Is pulpotomy a valid treatment option for irreversible pulpitis?

Based on the current state of knowledge, vital pulp treatment on teeth with deep carious lesions is indicated only in vital teeth which are asymptomatic, or at the most, show symptoms of reversible pulpitis. In cases of irreversible pulpitis, vital pulp extirpation and root canal treatment constitutes a reliable and established method that should still be considered the gold standard. However, recently published clinical studies show that, despite the diagnosis of "irreversible pulpitis", surprisingly high success rates can be achieved after partial or full pulpotomy. These findings do not only challenge the current treatment concepts for teeth affected by pulpitis, but also the current system for diagnosing different stages of the disease. Although the diagnosis of "irreversible pulpitis" is consistent with histologically detectable areas of bacterially infected or already necrotic tissue, these areas are localized beneath the carious lesion in the coronal pulp and do not affect the entire pulp tissue. Pulpotomy involves the complete removal of inflamed, and therefore heavily bleeding, pulp tissue up to the level where the remaining pulp tissue is healthy in order to create the necessary conditions for healing. To date, a total of 12 clinical studies with a focus on vital pulp treatment in teeth with deep carious lesions and irreversible pulpitis have been published. Success rates after observation periods of 1 to 5 years range between 85 % and 95 % in most studies, regardless of patient age and type of pulpotomy (partial or full). However, it must be taken into account that long-term studies are lacking, and the significance of the individual studies is limited by various qualitative deficits. In spite of these shortcomings, based on the current data, pulpotomy can be regarded as a valid treatment option for irreversible pulpitis and it certainly represents an alternative to vital pulp extirpation. Whereas the correct indication is critical, the success of a pulpotomy procedure mainly relies on the adequate performance of the necessary treatment steps. This includes, in addition to the aseptic treatment concept in combination with the consistent use of rubber dam and sterile instruments, the use of magnifying aids to enable a sufficiently precise amputation procedure, the endodontic expertise to assess the exposed pulp tissue, the application of appropriate disinfection measures and capping of the tissue with a bioactive material followed by an immediate coronal seal. Keywords: partial pulpotomy, pulpitis, vital pulp treatment, full pulpotomy