Traditional or minimal intervention endodontics for managing carious teeth with symptomatic pulpitis in general dental practice

Abstract

Despite an increasing body of evidence supporting pulpotomy as a predictable and evidence-based treatment for the pathologically exposed pulp, its use remains controversial for many clinicians. A growing number of studies have reported high success rates for pulpotomy as a definitive treatment for irreversible pulpitis, however, it is not clear if comparable results can be achieved in the real world of General Dental Practice. In parallel, only by understanding the views of primary stakeholders is it likely that pulp preservation will be more widely adopted. The clinical and radiographic success of complete pulpotomy and root canal treatment when carried out by General Dental Practitioners were compared in a randomized controlled trial. Secondly, the differential expression of inflammatory markers of pulpitis was explored and correlated with treatment outcome. Finally, the views of patients and the dental team were sought regarding the acceptability and wider implementation of pulpotomy as a definitive treatment for painful teeth. Clinical and radiographic outcomes of pulpotomy and root canal treatment were equivalent, although less than those reported when treatment is carried out by specialist practitioners. There were significant differences in gene expression between healthy pulp and that with a clinical diagnosis of irreversible pulpitis, however, in a targeted proteomic analysis, there was no correlation between the expression of TNF-α, MMP-9, IL-8, IL-1β, S100A-9 and CXCL-1 and treatment outcome. Most stakeholders viewed pulpotomy favourably, but several service provider, patient and health system level factors exist which may influence its wider application within the Northern Ireland health service system. Pulpotomy may be an acceptable and effective treatment for managing irreversible pulpitis, but clinicians require contract reform to be able to apply this treatment within the General Dental Practice setting. The search for a biomarker of pulpitis which could reliably support clinical decision-making, however, continues.

Thesis is embargoed until 31st July 2030.

Date of Award	Jul 2025
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	HSC Research & Development Northern Ireland
Supervisor	Ikhlas El Karim (Supervisor), Mike Clarke (Supervisor) & Fionnuala Lundy (Supervisor)