Comparative Effectiveness in the Management of Irreversible Pulpitis

Exclusion Criteria

• •Evidence of Pulp Necrosis or Apical Periodontitis, preoperatively or upon inspection of an exposure site
• •Teeth that are badly broken down and/or are not restorable.
• •Teeth with mechanical allodynia assessed by registering bite force that is at least 50N lower than the contralateral side.
• •Teeth with radiographic evidence of internal, or external cervical, inflammatory or replacement root resorption, or with complete pulp canal obliteration.
• •Radiographic evidence of PDL space wider than three times normal width
• •Clinical evidence of swelling or sinus tract
• •Periodontal pocket probing depth ≥5 mm in any site around the tooth.
• •Clinical evidence of cracks connecting mesial and distal surfaces and/or extending in pulp chamber or associated with periodontal pockets ≥ 5 mm.
• •History of taking centrally acting drugs (e.g., tricyclic antidepressants), which interfere with the release of pain mediators and/or modify pain experience, within the previous 6 months.
• •Use of medications that affect the host response such as methotrexate, corticosteroids or cyclosporin.
• •Patients on immunosuppressive agents, chronic corticosteroid use, autoimmune disease, or other immunocompromising diseases or medications.
• •Patients who require IV sedation or general anesthesia for their dental treatment.
• •Teeth with full coverage crowns.
• •Teeth undergoing active orthodontic movement.
• •Teeth that require elective RCTx to place a post for restorative purposes.
• •Teeth with no contralateral molars with normal pulp and periapical tissues for bite and pulp testing controls.
• •Teeth in the pulpotomy group in which, following complete pulpotomy, bleeding does not stop after 10 minutes with 3-4% hypochlorite cotton pellet. These will be considered treatment failure and treated with RCTx.