Preserving pulp vitality: part two - vital pulp therapies

Vital Pulpotomy on immature lower first permanent molars using Portland cement, a case of failure and success-case report with 2 years follow-up

Key clinical message

While the importance of vital pulp therapy comes from its ability to promote pulp healing allowing the tooth to continue its development and giving the patient a more convenient treatment, dental practitioners should be more aware of the minor mistakes which they might commit during treatment procedures that could reflect negatively on the treatment's outcome. Developing behavior management skills as well as learning from reported mistakes are beneficial to practitioners to provide a more precise and successful treatment.

Abstract

Vital pulp therapies are known to preserve tooth development and give pulp tissues a chance to heal. Despite the progress of biocompatible materials used in this field, these treatments are still facing some failure for several known and unknown reasons that might not only be related to the material used. This case report presents and discusses the possible reasons for the success of one vital pulpotomy procedure and the failure of another, both conducted on two immature lower first permanent molars of the same patient, in an attempt to conclude what led to both results.

Endodontic management strategies for permanent teeth with immature apices

This article will provide a summary of causes of incomplete root end closure and the implications of this on endodontic treatment. The limitations and benefits of traditional and more contemporary materials including the use of bioceramic cements are considered. The apical barrier technique is described in detail for teeth with immature apices utilising a variety of bioceramic cements and regenerative endodontic procedures with an overview of appropriate instruments to successfully complete the procedure.

Comparison between the Radiographic and Clinical Rates of Success for TheraCal and MTA in Primary Tooth Pulpotomy within a 12-Month Follow-Up: A Split-Mouth Clinical Trial

Background

The present study was conducted for contrasting the efficacy of TheraCal and MTA for primary molar pulpotomy.

Methods

During the current split-mouth randomized clinical trial, 90 bilateral primary molars from 45 healthy 5- to 8-year-old children were pulpotomized using TheraCal in one bilateral tooth and MTA in the other, randomly. Glass ionomer (GI) was used to cover these materials. Then, the treated teeth were restored with stainless steel crowns (SSC) and followed up clinically and radiographically at months 6 and 12 after treatment for any pulpotomy failure indications. Finally, data were analyzed by chi-square test considering p value < 0.05 as statistically significant.

Results

Among 82 teeth available at the final follow-up session, the total success rates were 98.1% and 99.3% for TheraCal and MTA, respectively, showing no significant difference between the two groups (p > 0.05).

Conclusion

TheraCal can be used as an alternative material for pulpotomy of primary teeth instead of MTA.

Pulp therapy and root canal treatment techniques in immature permanent teeth: an update

Background According to the Children's Dental Health Survey 2013, around one in ten children in Wales, Northern Ireland and England will have sustained dental trauma to a permanent incisor by the of age 15. Management of an exposed pulp in an immature permanent incisor is often urgent and has an impact on the long-term outcome of the tooth; therefore, it is essential that general dental practitioners feel confident in managing such a scenario to achieve an optimal outcome. This paper discusses the indications, technique, materials and outcomes.Aims This article aims to review the literature, which discusses various treatment modalities and materials for pulpal therapy and root canal treatment in the immature permanent tooth.Method Electronic searches were limited to English language, human studies, published within the past five years and the medical subject heading terms used were: direct pulp capping, apexogenesis, Cvek pulpotomy, full pulpotomy/pulpectomy, partial pulpotomy, apexification, non-vital pulp therapy and mineral trioxide aggregate apexification. Older, seminal articles identified through the references sections have also been included.Conclusion A number of options are available for the management of immature permanent teeth that have suffered an insult such as caries or trauma. This paper reviews the various methods of pulpal treatment, preservation therapy and root canal treatment options depending on the extent of the damage.

Pediatric Endodontic Treatment of Adolescent Patients

This article is intended to familiarize clinicians with several pulp therapy modalities and new materials that are currently available for immature young pulp in the adolescent population. Objectives and considerations for immature young permanent teeth as well as the healing potential of the young pulp tissue after treatment of the inflammatory process are discussed. The article emphasizes that the future holds great possibilities for the regeneration of dental pulp in adolescent patients.

How is carious pulp exposure and symptomatic irreversible pulpitis managed in UK primary dental care?

AIM

To investigate attitudes and approaches of UK primary care dentists to carrying out vital pulp treatment (VPT) after carious exposure and with additional signs and symptoms indicative of irreversible pulpitis.

METHODOLOGY

An electronic questionnaire was openly distributed via publicly funded (NHS) local dental committees, corporate dental service-providers, professional societies and social media. Principally NHS practitioners and those from mixed and private practice were targeted, in addition to community and military dental officers, and dental therapists. Participants were asked questions relating to several clinical scenarios, with responses analysed using descriptive statistics. χ² tests with sequential Bonferroni correction were used to explore variables including the method of remuneration, practitioner type (dentist/therapist), postgraduate qualification(s), place of graduation and years since qualification. Variables with a relationship p ≤ .2 were selected for backwards likelihood ratio logistic modelling.

RESULTS

In total, 648 primary care practitioners were included for analysis. Calcium hydroxide (CH) was most frequently used for direct pulp caps (DPCs) (398/600; 66.3%) with calcium silicate cements (CSCs) less frequently used (119/600; 19.8%). Rubber dam was used by 222/599 (37.1%) practitioners. A definitive pulpotomy for the management of teeth with signs and symptoms indicative of irreversible pulpitis was selected by 65/613 (10.6%) dentists. The principal barrier for the provision of definitive pulpotomies was a lack of training (602/612; 98.4%). Regression analysis identified NHS practitioners as a good predictor for using CH for DPCs, having shorter emergency appointments, limited access to magnification and not using rubber dam. Non-UK graduates were more likely to select CSCs, appropriately control pulpal haemorrhage, undertake appropriate postoperative evaluation and use rubber dam.

CONCLUSIONS

Practitioners deviated from evidence-based guidelines in a number of aspects including material selection, asepsis and case selection. A number of other challenges exist in primary care in providing predictable VPTs, including lack of time and access to magnification. These were most evident in NHS practice, potentially exacerbating existing social health inequalities. Possible inconsistencies in the UK undergraduate curriculum were supported by a lack of association between years since qualification and technique employed as well as the fact that non-UK graduates and dentists with postgraduate qualifications adhered more to evidence-based VPT guidelines.