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Pulp Therapy

38 - Root-cause Failure Analysis of Indirect Pulp Therapy on Posterior Teeth

Friday, May 23, 2025
11:00 AM - 11:20 AM MDT
Has Audio

    Presenting Author(s)

  • Dieu Vo, DMD

    Resident
    University of Florida-Gainesville
    University of Florida
    Sarasota, Florida, United States

    • Co-Author(s)

  • Marcio Guelmann (he/him/his)

    Department manager
    University of Florida
    University of Florida
    Gainesville, Florida, United States

    • Research Mentor(s)

  • Marcio Guelmann (he/him/his)

    Department manager
    University of Florida
    University of Florida
    Gainesville, Florida, United States

    • Program Director(s)

  • MC

    Matthew Cooke, DDS, MD, MPH

    Program director
    University of Florida
    Gainesville, Florida, United States

Abstract:



Purpose: The success of indirect pulp therapy (IPT) in primary and permanent teeth is well documented. Despite its high success rate (94-96%), reason(s) for failure have been understudied. The purpose of this study was to investigate predictive factors of IPT failure.  





Methods: A retrospective chart review was completed of 5-year records of otherwise healthy pediatric patients (3-18 years) treated with IPT and a final restoration at a University clinic. Inclusion criteria consisted of at least 6 months follow-up with radiographs, deep carious lesions in teeth diagnosed as asymptomatic or reversible pulpitis. Post-operative pain, infection, the need for root canal treatment, or extraction were considered failures. Frankl ratings at the time of treatment, dentition and tooth type, restoration margin quality, lesion depth and location, and CEJ lesion extension were evaluated. 





Results: Of 495 patients with 562 teeth, 270 teeth (183 primary,87 permanent) met the inclusion criteria. Eighteen failures (6%) were noted. Frankl ratings, dentition, tooth type and final restoration did not significantly contribute to failure. The rate of failures was significantly higher in open vs. closed margins (primary 50% vs. 4%,P < .001; permanent 50% vs. 2%,P < .001), in lesions that had no visible radiographic remaining dentin layer vs. lesions with visible dentin layer (primary 37% vs. 3%,P < .001; permanent 125% vs. 1%;P < .001) and in lesions below the CEJ vs. above the CEJ (primary only 133% vs. 4%,P < .001).



 

Conclusion: Lesions below the CEJ, no remaining dentin thickness pre-operatively and open margins of final restorations were contributors to failures of IPT.


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