Partial Pulpotomy in Permanent Incisors

Resident’s Name:  Joanne Lewis                                                                        Date: August 28, 2009

Article title:  A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture

Author(s):  Miomir Cvek, DMD PhD

Journal:  Journal of Endodontics

Volume (number):  4(8)

Date:  August 1978

Major topic:  parial pulpotomies on permanent incisors with pulpal exposures due to trauma

Type of Article:  scientific article

Main Purpose:  to assess the frequency of healing of accidentally exposed pulp treated by partial pulpotomy

Overview of method of research:  The sample consisted of 60 incisors (51 maxillary and 9 mandibular) with complicated crown fracture treated by partial pulpotomy.  Time interval between the accident and treatment ranged from 1 to 2160 hours, and size of pulp exposure ranged from 0.5 to 4.0 mm.  28 teeth had immature roots and 32 teeth had mature roots.  Patient age ranged from 7 to 16 years of age.  All teeth had a bleeding wound or a proliferated pulp tissue; no teeth demonstrated necrotic tissue disintegration.  All teeth were treated as follows:  rubber dam isolation, 0.5% chlorhexidine solution to clean field, removal of part of coronal pulp (approx. 2 mm) and surrounding dentin with a sterile diamond bur, copious irrigation and control of bleeding with sterile saline, covering of pulp with calcium hydroxide (Calasept) and sealing of the cavity with sterile ZOE.  Clinical and radiographic examinations were done at 3 weeks, 3 months, and 6 months.  When a continuous hard tissue barrier was seen radiographically, the ZOE and calcium hydroxide were removed under aseptic conditions, the barrier was clinically examined, and the tooth was restored with Dycal and composite.

Findings:  96% (58 teeth) demonstrated healing.  Healing was defined as the following:  no clinical symptoms, no radiographic pathologic changes, continued development of immature teeth, verifiable continuous hard tissue barrier, and sensitivity to electrical stimulation.

Key points/Summary:  The following variables had no influence on the frequency of healing:  interval between accident and treatment, size of pulpal exposure, and stage of root development.

Assessment of article:  I found these results to be pretty amazing, especially since I thought these variables generally did affect the success of the partial pulpotomy.  The key factor here seems to be that none of the pulps were necrotic.  (Even after 2160 hours of exposure!?)