Partial pulpotomy for immature permanent teeth, its present and future

Author(s): Cheng D. Fong BDS, MA DDS and Martin J. Davis
Journal: Pediatric Dentistry
Volume (number): 24:1
Month, Year: 2002
Major topic: Review of technique and prognosis of partial pulpotomies on immature permanent teeth
Type of Article: Technique review
Overview of method of research: None
Findings: Normally, mechanical or carious exposure of permanent teeth pulp chambers would necessitate RCT, but this is not necessarily the case in immature permanent teeth. In fact, RCT of immature teeth leaves you thin dentin in a short root which is prone to fracture. The retention of enough healthy pulp can allow the completion of root development. Complete pulpotomy will arrest dentin formation and can result in obliteration of the root canals. Partial pulpotomy shows promise as a treatment which would allow development of the root and would not need eventual RCT treatment. Indications for permanent tooth partial pulpotomy: no history of spontaneous pain; acute minor pain that resides with analgesics; no discomfort to percussion; no vestibular swelling; no mobility; normal PDL radiographically; pulp is exposed due to caries or recent trauma; tissue appears vital; bleeding from the pulp excision sites stops with isotonic saline irrigation within 2 minutes. Technique: local anesthesia and rubber dam isolation; remove sharp edges and/or carious dentin; flush with isotonic saline solution; excise pulp and surrounding dentin to approximately 2mm with a high speed diamond; flush with saline solution until hemostasis is achieved; apply a pulp medicament with available CaOH; cover with well sealed permanent restoration. Assessment of extent of infection and inflammation are essential to successful partial pulpotomy success. A number of pulp medicaments are used, such as CaOH and glass ionomer, but MTA has shown potential as well.
Key points/Summary: This article contends that direct pulp capping should no longer be performed, and that complete pulpotomies will still require eventual RCT. The partial pulpotomy should be the half measure between indirect pulp cap and complete RCT.
Assessment of article: Wicked pissa.

Brian Schmid DMD