Short-Term Outcomes of Full Pulpotomy Compared With Root Canal Treatment for Irreversible Pulpitis: The PROVE Study

To assimilate data from individual randomised trials and perform a pooled analysis of short-term outcomes of pulpotomy compared with root canal treatment (RCT) for teeth with symptomatic irreversible pulpitis (SIRP).

Randomised trials were conducted in eight countries using a standardised clinical protocol and outcome measures. Inclusion criteria were a diagnosis of SIRP in a restorable tooth that could be adequately isolated. A block randomisation method was used. Short-term outcomes were postoperative pain (assessed at baseline, day 3 and day 7), analgesic consumption and early failure, which was defined as the need for additional intervention within 4 weeks of treatment. Data were analysed using R v4.3.1.

A total of 410 patients were randomised, with data available for 385 patients. A significant reduction in pain intensity was observed over time for each treatment group (p < 0.0001). Participants who received RCT were observed to have a significantly greater decrease in pain intensity between baseline and day 3, mean Numeric Rating Scale (NRS-11) of 1.7 (p = 0.0034) and from day 3 to day 7 with a mean NRS of 0.7 (p = 0.0471) compared with participants treated with pulpotomy who had mean NRS of 2.4 and 1.2 respectively. Use of analgesics remained high between baseline and day 3 for participants treated with pulpotomy but significantly decreased for RCT (51.1%, 70/137 vs. 33.3%, 46/138; p = 0.0042). The use of analgesics was significantly reduced in both treatment groups between day 3 and day 7 but was significantly higher at day 7 for participants treated with pulpotomy compared to RCT (19.7%, 27/137 vs. 9.4%, 13/138; p = 0.0246). Early failure was significantly more common for participants who underwent pulpotomy treatment (10/192; 5.2%) compared with RCT (1/193; 0.5%) (p = 0.0141) and was associated with preoperative tenderness to percussion (TTP), molar teeth, sleep disturbance and prolonged bleeding time after exposure.

The PROVE study provides the first robust evidence that both pulpotomy and RCT provided effective pain relief up to day 7; but significantly more pain relief and reduced analgesic intake were evident after RCT. Early failure rate was low in both groups.