To Save or Remove the Tooth Nerve? | 医療法人社団EPSDC

1. Introduction: To Those Facing Severe Tooth Pain
When hit by a throbbing, intense toothache, the first thing many people feel is a fear-like anxiety: “Will I have to have the nerve removed?” On the other hand, modern dentistry is highlighting “Pulpotomy”—a procedure that preserves part of the nerve even in cases of severe inflammation. The desire to keep as much of one’s own natural tissue as possible is a natural and wise choice for anyone seeking to minimize invasive procedures.

However, for those of us who must maintain our Quality of Life (QOL) amidst a busy daily schedule, practical questions remain: “Which one relieves pain faster?” and “Which one is more predictable?”

Based on the latest evidence from the **PROVE Study (2026)**, a large-scale international collaborative study involving eight countries, this article reveals the clinical realities of the gap between Root Canal Treatment (RCT)—removing the nerve—and Pulpotomy—saving the nerve.

2. Shocking Fact #1: Root Canal Treatment (RCT) Provided Faster Statistical Pain Relief
The PROVE Study tracked post-treatment progress using an 11-point Numerical Rating Scale (NRS score: 0 = no pain, 10 = worst imaginable pain). Before treatment, the average scores were 6.2 for the RCT group and 6.4 for the pulpotomy group, indicating both groups suffered from severe pain.

While both groups saw dramatic improvements after treatment, there was a statistically significant difference in the “gradient of reduction.”

Comparison Item	Root Canal (RCT)	Pulpotomy
Pain Level (Day 3)	1.7	2.4
Pain Level (Day 7)	0.7	1.2

The research team concluded: “Participants who received RCT experienced a significantly greater reduction in pain intensity from baseline to day 3, and from day 3 to day 7, compared to those who received a pulpotomy.”　However, from a specialist’s perspective, while this difference (0.7 to 1.2 points) is statistically significant, it may not reach the threshold of “1 to 2 points” typically considered the Minimally Clinically Important Difference (MCID). In other words, while RCT is statistically faster, the actual level of distress felt by an individual patient might not differ drastically between the two.

3. Shocking Fact #2: The Gap in When You Can Stop Painkillers
Post-operative pain directly impacts work concentration and daily performance. A crucial metric for readers who need to stay sharp is “How long will I need to keep taking painkillers?”

The PROVE Study showed a clearer difference in the rate of analgesic use:

Comparison Item	Root Canal (RCT)	Pulpotomy

Analgesic Use (Day 3)	33.3%	51.1%
Analgesic Use (Day 7)	9.4%	19.7%
Early Failure Rate	0.5%	5.2%
Primary Value

If your priority is to stop taking medication as soon as possible and return to your complete daily routine, RCT offers a significant practical advantage due to its higher clinical predictability.

4. Shocking Fact #3: A Small but Clear Difference in “Certainty”
To evaluate the “predictability” of the treatments, let’s look at the rate of “early failure” (cases requiring re-treatment within 4 weeks).

RCT Failure Rate: 0.5%
Pulpotomy Failure Rate: 5.2%

While pulpotomy is a biologically superior option that preserves natural tissue, it carries roughly 10 times the risk of short-term failure compared to RCT. This is due to the medical limitations of “diagnostic uncertainty.” Even with the latest technology, it is difficult to determine with 100% accuracy how far inflammation has progressed. A failed pulpotomy means the nerve we tried to save was, in fact, already beyond repair. While pulpotomy is an attractive option, it is undeniable that RCT remains a more stable treatment at this time.

5. Can Your Nerve Be Saved? 4 Signs of Potential Failure
The study identified several warning signs that suggest a pulpotomy is more likely to fail. If these signs are present, prioritizing a reliable RCT might be the wiser decision:

Percussion Pain: The tooth is sensitive or painful when tapped.
Molars (Back Teeth): Due to their complex anatomical structure, back teeth carry higher risks than front teeth.
Disrupted Sleep: You have spontaneous pain severe enough to wake you up or prevent sleep.
Prolonged Bleeding Time: During treatment, it takes time for the bleeding from the nerve surface to stop.
Data shows that while the average hemostasis (stopping blood) time for successful cases was 4 minutes, the average for failed cases was 7 minutes (ranging from 4 to 10 minutes). The longer it takes to stop bleeding, the higher the risk of deep-seated inflammation.

6. Conclusion: A Precise Diagnosis Decides the Future of Your Tooth**
The latest international PROVE Study does not suggest that one treatment is absolutely superior. Instead, it highlights the trade-off between the minimally invasive, biological value of “saving the nerve” and the traditional, reliable solution of “fast and certain pain relief.”

The key is to calmly assess which option suits your condition based on evidence. If you are willing to accept a small risk of failure for the sake of the lifelong biological value of tissue preservation, pulpotomy is a wonderful choice. On the other hand, if you prioritize a fast return to comfort and high predictability for your work and life, RCT is the shortest path to protecting your QOL.

The key to a satisfying decision lies in a precise diagnosis by your dentist and aligning it with your personal values.
“Will you gamble on the slim possibility of preservation? Or will you choose the surest path back to your normal daily life?”

Ask question/ Send the Email to Mr. Root canal, Dr. Miyashita

Make an appointment for consultation today.

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