Postoperative Pain and Matrix Metalloproteinase-9 Pulpal Blood Level in Symptomatic Pulpitis of Mature Molars Treated with Biodentine and Portland Cement Full Pulpotomy: A Randomized Clinical Trial.

Background: This study compared postoperative pain after Biodentine and Portland cement full pulpotomy in mature molars with symptomatic pulpitis. Additionally, it correlated the pulpal blood level of Matrix Metalloproteinases-9 MMP-9; as a marker of the state of pulp inflammation, with the preoperative pain scores, and intra-operative bleeding time during pulpotomy. Materials and Methods: Seventy-two mature molars were randomly allocated to two full pulpotomy groups using either Biodentine or Portland cement. Intraoperatively, bleeding color, profuseness and pulp attachment were assessed under magnification of dental operating microscope. 10 µL pulpal blood sample was taken using heparinized microcapillary tube for the assessment of MMP-9 level. Hemostasis was achieved with cotton pellet soaked with 2.5% sodium hypochlorite and bleeding time was recorded. The assigned pulp capping material was placed followed by the permanent restoration. Preoperative pain scores were recorded using Numerical rating scale NRS and re-evaluated postoperatively; at 6, 12, 24, 48 and 1 week. MMP-9 concentration was measured using ELISA test. The following statistical analyses were performed to assess the data: Independent t-test, Mann Whitney test, Friedman test, Chi square test and Fisher's exact test. The significant level was set to be at P 0.05. Results: Full pulpotomy using Portland cement and Biodentine showed comparable results regarding postoperative pain at all time points. MMP-9 level showed a significant strong positive correlation with preoperative pain NRS score as well as with bleeding time. Furthermore, both preoperative scores and bleeding time revealed a significant positive correlation with postoperative pain scores at different time points. Conclusions: Full pulpotomy is an appropriate treatment option in mature molars with symptomatic pulpitis. Portland cement demonstrated promising results similar to Biodentine regarding postoperative pain relief when used as a pulp capping material in full pulpotomy. MMP-9 level in pulpal blood as well as bleeding time could offer a guiding tool similar to preoperative NRS scoring for diagnosis of pulp status. Preoperative scores and bleeding time could predict the degree of postoperative pain after full pulpotomy.