Extremely Deep Caries

Study Title: - The Relationship between pulpal inflammatory marker levels in moderate and severe pulpitis and outcome of full pulpotomy in mandibular molars with extremely deep caries: A prospective cohort study." RATIONALE: - Dental caries-induced pulpal inflammation represents a dynamic biological process in which the intensity of the host immune response increases with lesion depth. Extremely deep caries can be present clinically as moderate or severe pulpitis where the pulp inflammation is extensive and confine in the crown or possibly extend itself into the root canals respectively. Clinical diagnostic methods used to identify this stage are largely subjective and often fail to reflect the true biological status of the pulp, leading to inconsistent treatment outcomes. Aim \& Objectives- To assess and compare the levels of IL-1Beta and IL-6 in extremely deep caries in moderate and severe pulpitis and to correlate these levels with treatment outcomes of full pulpotomy. Setting: - Study will be conducted in Post Graduate Institute of Dental Sciences, Rohtak in department of Conservative Dentistry \& Endodontics. Study Design: - Prospective cohort study Time Frame: - 12-18 months Participants: -Inclusion criteria:- o Medically healthy patients (ASA 1). o Age 18-40 years o Patients with extremely deep caries in permanent mandibular molars. o Extremely deep caries, that is penetrating the entire thickness of the dentine without a radiopaque zone separating the lesion from the pulp o PAI score less then or equal to 2 o Pulpal diagnosis via clinical and radiographic examination as well as thermal, electric pulp testing, categorized as moderate pulpitis (Heightened and prolonged reaction to cold, which can last for minutes Possible percussion sensitive Stimulated or spontaneous lingering pain that can be suppressed with analgesics. No sleep disturbance) or severe pulpitis (Severe spontaneous pain Clear lingering pain reaction to cold and warms stimuli Sleeping disturbance and lingering pain Possible sensitive to percussion Extremely deep caries mostly). Exclusion criteria • Primary teeth • Traumatic or mechanical exposure • No pulp exposure after caries excavation. • Haemostasias not achieved within 10 minutes. • Presence of periapical lesion or evidence of internal or external resorption, calcified canals, as assessed by radiographic examination. • Patients with periodontal disease, swelling and sinus tract. • Immunocompromised or pregnant patients, patients with any systemic disease, and a positive history of antibiotic and analgesic use within week before the treatment. Sample size: -86 (43per group) Outcome variables: Primary outcome: Levels of IL-1beta and IL-6 in extremely deep caries in moderate and severe pulpitis Secondary outcome: To assess the correlation between the marker levels and clinical and radiographic success of full pulpotomy at 6 and 12 months interval. Statistical method: - The normality of the data will be checked by Shapiro-Wilks test in SPSS software. If the data will be non-normal, then non-parametric tests will be applied. Intergroup and intra group comparison will be done according to distribution of data. Categorical data will be analysed using chi-square test. Regression analysis will be done to observe any association between dependent and independent variable. The Spearman rank correlation test will be used to measure the strength of association between concentration of IL-6 ,IL-1Beta in pulpal blood samples.

The aim of this randomised control trial is to compare the effect of wound lavage using 2.5% Ca(OCl)₂ and 2.5% NaOCl on the outcome of partial pulpotomy in mature permanent mandibular molars with symptomatic irreversible pulpitis (SIP).Primary objective is to evaluate and compare clinical and radiographic outcome of partial pulpotomy following use of 2.5% Ca(OCl)₂ and 2.5% NaOCl in mature permanent mandibular molars with symptomatic irreversible pulpitis.secondary objective is to evaluate OHRQoL and pain experience after use of 2.5% Ca(OCl)₂ and 2.5% NaOCl during partial pulpotomy in permanent mandibular molars with clinical signs indicative of symptomatic irreversible pulpitis.

The aim of the study is to compare the clinical and radiographic outcomes of direct pulp capping for deep and extremely deep caries in mature permanent mandibular molars with reversible pulpitis. Primary objective of the study is to evaluate the clinical and radiographic success of direct pulp capping for deep and extremely deep caries in mature permanent mandibular molars with reversible pulpitis. Secondary objective of the study is to evaluate and compare postoperative pain following direct pulp capping for deep and extremely deep caries in mature permanent mandibular molars with reversible pulpitis. Subjects of age group 18 - 40 yrs will be included and divided into two groups 1) Permanent mature molars with deep carious lesion 2) Permanent mature molars with extremely deep carious lesion.

The aim of the study is to assess the Influence of proximal caries on outcome of direct pulp capping in permanent mandibular molars with sign of reversible pulpitis. objective- Primary objective- To evaluate and compare the clinical and radiographic outcome of Direct pulp capping in mandibular molars with occlusal and proximal carious lesions. Secondary objective- To evaluate and compare 1.OHRQoL after Direct pulp capping in occlusal and proximal lesion. 2. Postoperative pain, after Direct pulp capping in occlusal and proximal lesion Subjects of age group 15 - 40 yrs will be included and divided into two groups 1) Permanent mature molars with proximal carious lesion 2)Permanent mature molars with occlusal carious lesion.

AIM: -The aim of the study is to compare the outcome of Direct Pulp Capping and Partial Pulpotomy in mature permanent teeth with Reversible Pulpitis OBJECTIVES: - Primary Objective: to compare the difference in clinical and radiographic outcome of direct pulp capping and partial pulpotomy in mature permanent teeth with Reversible Pulpitis. Secondary objective: To evaluate and compare postoperative pain after Direct Pulp Capping and Partial Pulpotomy in teeth with Reversible Pulpitis STUDY GROUPS: - Subjects of age group 15 to 40 years will be included and divided into two groups 1. Direct Pulp Capping in Permanent mature molars with Reversible Pulpitis 2. Partial Pulpotomy in Permanent mature molars with Reversible Pulpitis

Recent clinical trials comparing pulpotomy versus root canal treatment (RCT) have shown promising outcomes; however, the current evidence lacks generalisability to general practitioners. It remains to be elucidated whether these favourable results can be replicated in a primary care setting. This study aims to address that gap by involving senior dental students undergoing supervised university education and training, with the potential to inform future best practice guidelines and promote the adoption of vital pulp therapy (VPT) as a predictable treatment alternative in the general dental population. The clinical procedure involves complete caries-free excavation carried out under rubber dam isolation. After confirming vital pulp status-demonstrated by bleeding upon entry, participants will be randomised to receive one of two treatments: RCT or full pulpotomy. Outcomes will include clinical and radiographic success or failure of the intervention at 12 months. Additionally, patient-reported outcomes will be collected, specifically pain experienced and the use of analgesia during the immediate post-operative period (days 3 and 7).

The aim of the study is to compare the outcome of Partial Pulpotomy in mature permanent teeth with moderate and severe pulpitis. OBJECTIVE: Primary objective- to compare the difference in clinical and radiographic outcome of partial pulpotomy in mature permanent teeth with moderate and severe Pulpitis. Secondary objective- To evaluate and compare OHRQoL and postoperative pain after Partial Pulpotomy in teeth with Moderate Pulpitis and Severe Pulpitis. Subjects of age group 15 to 40 years will be included and divided into two groups 1. Permanent mature molars with Moderate Pulpitis 2. Permanent mature molars with Severe Pulpitis