Pulpotomy for the management of irreversible pulpitis in mature teeth (PIP Feasibility Study)

Most adults experience tooth decay and many require restorative work involving dental caries removal prior to the irreversible pulpitis stage. If this fails, root canal treatment involving complete removal of the pulp is the only option (other than extraction) but it is a technically demanding procedure, time consuming and costly to the NHS and patients.

PIP has been funded by the NIHR HTA to investigate outcomes for partial irreversible pulpitis, the initial stage of the irreversible damage confined to the coronal (crown) pulp whilst the radicular (root) pulp remains vital. Removal of the coronal pulp with a Full Pulpotomy (FP) may keep the radicular pulp vital and thereby avoid the need for complex Root Canal Treatment (RCTx) or extraction.

The feasibility study will determine progression to a pragmatic, multi centre, two arm randomised controlled trial in a primary dental care setting comparing clinical and cost effectiveness of FP compared to RCTx in pre/molar teeth of adults 16 years and older with symptoms indicative of irreversible pulpitis.

The feasibility study aims to identify the training needs of GDPs to undertake FP, develop a clinical training package, assess if FP can be delivered optimally in routine NHS practice, and estimate number of eligible patients per practice and recruitment materials for the main trial.

This research is important to establish whether FP will, in addition to relieving pain, provide a treatment that is more acceptable for patients, avoiding complex treatment with multiple lengthy visits, possible crowning and a tooth that, if RCTx fails, is frequently extracted and a further fixed or removable prosthetic replacement needed. In addition to cost savings, FP may improve patient quality of life through better oral health, fewer episodes of dental pain and possible reduction in dental anxiety.

For more information on PIP please contact Anne Duncan - anne.duncan@abdn.ac.uk

 

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