Long-term Pulpal and Restorative Outcomes of Pulpotomy in Mature Permanent Teeth

Tan, Shao Yong; Yu, Victoria Soo Hoon; Lim, Kart-Leong; Tan, Beng Choon Keson; Neo, Chiew Lian Jennifer; Shen, Liang; Messer, Harold H.

doi:10.1016/j.joen.2019.11.009

Cited by 74 publications

(72 citation statements)

References 31 publications

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“…Longerterm studies of 5-10 years would be helpful to confirm the recommendation of 2 years as sufficient follow-up. Whereas early failures reflect inaccurate assessment of the inflammatory status of the pulp, late failures usually reflect reinfection of the pulp space via a leaky restoration 59 .…”

Section: Length Of Follow-upmentioning

confidence: 99%

Conservative Management of Mature Permanent Teeth with Carious Pulp Exposure

Taha

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Sedgley

et al. 2020

Journal of Endodontics

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Vital pulp therapy (VPT) in mature permanent teeth with carious pulp exposure has been a matter of debate, with root canal therapy being the conventional standard of care. Previously reported negative outcomes for VPT in these teeth were based on data from studies that have used calcium hydroxide in direct pulp capping and partial and full pulpotomy. The introduction of hydraulic calcium silicate-based materials with sealing and bioactive potentials have opened a new era in VPT with more favorable results. Understanding the histopathology and histobacteriology of the cariously exposed pulp and the healing potential of the inflamed pulp could guide the decision-making process toward an ultraconservative management of these teeth. However, proper case selection, strict aseptic condition, capping material, and good coronal seal are crucial for long-term success. (J Endod 2020;46:S33-S41.) KEY WORDSCaries; mature teeth; pulp biology; pulpitis; vital pulp therapy Epidemiologic studies consistently show a high global prevalence of dental caries, particularly in adults 1 . A prerequisite for any intervention intended to preserve the pulp is the presence of either healthy pulp tissue or pulpal damage that can be reversed. Inflammation of the pulp accompanies the carious process well before carious pulp exposure; however, the severity of the inflammation increases as the caries progresses toward the pulp. Nonetheless, even in the presence of carious pulp exposure, inflammation is typically limited to within 2 mm of the exposure site unless the carious exposure is of long standing, and it is not uncommon to find healthy pulpal architecture in the opposing pulp horn or further away in the pulp chamber 2,3 .Historically, the use of vital pulp therapy (VPT) for mature permanent teeth with carious pulp exposure has been discouraged, with the majority recommending pulpectomy and root canal therapy 4 . The consensus that the pulp should be regarded as irreversibly inflamed whenever a carious exposure occurs in mature permanent teeth has been based on clinical outcomes of direct pulp capping with calcium hydroxide (CH). The biological rationale for this conclusion is that underlying pulpal inflammation has spread throughout the pulp and that the blood supply through a mature apex is insufficient to promote healing even after the insult is removed.Significant improvement has occurred in the understanding of pulp biology and the response of the pulp to the carious process; the release of dentin-bound growth factors and active molecules such as stem cell factor, insulin-like growth factor binding protein, nerve growth factor, glial cell line-derived neutrophilic factor, and transforming growth factor beta 1 has highlighted the fact that the pulp in mature teeth has greater regenerative potential than what was previously thought 5,6 . Placement of bioactive materials, specifically tricalcium silicate-based materials (mineral trioxide aggregate [MTA], Biodentine, Bioceramics) has been shown to induce the release of these growth factor...

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Section: Length Of Follow-upmentioning

confidence: 99%

Conservative Management of Mature Permanent Teeth with Carious Pulp Exposure

Taha

About

Sedgley

et al. 2020

Journal of Endodontics

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“…Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy, claiming the superiority of vital pulp treatment (VPT) techniques such as pulp capping, partial and complete pulpotomy [2]. This constant turn toward a conservative and minimally invasive approach is strongly associated with the fact that the emphasis of the profession is also slowly shifting to care for the senior adult segment of the population [3,4]. Under these circumstances, retaining natural teeth is of paramount importance.…”

Section: Introductionmentioning

confidence: 99%

Bio-Inductive Materials in Direct and Indirect Pulp Capping—A Review Article

2020

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The article is aimed at analyzing the available research and comparing the properties of bio-inductive materials in direct and indirect pulp capping procedures. The properties and clinical performances of four calcium-silicate cements (ProRoot MTA, MTA Angelus, RetroMTA, Biodentine), a light-cured calcium silicate-based material (TheraCal LC) and an enhanced resin-modified glass-ionomer (ACTIVA BioACTIVE) are widely discussed. A correlation of in vitro and in vivo data revealed that, currently, the most validated material for pulp capping procedures is still MTA. Despite Biodentine's superiority in relatively easier manipulation, competitive pricing and predictable clinical outcome, more long-term clinical studies on Biodentine as a pulp capping agent are needed. According to available research, there is also insufficient evidence to support the use of TheraCal LC or ACTIVA BioACTIVE BASE/LINER in vital pulp therapy.

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“…For many years, the pulpotomy was seen as a provisory treatment which should be substituted by conventional endodontic therapy after the radicular closing and apical foramen formation (Cvek, 1978;Bergenholtz & Spångberg, 2004). However, some researchers have already considered it as definitive treatment when well indicated and carried out, with high rates of success in the long run (Robertson et al, 1996;Rafter, 2005;Forghani et al, 2013;Fuks et al, 1982;Tan et al, 2020). Through periodic clinical-radiographic controls it has become possible to follow-up the biological response to conservative pulp treatment, and also highlight beforehand any possible pathologic alterations (Sonmez & Sonmez., 2007).…”

Section: Discussionmentioning

confidence: 99%

Vital pulp therapy: an alternative to root maturation of a tooth with superficial micro abscess

Ubaldini

Queiroz

Nunes

et al. 2020

RSD

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Maintenance of pulp functional integrity should be aimed by the treatment of trauma affected immature permanent teeth. The prognosis of vital pulp therapies (VPT), when well indicated and correctly performed, not only preserves pulp vitality but also provides the immature root development. This case reports the treatment of a patient with a crown fractured immature maxillary right central incisor. Clinical examination, radiographic inspection and sensitivity tests confirmed tooth vitality. In spite of the superficial micro abscess presence, pulpotomy was the treatment of choice according to the pulp vitality characteristics found during the undergoing surgery. Root development and apical closure were verified at the 1st year radiographic control. After 3 years of follow-up, even with the occurrence of 3 new traumatisms, the treated tooth showed radiographic sound characteristics. Nevertheless, on the fourth-year return, the conventional endodontic treatment had to be carried out due to radiographic signal of initial root obliteration. It was concluded that pulp vitality diagnosis step and clinical-radiographic follow-up are extremely important for the pulpotomy outcome. This conservative approach resulted in success since it induced root development and apical closure, permitting the posterior execution of the endodontic therapy.

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Long-term Pulpal and Restorative Outcomes of Pulpotomy in Mature Permanent Teeth

Cited by 74 publications

References 31 publications

Conservative Management of Mature Permanent Teeth with Carious Pulp Exposure

Conservative Management of Mature Permanent Teeth with Carious Pulp Exposure

Bio-Inductive Materials in Direct and Indirect Pulp Capping—A Review Article

Vital pulp therapy: an alternative to root maturation of a tooth with superficial micro abscess

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