Evaluation of Chitosan Scaffold and Mineral Trioxide Aggregate Pulpotomy in Mature Permanent Molars With Irreversible Pulpitis

Evaluation of Chitosan Scaffold and Mineral Trioxide Aggregate Pulpotomy in Mature Permanent Molars With Irreversible Pulpitis

The aim of this study is to evaluate the clinical and radiographic outcomes of Chitosan scaffold and Mineral trioxide aggregate (MTA) when used as pulpotomy agents in mature permanent teeth with irreversible pulpitis.

Thirty permanent mandibular molars of patients with signs and symptoms of irreversible pulpitis will be selected. They will be randomly allocated into two groups, Group 1(Chitosan scaffold/ MTA pulp dressing materials), Group 2 (MTA pulp dressing material). A single visit full pulpotomy procedure will be carried out. Chitosan scaffold and / or MTA will be used as the pulp dressing materials. The teeth will be then restored with base of Glass ionomer cement followed by composite restoration.

Inclusion Criteria:

• Participants free from any systemic disease.

• Deep caries in a permanent lower molar with mature roots.

• Probing pocket depth and mobility within normal limits.

• No signs of pulpal necrosis including sinus tract or swelling.

• Vital bleeding pulp tissue should be present in all canals after complete pulpotomy.

• The tooth is restorable.

• Clinical diagnosis of symptomatic irreversible pulpitis based on subjective and objective examinations:

  • Subjective examination: Patients complaining of intermittent or spontaneous pain or pain exacerbated by dramatic temperature changes especially to cold stimuli and lasting for a few seconds to several hours.

  • Objective examination:

    • Clinical examination: Teeth that will experience immediate, excruciatingly painful sensation as soon as the cold stimulus is placed on and which may last for a while even after the removal of the stimulus.

    • Radiographic examination: Preoperative radiographs will be taken using a paralleling device.

    • The periapical index developed by Orstavik et al. (1986)(35) will be used to score cases with periapical rarefaction during diagnosis and follow-up periods. It consists of five categories:

      1. Normal periapical structures.
      2. Small changes in bone structures.
      3. Change in bone structure with mineral loss.
      4. Periodontitis with well-defined radiolucent area.
      5. Severe periodontitis with exacerbating features. Score 1 and 2 are considered healthy, score 3-5 are considered diseased

    • The teeth that will be included should have score 1 or 2.

Exclusion Criteria:

• Negative response to cold testing.
• No pulp exposure after caries excavation.
• Bleeding could not be controlled in 10 minutes after 2.5% NaOCl
• Absence of bleeding from any of the canals.
• Teeth with radiographic signs of internal resorption.
• Pulpal calcifications.
• Participants with stainless-steel wires and brackets.