Patient Perception Between Two Emergency Treatments of Symptomatic Irreversible Pulpitis.

Clinical procedure will be the same in both groups with regard to the anesthetic technique, and the cavity access and provisional closure of the aperture. The characteristics of both interventions will be described in detail in order to homogenize the procedures. The patient will be conveniently informed before requesting his/her Informed Consent for his/her voluntary participation in the study. Their identification data will be treated in accordance with the provisions of Regulation (EU) 2016/679 of the European Parliament and Council of April 27, 2016, and the Organic Law 3/2018 of 5/12, currently in force, will remain in custody at the Center where they receive treatment and will not be shared by the other centers of the study.

The patient will not be aware of the type of procedure he has been assigned for and will express in a numerical scale according to his perception of the pain on 4 occasions: before starting treatment, at 8-12, 24 and 72 hours after treatment. Likewise, right after receiving the treatment, he will answer some questions related to the degree of comfort during the treatment and about his perception of the time of the intervention.

Data sheets will be collected and treated statistically.

• Pulpotomy (Procedure): Access to pulp chamber. Removal of the pulp chamber tissue. Use of Sodium Hypochlorite (5.25% NaCl) during the whole procedure and in the amount considered appropriate by each operator. Wait until confirmation of absence of bleeding from the conducts. Placement of polytetrafluroethylene in pulp chamber. Placement of temporary filling. Reduction of the occlusal surface of the tooth until there is no contact with the articulating paper from 200μ.
• Pulpectomy (Procedure): Access to pulp chamber. Removal of the pulp chamber tissue. Use of Sodium Hypochlorite (5.25% NaCl) during the whole procedure and in the amount considered appropriate by each operator. Establishment of working length by means of Electronic Apex Locator and a number 8 K file. Access to all conducts with a number 10 K file. Rotary instrumentation with one reciprocating system up to working length and up to an apical diameter of 25. Placement of polytetrafluroethylene in pulp chamber. No intermediate medication will be filled into the conducts. Placement of temporary filling. Reduction of the occlusal surface of the tooth until there is no contact with the articulating paper from 200μ.

Primary outcomes

• Patients´ pain perception [Through study completion, an average of 1 year.]: The patient's perception of the degree of post-operative pain following emergency treatment

Secondary outcomes

• Procedure time [Through study completion, an average of 1 year.]: The time it takes for each procedure.

Sex: All, ages: 20 Years to 100 Years, accepts healthy volunteers

Inclusion Criteria:

* Patient in American Society of Anesthesiologists I or II condition.
* Patient who comes to the emergency room with irreversible pulpitis in a single tooth.
* Patients of age >20 years.
* Positive response to the vitality test and bleeding after pulp exposure.

Exclusion Criteria:

* American Society of Anesthesiologists patients>II.
* Pharmacological allergies that contraindicate the intervention.
* Teeth with negative vitality test and no bleeding after pulp exposure.
* Signs of concomitant periodontal infection such as swelling or fistula.
* Teeth with immature roots.
* Patients who are medicated with anxiolytics.
* Abuse of psychotropic drugs or medication that may alter the perception of pain 15 days before the intervention.
* Pregnant or breast-feeding women.
* Interventions with conscious sedation.
* Pathological mental state (dementia, psychosis).
* Lack of collaboration or non-acceptance of the consent of the study.

• Gatewood RS, Himel VT, Dorn SO. Treatment of the endodontic emergency: a decade later. J Endod. 1990 Jun;16(6):284-91. doi: 10.1016/S0099-2399(06)81631-6. PMID 2074427
• Lee M, Winkler J, Hartwell G, Stewart J, Caine R. Current trends in endodontic practice: emergency treatments and technological armamentarium. J Endod. 2009 Jan;35(1):35-9. doi: 10.1016/j.joen.2008.10.007. PMID 19084121
• Nyerere JW, Matee MI, Simon EN. Emergency pulpotomy in relieving acute dental pain among Tanzanian patients. BMC Oral Health. 2006 Jan 21;6:1. doi: 10.1186/1472-6831-6-1. PMID 16426455
• Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod. 2011 Apr;37(4):429-38. doi: 10.1016/j.joen.2010.12.016. PMID 21419285
• Results publication: Eghbal MJ, Haeri A, Shahravan A, Kazemi A, Moazami F, Mozayeni MA, Saberi E, Samiei M, Vatanpour M, Akbarzade Baghban A, Fazlyab M, Parhizkar A, Ahmadi M, Akbarian Rad N, Bijari S, Bineshmarvasti D, Davoudi P, Dehghan R, Dehghani M, Ebrahimi H, Emami N, Farajian N, Fereidooni R, Ghobadi G, Ghodrati M, Gohari A, Hashemi A, Hosseini M, Karami E, Kheirabadi N, Kozegari S, Labaf Ghasemi H, Majidi A, Malekzadeh P, Mehrabi V, Mohammadi M, Moradi Eslami L, Noghani A, Omatali N, Pourhatami N, Rahbani Nobar B, Rahmani S, Shafaq P, Soofiabadi S, Teimoori S, Vatandoost F, Asgary S. Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial. Pain Res Manag. 2020 Jun 30;2020:5853412. doi: 10.1155/2020/5853412. eCollection 2020. PMID 32676136
• Results publication: Eren B, Onay EO, Ungor M. Assessment of alternative emergency treatments for symptomatic irreversible pulpitis: a randomized clinical trial. Int Endod J. 2018 Apr;51 Suppl 3:e227-e237. doi: 10.1111/iej.12851. Epub 2017 Oct 16. PMID 28857203
• Results publication: Oguntebi BR, DeSchepper EJ, Taylor TS, White CL, Pink FE. Postoperative pain incidence related to the type of emergency treatment of symptomatic pulpitis. Oral Surg Oral Med Oral Pathol. 1992 Apr;73(4):479-83. doi: 10.1016/0030-4220(92)90330-s. PMID 1574311

• Guillem Esteve-Pardo, DDS, Principal investigator, Aula Dental Avanzada