Survival of permanent first molars that have undergone coronal pulpotomy treatment of children aged between 6 and 18 years

Abstract

Background: Coronal pulpotomy (CP) treatment has recently been used as an alternative to root canal treatment (RCT) for deep carious lesion in young permanent teeth with the aim of preserving tooth viability. There are currently limited longitudinal studies related to the treatment outcome and prognostic factors of this treatment. Objectives: To examine survival probabilities and identify prognostic factors that may influence treatment outcome of young permanent first molars that have undergone CP treatment of children aged between 6 and 18 years.

Materials and methods: This retrospective cohort study included first permanent molars that were treated with CP treatment in patients aged 6 to 18 at the Pediatric Dentistry Clinic. Faculty of Dentistry, Chiang Mai University. All teeth were evaluated for at least 6 months after treatment. The outcome was considered on two definitions (focused on success and focused on functional survival). Survival analysis was used to analyze the survival function of the CP-treated teeth and their prognostic factors.

Results: A total of 73 CP-treated teeth from 67 patients were included in this study with follow-up period range from 6 to 98 months. When the CP outcome focusing on success, the survival probabilities of CP-treated teeth declined by approximately 10% annually in the first two years (92.6% and 81.5% respectively), and steadily declined in the third, fourth, and fifth years (78.5%, 75%, and 71%, respectively), before re remaining stable in the sixth to eighth years at 66%. However, when the CP outcome focusing on functional survival. the survival probability of CP-treated teeth decreased slightly from 100% to 96.3% in the second years and remained constant until the end of the study at 98 months. In univariable analysis, the older age group (12-14 years) showed a significantly higher probability of CP treatment failure compared to the younger age groups (6-11 years) with a hazard ratio of 3.41 (95% CI: 1.08-10.73; p = 0.04). Movever, the mandibular first permanent molars had significantly lower probability of treatment failure than the maxillary first permanent molars with a hazard ratio of 0.33 (95% CI: 0.12-0.93; p = 0.04). However, multivariable analysis revealed that none of the prognostic factors had a significant association with the survival of CP-treated teeth.

Conclusion: Based on the result of this study, it is feasible to infer that coronal pulpotomy can be used to treat deep carious lesion with vital pulp status in permanent first molars of children aged 6 to 18. with a high probability of long-term survival.