Vital pulp therapy with three different pulpotomy agents in immature molars: a case report (original) (raw)
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International Journal of Paediatric Dentistry, 2012
To compare clinical and radiographic outcomes of pulpotomy treatment using calcium-enriched mixture (CEM) cement and mineral trioxide aggregate (MTA) in carious-exposed vital immature permanent first molars. Fifty-one immature molars with clinical carious exposure with symptomatic/asymptomatic pulpitis met the inclusion criteria and randomly assigned to one of the treatment groups (CEM [26 teeth; 59 roots], MTA [25 teeth; 59 roots]). After performing pulpotomy and covering the radicular pulps with the biomaterials, all teeth were permanently restored. Blinded clinical and radiographic evaluations were performed at 6 and 12 months after operation for signs of success or failure. Radiographs were evaluated for complete/partial apical closure. The data were analysed using chi-square test and generalized estimating equation (GEE) model. There was no significant difference at the baseline between the two experimental groups. All available cases (49 teeth) showed pulp survival and signs of continuous root development after 12 months. Overall, complete apical closure (apexogenesis) occurred in 76.8% and 73.8% of radiographically interpreted roots in CEM cement and MTA groups, respectively. There was no statistical difference in terms of radiographic outcomes between two groups. Calcium-enriched mixture cement and MTA showed similar performance in pulpotomy of immature caries-exposed permanent molars.
Vital Pulp Therapy of a Symptomatic Immature Permanent Molar with Long-Term Success
Iranian endodontic journal, 2016
Vital pulp therapy (VPT) is the preferred conservative treatment for preservation of symptomatic pulps in immature permanent teeth. The present case report summarizes VPT of an immature permanent molar with irreversible pulpitis associated with apical periodontitis in a 9-year-old boy. Cervical pulpotomy was performed and radicular pulp stumps were covered with calcium-enriched mixture (CEM) cement; the tooth was then restored with stainless steel crown. After a 50-month follow-up period, the pulpotomized molar was clinically functional and asymptomatic. Moreover, radiographic evaluation revealed evidence of complete root development as well as normal periodontal ligament around the roots. The successful outcome achieved through VPT using CEM biomaterial in the reported case suggests that this method may produce favorable outcome for vital immature permanent teeth with irreversible pulpitis and periapical disease.
The Open Dentistry Journal, 2016
Objectives: To evaluate the outcome of vital pulp therapy in primary teeth with irreversible pulpitis by using calcium-enriched mixture (CEM) cement according to clinical and radiographic assessment. Participants and Methods: Fifty primary molar teeth with irreversible pulpitis in 50 children aged 6-8 years underwent pulpotomy using CEM cement as the dressing material. Following pulpotomy, pain intensity was evaluated by use of a visual analog scale at 1 and 7 days from the treatment and in clinical appointments at 3, 6 and 12 months after baseline. Radiographic evaluation was performed at 6 and 12 months. Data were analyzed using the McNemar test. Results: A total of 42 children (mean age 7.26 ± 0.82 year) completed the study. After one day treatment 56 % of children reported complete relief of pain and after 7 days 62% reported the same. However, two children complained of increased pain 1 day after treatment. None of the children reported pain in the subsequent appointments. One ...
Vital Pulp Therapy with Calcium-Silicate Cements: Report of Two Cases
ARTICLE INFO ABSTRACT Article Type: Case Report This article describes successful use of calcium-enriched mixture (CEM) cement and Biodentine in apexogenesis treatment in two 8-year-old patients, one with immature permanent molar diagnosed primarily with irreversible pulpitis and the other with partially vital maxillary central incisor. After access cavity preparation, partial pulpotomy in molar and full pulpotomy in central was performed, and the remaining pulps was capped with either Biodentine or CEM cement, in each tooth. The crowns were restored with composite filling material at the following visit. The post-operative radiographic and clinical examinations (approx. average of 16 months) showed that both treated teeth remained functional, with complete root development and apex formation. A calcified bridge was produced underneath the capping material. No further endodontic intervention was necessary. Considering the healing potential of immature vital pulps, the use of CEM cement and Biodentine for apexogenesis might be an applicable choice. These new endodontic biomaterials might be appropriate for vital pulp therapies in an immature tooth. However, further clinical studies with longer follow-up periods are recommended.
European archives of paediatric dentistry, 2013
Background Pulpotomy is one of the most commonly used treatments for retaining pulpally involved primary molar teeth in order to prevent tooth extraction and maintain space within the jaws. A recent randomised clinical trial found that calcium enriched mixture (CEM) cement demonstrated favourable 2-year treatment outcomes for pulpotomy of carious primary molars comparable with mineral trioxide aggregate (MTA). The use of cone beam computer tomography (CBCT) has not previously been used to evaluate pulpotomy and histological outcomes. Case report A coronal pulpotomy was performed on a carious maxillary first primary molar in a 7-year-old child with non-contributory medical history. Following haemostasis, the radicular pulp was covered with 2-3 mm of CEM and the tooth restored. Follow-up At the 2-year follow-up appointment, clinical/ radiographic examinations of the pulpotomised tooth revealed that vital pulp therapy was successful in maintaining the tooth asymptomatic; however, the first maxillary molars had to be extracted for orthodontic reasons. CBCT and histological examinations showed thick/complete calcific bridges with tubular dentine at the amputation sites. The underlying dental pulp had normal structure and was un-inflamed. Conclusion Based on these findings, it seems that CEM cement can induce a favourable biological response in dental pulps of primary teeth and CBCT may be useful to evaluate pulpotomy outcomes.
Pediatric dentistry
The purpose of this study was to compare mineral trioxide aggregate (MTA) with calcium hydroxide (Ca(OH)2) clinically and radiographically as a pulpotomy agent in immature permanent teeth (apexogenesis). Fifteen children, each with at least 2 immature permanent teeth requiring pulpotomy (apexogenesis), were selected for this study. All selected teeth were evenly divided into 2 test groups. In group 1, the conventional Ca(OH)2pulpotomy (control) was performed, whereas in group 2, the MTA pulpotomy (experimental) was done. The children were recalled for clinical and radiographic evaluations after 3, 6, and 12 months. The follow-up evaluations revealed failure due to pain and swelling detected at 6 and 12 months postoperative evaluations in only 2 teeth treated with Ca(OH)2. The remaining 28 teeth appeared to be clinically and radiographically successful 12 months postoperatively. Calcific metamorphosis was a radiographic finding in 2 teeth treated with Ca(OH)2 and 4 teeth treated with...
SciDoc Publishers, 2021
Objective: The aim of this study was to evaluate the efficacy of vital pulp therapy using bioceramic Endosequense Root Repair Material (ERRM) compared to Enriched Mixture Cement (CEM) in Mature permanent posterior teeth suffering from symptoms of non-reversible acute pulpitis due to caries. Methods: The sample consisted of60 permanent human posterior teeth suffering from non-reversible pulpitis in 53 male and female patients aged between 18-40 years. An assessment of the dental condition was conducted clinically and radiologically before starting the treatment based on: the presence of a history of the disease (persistent spontaneous pain that does not go away with the disappearance of the cause), the results of the cold test, in addition to the radiological findings. Vital pulp therapy was performed (partial or complete pulp amputation)after haemostasis using either (ERRM) or (CEM). The final restoration was applied in the same session, then an x-ray radiograph was taken immediately after the treatment procedure. Patient were re-called after 24 hours to ensure the disappearance of symptoms and then according to the following time intervals: (a week, 3 months, 6 months, a year) to evaluate the cases clinically and radiographically. Results: This study showed that there were no statistically significant differences in the frequencies of clinically and radiographically assessment results between the CEM group and ERRM group, in each of the studied time periods (after one week, after one month, after three months, after six months, after one year) Conclusion: Vital pulp Therapy using ERRM and CEM showed a high success rate after a one-year observation period in permanent teeth suffering from non-response pulpitis, and it can be a staged alternative to traditional endodontic treatments.
Journal of Conservative Dentistry, 2011
The aim of this case series was to determine the clinical and radiographic success rate of pulpotomy, with new endodontic cement (NEC), in human mature permanent molar teeth. Twelve molars with established irreversible pulpitis were selected from patients 14-62 years old. The selection criteria included carious pulp exposure with a positive history of lingering pain. After isolation, caries removal, and pulp exposure, pulpotomy with NEC was performed and a permanent restoration was immediately placed. At the first recall (+1 day) no patients reported postoperative pain. One wisdom tooth had been extracted after two months because of failure in coronal restoration. Eleven patients were available for the second recall, with a mean time of 15.8 months. Clinical and radiographic examination revealed that all teeth were functional and free of signs and symptoms. Histological examination of the extracted teeth revealed complete dentin bridge formation and a normal pulp. Although the results favored the use of NEC, more studies with larger samples and a longer recall period were suggested, to justify the use of this novel material for treatment of irreversible pulpitis in human permanent molar teeth.
Delayed miniature pulpotomy in a symptomatic mature molar
Dental Research Journal
This case report describes miniature pulpotomy (MP) with calcium-enriched mixture (CEM) cement, 1 week after carious pulpal exposure of a symptomatic mature molar. A 24-year-old woman was referred with complaining of severe lingering pain on the second upper left molar; a dental history revealed that the tooth had been prepared 1 week ago, but on pulp exposure, her dentist just dressed the cavity. After anesthesia/isolation in the same session, the temporary restoration was removed, the previously pulpal exposure was observed, and MP was carried out. Hemorrhage was effectively controlled using 5.25% NaOCl, the clot free pulpal wound was completely covered employing CEM cement, and the cavity was permanently restored by resin composite. The patient's pain gradually relieved within 24 h. The tooth was functional and able to respond to vitality tests in regular clinical follow-ups. At 15-month follow-up, a dentinal bridge was observed under the capping biomaterial, radiographically; moreover, no calcification or apical pathosis was detected. MP with CEM cement might be a treatment option for the management of exposed dental pulp with a clinical diagnosis of irreversible pulpitis, although further trials with larger sample size and longer follow-ups are recommended.