A Novel Pain Relief Approach for the Treatment of Multiple Dental Caries and Pulpitis

Super Minimally Invasive Pulp Therapy for Severe Pulpitis: A Report of Two Cases

In regions where preventive dentistry is widespread, tooth loss due to root fracture occurs approximately 10 times more frequently than that due to caries and periodontal disease. Root fracture is most likely to occur in non-vital teeth, where the dental pulp has been removed, often through a procedure known as pulpectomy. However, super minimally invasive pulp (SMIP) therapy has recently been reported as a novel treatment approach for pulpitis of any degree. In this study, SMIP therapy was performed to preserve the vitality of teeth in two patients with severe pulpitis. Case one involved a 35-year-old man with a history of hypertension who presented with intense spontaneous pain in tooth #34. The pain was particularly severe while sleeping at night and on exposure to cold water or heat, but it was absent on percussion. Following the detection of cervical caries and severe pulp exposure, SMIP therapy was administered, and the tooth was subsequently restored using glass ionomer cement. Case two involved an 18-year-old woman with no significant medical history who had deep caries in tooth #46. She experienced mild tooth pain when exposed to cold water, and examination revealed pulp exposure. We applied mineral trioxide aggregate over the dental pulp and restored the tooth using composite resin. The vitality of both teeth was maintained at the three-month follow-up. To our knowledge, this is the first report of SMIP therapy for teeth with severe pulpitis. SMIP therapy is an innovative treatment that may cause a paradigm shift from conventional dental treatment.

Maintaining Tooth Vitality With Super Minimally Invasive Pulp Therapy

In aging humans, tooth loss is a predictor of decreased longevity. Tooth loss is mainly caused by dental caries and periodontal disease. Pulpitis refers to inflammation of the dental pulp caused by bacterial infection secondary to dental caries. It is accompanied by severe toothache and has infectious disease-associated pathophysiology. Pulpitis is mainly treated by pulpectomy, which is aimed at removing the infected dental pulp and controlling pain by removing nociceptive nerve fibers. However, teeth without dental pulp have a poor prognosis. In this report, we proposed a novel “super minimally invasive pulp” therapy for treating pulpitis without pulpectomy, which combines antibiotics, steroids, and ultrasound-guided trigeminal nerve block (UGTNB) to protect the dental pulp. UGTNB is used as an analgesic for severe pain, antibiotics for pulp infections, and steroids as antiinflammatory drugs. This novel therapy could improve the longevity of the tooth and thereby oral health.