Preserving pulp vitality: part two - vital pulp therapies

Edwards, D. G.; Stone, Simon; Bailey, Oliver; Tomson, Phillip

doi:10.1038/s41415-020-2599-y

Cited by 10 publications

(21 citation statements)

References 78 publications

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“…The location of the exposure is also an important determinant of VPTs prognosis, with better success reported in occlusal rather than proximal exposures. Which could be an additional reason contributed to the treatment failure of the lower right first permanent molar 5 . Edwards et al recommended that in case of an interproximal carious lesion, the periphery of the lesion should be cleared to sound tooth structure, staying away from the pulp.…”

Section: Discussionmentioning

confidence: 99%

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

Abed

Bchara

Bshara

2023

Clinical Case Reports

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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.

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Section: Discussionmentioning

confidence: 99%

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

Abed

Bchara

Bshara

2023

Clinical Case Reports

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“…It has been previously discussed that in deep or extremely deep caries, where pulp inflammation is anticipated, an enhanced protocol should be used including disinfection, magnification and application of a CSC (ESE, 2019). In radiographically deep caries, where there remains a dentine barrier between the caries and the pulp, it can be argued that an enhanced protocol should be used following pulp exposure regardless, because in conjunction with preoperative symptoms, direct visualization of the pulp (including haemorrhage control) remains the most appropriate method of assessing the potential of the pulp to recover (Edwards, Stone, Bailey, & Tomson, 2021; Edwards, Stone, Baily, & Duncan, 2021; ESE, 2019). It is also likely that an exposure during caries removal will result in some bacterial contamination.…”

Section: Discussionmentioning

confidence: 99%

“…This low usage aligns with the recent findings of rubber dam use in the management of symptomatic irreversible pulpitis with only 19% of UK dentists accessing teeth under rubber dam isolation (Gemmell et al, 2020). The placement of a cotton wool pledget soaked in sodium hypochlorite or chlorhexidine (CHX) for up to 5 min following a pulp exposure which in addition to disinfection and reduced failure (Ballal et al, 2020) serves the purpose of both haemorrhage control and the ability to make an assessment of pulp health (Edwards, Stone, Bailey, & Tomson, 2021; ESE, 2019). This was not common practice, potentially compromising treatment outcomes (Ballal et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…DPC can offer a predictable alternative to conventional root canal treatment as long as a number of pre‐requisites are met, including operating in an aseptic field and ensuring the pulp is not damaged beyond repair (it is ‘healthy’). Preoperative and intra‐operative assessment form the cornerstone of case selection, with intra‐operative visual assessment of pulp tissue and the ability to arrest haemorrhage in a given timeframe critical (AAE, 2021; Edwards, Stone, Bailey, & Tomson, 2021; ESE, 2019). Optimal outcomes rely on appropriate case selection and meticulous management, which should involve an enhanced protocol including the use of magnification, the use of rubber dam, appropriate haemorrhage control, disinfection of the pulp wound and application of CSC (AAE, 2021; ESE, 2019).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…10 Bioceramic cements have numerous benefits over traditional calcium hydroxide but of course do come with some limitations, as shown in Table 1. 11-14 The use of bioceramic cements has been advocated as the treatment modality of choice for non-vital anterior teeth with incomplete root development. 15 This paper will discuss clinical management techniques of teeth with immature apices utilising the apical barrier technique with a variety of materials and techniques.…”

Section: Introductionmentioning

confidence: 99%

Endodontic management strategies for permanent teeth with immature apices

Ayub

Darcey

2023

Prim Dent J

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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.

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Preserving pulp vitality: part two - vital pulp therapies

Cited by 10 publications

References 78 publications

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

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

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

Endodontic management strategies for permanent teeth with immature apices

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