Two Case Reports of Complicated Permanent Crown Fractures Treated With Partial Pulpotomies

Resident: Adam J. Bottrill
Date: 27OCT10
Region: Providence
Article title: Two Case Reports of Complicated Permanent Crown Fractures Treated With Partial Pulpotomies
Author(s): McIntyre, Judy
Journal: Pediatric Dentistry
Page #s: 117-122
Date: Mar/Apr 2009, V31:No2
Major topic: Par
Minor topic(s): NA
Type of Article: Case Reports
Main Purpose: The purpose of this paper was to review scientific evidence supporting partial pulpotomy and its high success rate and illustrate the clinical technique by presenting 2 challenging cases of complicated crown fractures with long term follow-up.

Key points in the article discussion:

I. General:

A. Partial pulpotomy/vital pulp amputation/Cvek Pulpotomy, is a procedure that involves the surgical amputation of a TRAUMATICALLY EXPOSED pulp.
B. Dr. Cvek reported in 1978 that 96% of traumatically exposed pulps that were treated within 30 hours experienced "healing".
C. Procedure:
1. High speed with sterile diamond bur.
2. RDI
3. Saline rinse
4. Chlorhexidine antiseptic
5. 2 mm partial pulpotomy
6. CaOH placed on the NON-hemorrhaging pulp
7. Layer of ZOE
8. Final resin restoration.
9. MANY studies since then with varying results and techniques.

II. CASE REPORT #1

A. Healthy, 10yo, male, dental injury on swimming pool bottom, sheared-off maxillary centrals.
B. Nurse concluded his centrals had been "knocked out" and transported the fragments in milk to pedodontist... within 30 minutes (***immediate neuro screening***).
C. Exam and radiographs taken. No other significant injury other than fractured centrals.
D. Maxillary Centrals: non-hemorrhagic pulp exposures, no root fractures, PDL concussion, nearly closed apices.
E. Tx: 2-3 mm cvek pulpotomy, saline rinse, CaOH, GI cement, composite restoration.
F. Recc: soft diet, perfect OH, Tx options discussed.
G. 3wks: fractured segments re-bonded
H. Mouthgaurd delivered.
I. 3mo recare for a yr and then normal visits.
J. At 42 mo, no periapical pathology and normal vitality test responses.
K. SUCCESS! ... tooth vitality maintained and final closure of the root end obtained.
L. Ortho performed at 24 months with no adverse outcomes.
M. 2 uneventful debonds of the bonded fragments, but no other sequelae.

III. CASE REPORT #2

A. Healthy, 7yo, female, dental injury during archeological dig (totally normal activity for 7yo's), sheared-off maxillary centrals.
B. Dig was 5hr away from nearest civilization... 6.5 hours between trauma and dental care.
C. Exam performed and radiographs taken. No other significant intraoral injury other than fractured/SLIGHTLY mobile centrals. Unsure whether fracture extended sub-g or more apically toward the roots.
D. Same procedure as Case #1
E. Teeth continued to erupt normally and apices closed.
F. At 12 mo, fully erupted and complete restoration/seal placed.
G. At 24 mo, ortho.
H. By 60 mo, Rt central showed delayed response to cold. Increased pulp canal obliteration (PCO) evidence over the next several years.
I. Partial eruption made this case more difficult. Definitive sealing of the coronal pulp was delayed until full eruption.

Assessment of article: Quality write-ups... HOWEVER. I didn't really learn anything new.... "Medium Likey"