Combination of Non-Surgical Endodontic and Vital Pulp Therap
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This prospective study evaluated the outcome of a combination of non-surgical endodontic (NSET) and vital pulp therapy (VPT) for the management of mature permanent mandibular molar tooth with symptomatic irreversible pulpitis (SIP) and apical periodontitis (AP).

Mandibular molar teeth (n= 60) with a definitive diagnosis of SIP and AP with a radiographic periapical index score (PAI) of more than 3 in either one of the roots (mesial or distal) were included. Block randomization was used for allocation. In the NSET group (n=30), single visit NSET was performed using a standardized operating protocol. In NSET-VPT group (n=30), subsequent to full pulpotomy, the root orifice where a vital pulp was observed (as determined by the arrest of pulpal bleed on application of 2.5% sodium hypochlorite pressure pack), an MTA radicular barrier was placed, and it was covered with light-cured RMGIC. NSET was performed in the root exhibiting PAI score more than 3. The tooth was permanently restored. Postoperative pain was assessed at 24, 48 and 72- hours. Teeth were followed up clinically and radiographically at 12-months. Presence/absence of symptoms and change in PAI scores were noted. The data was statistically analyzed.

The success rate was 90% in the NSET group and 93.3% in the NSET-VPT group. On an inter-group comparison between the proportion of teeth healed and non-healed (radiographic), there was no significant difference. The combination of NSET and VPT is a viable biologically based minimally invasive treatment option for multi-rooted mandibular teeth with SIP and AP.