Evaluation of Chitosan Scaffold and Mineral Trioxide Aggregate Pulpotomy in Mature Permanent Molars With Irreversible Pulpitis
Evaluation of Chitosan Scaffold and Mineral Trioxide Aggregate Pulpotomy in Mature Permanent Molars With Irreversible Pulpitis
The aim of this study is to evaluate the clinical and radiographic outcomes of Chitosan
 scaffold and Mineral trioxide aggregate (MTA) when used as pulpotomy agents in mature
 permanent teeth with irreversible pulpitis.
Thirty permanent mandibular molars of patients with signs and symptoms of irreversible
 pulpitis will be selected. They will be randomly allocated into two groups, Group 1(Chitosan
 scaffold/ MTA pulp dressing materials), Group 2 (MTA pulp dressing material). A single visit
 full pulpotomy procedure will be carried out. Chitosan scaffold and / or MTA will be used as
 the pulp dressing materials. The teeth will be then restored with base of Glass ionomer
 cement followed by composite restoration.
Inclusion Criteria:

 -  Participants free from any systemic disease.

 -  Deep caries in a permanent lower molar with mature roots.

 -  Probing pocket depth and mobility within normal limits.

 -  No signs of pulpal necrosis including sinus tract or swelling.

 -  Vital bleeding pulp tissue should be present in all canals after complete pulpotomy.

 -  The tooth is restorable.

 -  Clinical diagnosis of symptomatic irreversible pulpitis based on subjective and
 objective examinations:

 -  Subjective examination: Patients complaining of intermittent or spontaneous pain
 or pain exacerbated by dramatic temperature changes especially to cold stimuli
 and lasting for a few seconds to several hours.

 -  Objective examination:

 -  Clinical examination: Teeth that will experience immediate, excruciatingly
 painful sensation as soon as the cold stimulus is placed on and which may
 last for a while even after the removal of the stimulus.

 -  Radiographic examination: Preoperative radiographs will be taken using a
 paralleling device.

 -  The periapical index developed by Orstavik et al. (1986)(35) will be used to
 score cases with periapical rarefaction during diagnosis and follow-up
 periods. It consists of five categories:

 1. Normal periapical structures.

 2. Small changes in bone structures.

 3. Change in bone structure with mineral loss.

 4. Periodontitis with well-defined radiolucent area.

 5. Severe periodontitis with exacerbating features. Score 1 and 2 are
 considered healthy, score 3-5 are considered diseased

 -  The teeth that will be included should have score 1 or 2.

 Exclusion Criteria:

 -  Negative response to cold testing.

 -  No pulp exposure after caries excavation.

 -  Bleeding could not be controlled in 10 minutes after 2.5% NaOCl

 -  Absence of bleeding from any of the canals.

 -  Teeth with radiographic signs of internal resorption.

 -  Pulpal calcifications.

 -  Participants with stainless-steel wires and brackets.