Irreversible pulpitis: is root canal treatment the only answer?
60 Second Journal, Vol. 3. For colleagues.
Lingering pain in a mature tooth has long meant root canal treatment. A growing body of evidence suggests that in many of these teeth the inflammation is limited to the coronal pulp, and that removing that tissue while keeping the radicular pulp alive can work.
What the evidence shows
A 2024 meta-analysis of randomised and single-arm trials reported a pooled clinical success of about 93% for pulpotomy beyond 24 months, with no significant difference from root canal treatment.
Full and partial pulpotomy performed similarly, as did MTA and calcium-enriched mixture.
Earlier reviews reported high success at 12 to 36 months but noted heterogeneous studies with a high risk of bias.
Practical points
Case selection and an intra-operative look at the pulp, including time to haemostasis, are central.
Hydraulic calcium silicate materials are the material of choice in these studies.
Root canal treatment remains the right answer when the pulp does not look or bleed like vital tissue.
The evidence is promising but not yet definitive. Well-designed long-term trials are still needed before this replaces root canal treatment as routine.
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References
Li Y, et al. Efficacy of pulpotomy in managing irreversible pulpitis in mature permanent teeth: a systematic review and meta-analysis. J Dent. 2024;144:104923. doi:10.1016/j.jdent.2024.104923
Cushley S, et al. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: a systematic review. J Dent. 2019;88:103158. doi:10.1016/j.jdent.2019.06.005
Santos JM, et al. Vital pulp therapy in permanent mature posterior teeth with symptomatic irreversible pulpitis: a systematic review of treatment outcomes. Medicina (Kaunas). 2021;57(6):573. doi:10.3390/medicina57060573
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