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Implications of root, pulp chamber, and canal anatomy on pulpotomy and revitalization procedures

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Abstract

Objectives

This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures.

Methods

This narrative review was undertaken to address two main questions – why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures.

Results

Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up.

Conclusions

Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups. 

Clinical relevance

Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.

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Funding

The micro-CT scanning involved in this review is supported by the following Universiti Malaya Research Grant number GPF018A-2020.

Author information

Authors and Affiliations

  1. Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, 50603, Kuala Lumpur, Malaysia

    Hany Mohamed Aly Ahmed

  2. School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK

    Ikhlas El-karim

  3. Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland

    Henry F. Duncan

  4. Department of Conservative Dentistry and Periodontology, Center of Dental, Traumatology University Hospital of Würzburg Pleicherwall, 2, 97070, Würzburg, Germany

    Gabriel Krastl

  5. Department of Restorative Dentistry and Periodontology, University Hospital Erlangen, Erlangen, Germany

    Kerstin Galler

Authors
  1. Hany Mohamed Aly Ahmed
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  2. Ikhlas El-karim
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  3. Henry F. Duncan
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  4. Gabriel Krastl
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  5. Kerstin Galler
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Contributions

H.M.A.A., I.E., H.F.D., G.K., and K.G. wrote the manuscript text. All authors reviewed the manuscript.

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Correspondence to Hany Mohamed Aly Ahmed.

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Ahmed, H.M.A., El-karim, I., Duncan, H.F. et al. Implications of root, pulp chamber, and canal anatomy on pulpotomy and revitalization procedures. Clin Oral Invest 27, 6357–6369 (2023). https://doi.org/10.1007/s00784-023-05284-9

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