Postoperative pain after pulpotomy versus pulpectomy of primary molars with symptomatic irreversible pulpitis: an equivalent randomized clinical trial

Abstract

Abstract Objectives The study aimed to compare the incidence of postoperative pain after pulpotomy versus pulpectomy of primary molars with symptomatic irreversible pulpitis (SIP). Materials and methods An equivalent parallel, two-tailed randomized controlled trial was conducted involving 92 children aged 5 to 7 years presenting with carious mandibular second primary molars exhibiting signs of SIP. Participants were randomly assigned to two equal groups of 46 children each, with the affected mandibular second primary molars treated using either pulpotomy as the intervention or pulpectomy as the control treatment. The postoperative severity of pain was determined at 6, 12, 24, 48, 72 h and after one-week following treatment using a modified Wong-Baker FACES (WBF) pain scale. Considering an equivalence margin of 10% between the two endodontic techniques, the absolute risk difference (ARD) was calculated at a 90% confidence interval. The level of significance was set to < 5%. Results After six hours, 65.2% of pulpotomy and 73.9% of pulpectomy patients reported no pain. At 24 and 48 h, pain absence was comparable between groups (73.9% vs. 78.3%). However, by one week, 8.7% of pulpotomy patients still experienced severe pain versus 2.2% in pulpectomy. The incidence of postoperative pain severity after either pulpotomy or pulpectomy was equivalent with no significant difference over the follow-up periods. Conclusions Pulpotomy could be an alternative approach to treat primary molars with SIP when hemostasis can be achieved. Clinical relevance Postoperative pain intensity is a critical factor in assessing the success of endodontic treatment, especially in children. Pulpotomy can be a suitable and less invasive endodontic treatment for primary teeth with SIP.