Dentaltown May 2017 - 90

Case 4: Pulp exposure and restoration
An 11-year-old male presented with
history of pain originating from the mandibular left quadrant. He had previously
been evaluated by a general practitioner,
placed on an antibiotic, and was referred to
an endodontist for root canal therapy but
was unable to be seen by the specialist. The
patient reported moderate intermittent pain
originating from the tooth but no history
of spontaneous pain.
Clinically, tooth #19 had a large carious
lesion on the occlusal surface. It responded
to sensibility testing and did not exhibit
lingering pain to cold. Radiographically, the
lesion appeared to be more than two-thirds
into dentin and apical formation appeared
to be incomplete. The diagnosis: reversible
pulpitis with normal apical tissues.
The patient was anesthetized and the
tooth isolated with a rubber dam. After caries
removal was completed, a pulp exposure was
evident. A partial pulpotomy was completed
using a diamond bur from Komet USA, and
the pulp was treated with 6 percent sodium
hypochlorite from Vista Dental. ProRoot
MTA from Dentsply was adapted to the
exposure site using an amalgam carrier and
a cotton pellet. A Fuji IX glass ionomer

base from GC America was placed and the
tooth was restored with Filtek Supreme A2B
composite resin from 3M.
At the recall appointment, the patient
remained asymptomatic and no apical pathology was evident. The tooth will be re-evaluated
to determine if apexogenesis occurs.

Pulpotomy
Pulpotomies are very common practice
in primary teeth and are increasing in
frequency in permanent teeth. A systematic
review reported the success rates for MTA
pulpotomies in primary teeth to be 89.6
percent.24 The properties of MTA make it
a suitable material for pulpotomies in the
permanent dentition. Recently it has been
advocated for teeth with signs of irreversible
pulpitis and has been shown to have success.25
Case 5: Irreversible pulpitis
A mandibular right permanent first
molar presented with a diagnosis of irreversible pulpitis. Radiographically, the apices
appeared to be immature. After anesthesia,
rubber dam isolation was utilized and caries
removal was completed. Vital tissue was
evident in the orifi and hemostasis was
controlled. Sodium hypochlorite was utilized

as a pulpal medicament, and ProRoot MTA
was adapted over the vital tissue.
A wet cotton pellet was placed over the
MTA, and the tooth was temporized with
IRM. Later the tooth was restored with a
stainless steel crown. Radiographically, at
follow-up visits the tooth remained asymptomatic and showed signs of increased root
development.

Conclusion
The goal of all treatment modalities
presented is to maintain pulpal vitality
to avoid extraction or root canal therapy.
These modalities have an advantage of
being more cost effective in maintaining
teeth than root canal therapy given the
proper diagnosis is reached. The practitioner is charged with making the proper
clinical diagnosis based off the subjective
and objective findings that are gathered
during examination to help guide the
correct treatment of the disease.
If done properly, clinicians can obtain
a high level of success when treating deep
carious lesions on vital permanent teeth.
Every attempt should be made to maintain
a viable and healthy pulp when treating
children and adolescents. ■

Case 4

90

Preop periapical

Postop periapical

Recall BW

Recall periapical

Pulp exposure

MTA placement

Base placement

Final restoration

MAY 2017 // dentaltown.com


http://www.dentaltown.com

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