusion
Within the limitations of this study, time required to achieve pulpal haemostasis (up to 15 min) did not significantly influence treatment outcome at 12 months, indicating that haemostasis time may not be a reliable predictor of success. PP demonstrated a high overall success rate, suggesting that favourable outcomes can be achieved even in cases with prolonged bleeding, provided adequate haemostasis is attained.
Trial Registration
The study was registered prospectively with the Clinical Trials Registry of India with Registration No. (CTRI/2023/06/054485)