Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP): a feasibility study

Alice Hamilton*, Jan E. Clarkson, Craig R. Ramsay, Francesco Mannocci, Fadi Jarad, Sondos Albadri, David Ricketts, Carol Tait, Avijit Banerjee, Chris Deery, Dwayne Boyers, Zoe Marshman, Beatriz Goulao, Alice R. Hamilton, Katie Banister, Rosanne Bell, Lori Brown, David I. Conway, Pina Donaldson, Anne DuncanKatharine Dunn, Patrick Fee, Mark Forrest, Anne Marie Glenny, Jill Gouick, Ekta Gupta, Elisabet Jacobsen, Jennifer Kettle, Graeme MacLennan, Lorna Macpherson, Tina McGuff, Fiona Mitchell, Marjon van der Pol, Rebecca Moazzez, Douglas Roberston, Gabriella Wojewodka, Linda Young, Thomas Lamont

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Background: Progression of dental caries can result in irreversible pulpal damage. Partial irreversible pulpitis is the initial stage of this damage, confined to the coronal pulp whilst the radicular pulp shows little or no sign of infection. Preserving the pulp with sustained vitality and developing minimally invasive biologically based therapies are key themes within contemporary clinical practice. However, root canal treatment involving complete removal of the pulp is often the only option (other than extraction) given to patients with irreversible pulpitis, with substantial NHS and patient incurred costs. The European Society of Endodontology’s (ESE 2019) recent consensus statement recommends full pulpotomy, where the inflamed coronal pulp is removed with the goal of keeping the radicular pulp vital, as a more minimally invasive technique, potentially avoiding complex root canal treatment. Although this technique may be provided in secondary care, it has not been routinely implemented or evaluated in UK General Dental Practice. Method: This feasibility study aims to identify and assess in a primary care setting the training needs of general dental practitioners and clinical fidelity of the full pulpotomy intervention, estimate likely eligible patient pool and develop recruitment materials ahead of the main randomised controlled trial comparing the clinical and cost-effectiveness of full pulpotomy compared to root canal treatment in pre/molar teeth of adults 16 years and older showing signs indicative of irreversible pulpitis. The feasibility study will recruit and train 10 primary care dentists in the full pulpotomy technique. Dentists will recruit and provide full pulpotomy to 40 participants (four per practice) with indications of partial irreversible pulpitis. Discussion: The Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) study will address the lack of high-quality evidence in the treatment of irreversible pulpitis, to aid dental practitioners, patients and policymakers in their decision-making. The PIP feasibility study will inform the main study on the practicality of providing both training and provision of the full pulpotomy technique in general dental practice. Trial registration: ISRCTN Registry, ISRCTN17973604. Registered on 28 January 2021. Protocol version Protocol version: 1; date: 03.02.2021

Original languageEnglish
Article number77
Number of pages11
JournalPilot and Feasibility Studies
Volume8
Early online date2 Apr 2022
DOIs
Publication statusPublished - 2 Apr 2022

Keywords

  • Feasibility
  • Full pulpotomy
  • General dental practice
  • Irreversible pulpitis
  • PPI
  • Primary care
  • Root canal treatment
  • Training
  • Vital pulp therapy

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