A Conservative Restorative Protocol for Symptomatic Irreversible Pulpitis: Clinical Success and Rapid Pain Relief in a 27-Case Series with 36-Month Follow-Up.

Background/Objectives: Symptomatic irreversible pulpitis (SIP) is conventionally treated with pulp tissue removal via root canal treatment, pulpectomy, or pulpotomy. This case series introduces the Pulpitis Restorative Protocol (PRP), a novel method used to treat SIP without pulp removal, relieve pain, and maintain a positive pulp sensibility response. Methods: In this retrospective case series (March 2022-March 2025), 17 SIP patients (plus 10 reversible pulpitis [RP] control cases) were treated with the PRP utilizing a bioactive glutaraldehyde (GA)-resin-modified glass ionomer (RMGI) solid matrix. Follow-up to 36 months (average 17.37 ± 9.61 months) included clinical examination, cold sensibility testing, and radiographs. Results: Treatment was successful in 15/17 SIP cases, an 88.2% success rate, and 9/10 RP cases, a 90.0% success rate. Overall, a total of 24 of 27 cases were successful, a rate of 88.89%. Success criteria were the absence of pain, no soft-tissue abnormality, a positive cold test response, and no radiographic apical lesions. No failures occurred in the first year; two cases failed in the second year and one in the third year. The PRP provided favorable pain relief: 74.1% of patients reported minimal post-operative pain (0-1/10 VAS) the evening of treatment, and 96.3% of patients reported no pain at 24 h without analgesics. All 24 successful cases maintained a positive pulp sensibility response at their final visit. Radiographs were stable in 24 cases. In vitro experiments showed that the GA-RMGI solid matrix exhibits contact-independent bactericidal activity. Conclusions: The PRP provides a promising approach to SIP management, offering a conservative, cost-effective, and efficient alternative to conventional endodontic treatments alongside favorable pain relief. Its clinical significance warrants further verification in various clinical settings and randomized clinical trials.