Dentaltown May 2017 - 86

Pulp Vitality

in Pediatric Patients
Treating deep carious lesions
in vital permanent teeth
by Jarod Johnson, DDS
Jarod Johnson, DDS, earned a
bachelor's degree in biomedical
engineering from the University
of Iowa in 2009, and his DDS from
the same school in 2013. He
earned a certificate in pediatric
dentistry from the University
of Nevada, Las Vegas, School of
Dental Medicine. Johnson is a
diplomate of the American Board
of Pediatric Dentistry and has received advanced training in
behavior management, sedation, hospital dentistry, trauma,
special health care needs, interceptive orthodontics, space
maintenance, oral hygiene and dietary counseling. He enjoys
educating children and their families on the importance of
oral health so they can establish good habits for a lifetime
of smiles.

86

MAY 2017 // dentaltown.com

Vital pulp therapy is practiced daily
in dentistry. We routinely arrest or remove
carious lesions in our offices using a variety
of treatments. There is some debate, though,
in the fields of pediatric dentistry and endodontics about therapy for vital permanent
teeth with deep carious lesions.1,2
There are several clinical techniques for
treating vital carious permanent teeth in
children and adolescents. Maintaining pulp
vitality is important in an effort to avoid
root canal therapy or extraction. If necrosis
develops it can be problematic-specifically
in immature permanent teeth, which can
be difficult to treat because of:
* thin dentinal walls that are susceptible to fracture.
* the amount of necrotic debris.
* ability to disinfect the root.
* the lack of an apical stop.
Pulpal vitality is key to obtaining
apexogenesis, or ensuring continued root
development.3-5 Aside from the clinical and
anatomical difficulties, management of a
young patient's behavior can also present
issues for clinicians.6
Developments in the use of calcium
silicates led by ProRoot MTA proved

beneficial in the management of vital
immature permanent teeth affected by deep
carious lesions.7 Mineral trioxide aggregate,
or MTA, is a biocompatible material made
of tricalcium and dicalcium silicates. It has
been used successfully for indirect pulp caps,
direct pulp caps, partial pulpotomies and
complete pulpotomies in permanent teeth.8
When MTA contacts tissue fluid, it
releases calcium, which in turns results in the
formation of hydroxyapatite.9 This appears
to form a chemical bond to dentin and will
entomb bacteria in dentinal tubules.10 MTA
has a basic pH, which creates an unfavorable
environment for bacteria and can create
adequate seal against leakage.11-12
The setting time of MTA is two to four
hours, which can impose difficulty when
attempting to restore teeth at the same time
of treatment. It has been associated with a
high cost and difficult handling.7
MTA can create a dark discoloration
when in contact with sodium hypochlorite,
a commonly used endodontic irrigant.
Staining has been attributed to bismuth
oxide, which is added to the material as a
radiopaquing agent. Other compositions
often have less discoloration.13
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