Biodentine™ Partial Pulpotomy of a Young Permanent Molar with Signs and Symptoms Indicative of Irreversible Pulpitis and Periapical Lesion: A Case Report of a Five-Year Follow-Up

Abstract

The purpose of this paper was to report the five-year success of Biodentine™ partial pulpotomy in a young permanent molar, with signs and symptoms indicative of irreversible pulpitis and periapical lesion, in a nine-year-old girl. Preoperative clinical examination revealed a large carious lesion of the left mandibular permanent first molar. The patient reported pain on percussion. The tooth responded positively to the electric pulp test and had lingering pain after cold testing. A periapical radiograph showed a deep carious lesion and periapical lesion. Based on the clinical and radiographical examination, the tooth had signs and symptoms indicative of irreversible pulpitis and periapical lesion. During caries removal, pulp exposure occurred, and 2-3 mm in depth of pulp tissue at the exposure site was removed. Haemorrhage was controlled within four minutes with 2.5% sodium hypochlorite-moistened cotton pellets. Biodentine™ was then applied as both a pulp dressing and a temporary restoration. At the following visit, composite resin was placed over the Biodentine™ as a final restoration. During a five-year follow-up, the tooth was asymptomatic, had positive responses to sensibility tests, and had no discolouration. Follow-up radiographs showed a dentine bridge and periapical healing.

The Understanding of Vital Pulp Therapy in Permanent Teeth: A New Perspective

“…There are also some studies showing that pulp preservation of young permanent teeth may have broader indications. For the indication of pulpotomy, the size of the pulp exposure, the time, and the location of pulp exposure, whether it is irreversible pulp inflammation and even periapical periodontitis, are not necessarily related [39][40][41][42][43][44][45][46]. It is suggested that the status and repairing ability of the pulp have more important significance in the prognosis of pulpotomy [47].…”

Assessment of Biodentine Pulpotomy as an Alternative to Conventional Root Canal Treatment for Permanent Teeth in Children-an in Vivo Study

“…Biodentine (Septodont, Saint-Maur des-Fossés, France), one of the new-generation, bioactive endodontic cements, has been claimed to have improved properties over MTA. 23 It is a is a calcium silicate-based material that has fetched attention in recent years and became commercially available in 2009.It was initially & specifically designed as a "dentin replacement material'. Biodentine is primarily formulated using the MTA -based cement technology with improvement in some properties of these types of cements such as physical qualities and handling.…”

Regenerative Endodontic Procedures in Immature Permanent Teeth With Dental Trauma: Current Approaches and Challenges

“…Calcium hydroxide has a long history of use as a pulpcapping agent for IPT and it may still have some advantages. However, after the advent of MTA in its various forms [iRoot BP, Biodentine, Portland cement (PC), and calcium-enriched mixture], it has become the most widely used pulp capping biomaterial (18,19,24,34,35). Most of these MTA pulp capping materials displayed similar clinical success rates when used in a partial pulpotomy, but iRoot BP was more convenient to handle because it was premixed (36).…”

“…However, most dentists inevitably modified their treatment procedures based on their clinical judgment. It was demonstrated that IPT with partial pulp necrosis and symptomatic apical periodontitis could achieve successful outcomes by the partial pulpotomy (18,19), which could be explained that the pulp of immature permanent teeth had a strong disease resistance and repair function due to its unique physiological and anatomical characteristics (7). In addition, it was also explained that the clinical diagnosis of pulp status was inaccurate, especially for traumatic teeth (67).…”

“…In addition to showing new pulp tissue regeneration, it may also be possible for periapical lesions to heal and to continue root development to strengthen the dentinal root canal walls (13)(14)(15)(16)(17). However, there can be substantial variations between the current REPs guidelines and the actual clinical procedures used by different dentists (18,19). Most case reports show that REPs have favorable clinical outcomes, but the amount of favorable outcomes for different REPs has proved to be controversial (12,20,21).…”