Thursday, April 20, 2017

Partial Pulpotomy in Young Permanent Teeth with Deep Carious Lesions

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Michael Hatton                                                                   Date: 4.20.17
Article Title: Partial Pulpotomy in Young Permanent Teeth with Deep Carious Lesions
Author(s): Mejare I, Cvek M
Journal: Endodontics and Dental Traumatology
Date: 1993
Major Topic: Endodontics
Type of Article: Case Series
Main Purpose: Evaluation of success rates of partial pulpotomy in young permanent posterior teeth with carious exposure of the pulp
Key Points/Summary:
37 posterior permanent teeth with carious exposure of the pulp in patients aged 6 - 15 were treated with partial pulpotomy and dressed with Calcium hydroxide and follow-up was conducted for 24+ months.

The procedure was conducted with rubber dam, caries were excavated and irrigated with sterile saline, 1-1.5mm of dentin and pulp was excavated with a diamond burr and irrigated with sterile saline until hemostasis was achieved, calcium hydroxide was placed, ZOE was placed, and a permanent restoration was placed.

Successful healing was defined as: asymptomatic tooth with no deleterious radiographic changes that reports as vital to pulp testing. 93.5% of asymptomatic teeth met the paper’s criteria for success. 66% of symptomatic teeth met the paper’s criteria for success, though the sample size of symptomatic teeth was too small to draw any conclusions from.

It is postulated that, in advanced stages of a caries lesion, just prior to or soon after pulp exposure, bacterial components cause only irreversible changes at the immediate site of carious exposure, whereas the remainder of the inflamed pulp is merely infiltrated with inflammatory cells. Evidently, bacteria can only thoroughly infiltrate the pulp chamber after necrosis begins, thus pulpal healing may occur in cases where the carious exposure can be excised, eliminating the bacterial infection, removing the stimulus of inflammation, and alleviating the immune response, providing a definitive restoration can ensure the prevention of recontamination from microleakage.

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