Could mineral trioxide aggregate pulpotomy replace root canal treatment in children and adolescents?

Objective: To assess the clinical and radiological success of permanent molar pulpotomy in children and adolescents with clinical signs and symptoms of irreversible pulpitis (IP) using white mineral trioxide aggregate (WMTA) as a pulp dressing material after 1 year. Materials and methods: Nineteen patients with 19 permanent molars demonstrating signs and symptoms of symptomatic/asymptomatic IP were included. After standardised pulpotomy was performed, 5% sodium hypochlorite was used to obtain haemostasis. A mixture of WMTA was placed in the pulp chamber. Molars were restored with glass ionomer, and in some of the cases restored with full crowns. Results: The success rate was 94.7%, as one case developed an acute apical abscess on day 7 after the initial treatment. The mean time for recalls was 14.2 ± 4.1 months. Time to stop pulpal haemorrhage ranged between 1 and 12 minutes (mean 4.89 ± 3.4 minutes). At the beginning of the study, seven molars had open apices (36.8%), and all of them showed continued root maturation. Four molars showed radiographic apical radiolucencies (21.1%); all lesions healed completely by the end of the follow-up period. Narrowing of the root canal was observed without complete obliteration in five molars (26.3%). There was no periradicular bone or root resorption. Additionally, no evidence of internal root resorption was noticed. Conclusion: The favourable outcomes of this prospective study suggest that WMTA may be used as a simple, valuable and valid pulpotomy agent in the treatment of permanent molars with IP. More studies are required to assess this procedure, in particular studies with a larger number of patients over a longer period of recalls. Keywords: irreversible pulpitis, mineral trioxide aggregate (MTA), molar pulpotomy