Case 3 Preop BW Preop periapical Preop periapical Postop periapical Two-year recall Caries removal NaOCI disinfectioin After disinfection MTA placement Case 3: Treatment instead of extraction An 8-year-old female presented with a history of pain associated with the maxillary left permanent first molar. She was evaluated and extraction of the permanent first molars was recommended because of the depth of carious lesions and evident space loss from premature loss of primary molars. The family denied extraction and elected for treatment. Tooth #19 was diagnosed with reversible pulpitis. The tooth was anesthetized and rubber dam isolation was performed. Caries removal was completed and a pulp exposure was evident. The tooth was disinfected with sodium hypochlorite; ProRoot MTA was placed with an amalgam carrier and adapted to cover the entire pulpal floor with a cotton pellet. A wet cotton pellet was placed over the MTA, and the tooth was temporized with IRM. The tooth was later restored with a composite resin restoration. The tooth remains asymptomatic and shows no signs of pathology after two years. MTA placement Temporization Cvek (partial) pulpotomy The Cvek pulpotomy is named after Dr. Miomir Cvek, who initially popularized the partial pulpotomy procedure. The procedure removes the inflamed or exposed portion of pulpal tissue and leaves healthy pulp tissue apical the exposure site with the goal of maintaining as much healthy tissue as possible. A medicament is then placed to allow for pulpal healing to occur.21 Traditionally, the material that has been utilized is calcium hydroxide, but calcium silicates such as mineral trioxide aggregate have been shown to have equivocal results.22 The procedure is backed by the histological progression of dental caries and the pulpal response. As caries progression occurs, the pulp responds to the bacterial invasion; studies have shown that even when coronal inflammation and necrosis exists, healthy pulp tissue may exist below the site.23 dentaltown.com \\ MAY 2017 89http://www.dentaltown.com