Pulpotomy in mature permanent teeth
16/06/2022
Fitim Shabani
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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.
Bibliography
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3. Qudeimat MA, Alyahya A, Hasan AA. Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: A preliminary study. Int Endod J. 2017;50:126–34.
4. McDonald RE, Avery DR, Dean JA. Treatment of deep caries, vital pulp exposure and pulpless teeth. In: Dentistry for the Child and Adolescent. 8th ed. St. Louis: Mosby: 2004. pp. 389–412.
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