Pulpotomy in mature permanent teeth
16/06/2022
Fitim Shabani
Irreversible pulpitis is an inflammatory condition of the dental pulp that is characterized by spontaneous, lingering pain that persists for minutes to hours and can lead the pulp tissue to a state where it is incapable of self-healing. In an era of minimally invasive dentistry, where the paradigm of dental care is shifting toward conservative dentistry and selecting biologic options, pulpotomy is now increasingly being considered as a minimally invasive approach for the management of teeth with irreversible pulpitis.
With better understanding of pulp biology and the development of bioactive materials, pulpotomy has now been reinvestigated as a definitive treatment option for mature permanent teeth presented with irreversible pulpitis.
In this clinical case we will present all the pulpotomy procedures, which has been successful as a definitive treatment.
Fig. 1
Age : 15y
Tooth : Second maxillary right premolar
Dg : Irreversible pulpitis
Treatment plan : Pulpotomy
Fig. 2
Pre operative X-ray
Fig. 3
Isolation, initial preparation which has resulted in pulp opening.
Fig. 4
Caries removal prior to pulpal access is required to reduce the bacterial load.
Hemostasis – cotton pellet within 3min.
video of the procedure
Fig. 5
MTA (mineral trioxide aggregate) was placed against the wound.
Fig. 6
Composite restoration
Fig. 7
X-ray after 1 treatment
Fig. 8
Intraoral picture after 1.5 year
Fig. 9
X-ray after 1.5 year
The patient has no complaints
The vitality test is positive delayed
Conclusions
Pulpotomy is a prospective substitute for root canal treatment in managing permanent teeth with carious pulp exposures, even in permanent teeth with irreversible pulpitis. Large, well-designed trials comparing pulpotomy with other treatments in terms of cost-effectiveness should be informative.
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