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

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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Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals—A Review

Journal of Veterinary Dentistry ◽

10.1177/08987564211046325 ◽

2021 ◽

pp. 089875642110463

Author(s):

Amalia Zacher ◽

Sandra Manfra Marretta

Keyword(s):

Treatment Options ◽

Mineral Trioxide Aggregate ◽

Permanent Teeth ◽

Small Animals ◽

Unique Challenge ◽

Pulp Capping ◽

Pulp Therapy ◽

Vital Pulp Therapy ◽

Pulp Vitality ◽

And Function

Immature permanent teeth with crown fractures present a unique challenge in human and animal patients. Immature permanent teeth have not yet developed completely, often presenting with thin dentin walls, incomplete apical formation, and increased crown-to-root ratios. Loss of pulp function at this stage has devastating long-term implications for these teeth. Ideally, attempts should be made to preserve pulp vitality in immature permanent teeth to allow for continued dental development. The range of treatment options for vital teeth includes odontoplasty with bonding and sealing +/− restoration, indirect pulp capping, and direct pulp capping/vital pulp therapy. These treatments have long been established in human and veterinary medicine, and cases have been reported in dogs and cats. Apexification using calcium hydroxide is a well-established treatment for nonvital immature teeth. The advent of mineral trioxide aggregate and other bioceramic materials for use in vital pulp therapy and apexification has reduced treatment sessions and improved outcomes. Recent developments in the field of regenerative endodontic therapy further expand treatment options and provide the possibility for continued development of a formerly nonvital tooth. Selecting the appropriate treatment based on the severity of tooth fracture and status of pulp vitality can avoid a lifetime of poor structure and function for the affected tooth. This article provides multiple step-by-step protocols for the management of immature permanent teeth with crown fractures in small animals.

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Apexogenesis of traumatized maxillary right central incisor: Case report with 4years follow up

International Journal of Dental Research ◽

10.14419/ijdr.v7i1.27190 ◽

2019 ◽

Vol 7 (1) ◽

pp. 8

Author(s):

Mohammad Hammo DDS ◽

Mazen Doumani DDS. MSc. ◽

Adnan Habib DDS. MSc. PhD

Keyword(s):

Composite Resin ◽

Dental Materials ◽

Glass Ionomer Cement ◽

Permanent Teeth ◽

Glass Ionomer ◽

Central Incisor ◽

Vital Pulp Therapy ◽

Open Apices ◽

Ionomer Cement

The main goal of vital pulp therapy is to preserve and maintain pulpal health in teeth that have been exposed to caries, trauma, and restorative procedures. This type of endodontic treatment is very important in young permanent teeth that have not reached their complete length and exhibit thin-walled roots and wide open apices. The developments in knowledge of pulpal physiology and immunology, beside to newly introduced dental materials, have changed the treatment approaches for teeth with involved pulps. This report describes a case of a young patient in whom maxillary right central incisor suffered crown fractures because of a traumatic accident. Pulpotomy with MTA were performed in order to achieve apexogenesis and the tooth was restored with a glass ionomer cement and composite resin. The patient was reviewed over 4years.

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Delayed Replantation of Avulsed Teeth: Two Case Reports

Case Reports in Dentistry ◽

10.1155/2015/197202 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Selcuk Savas ◽

Ebru Kucukyilmaz ◽

Merve Akcay ◽

Serhat Koseoglu

Keyword(s):

Case Report ◽

Treatment Guidelines ◽

Case Reports ◽

Prophylactic Antibiotic ◽

Endodontic Treatment ◽

Permanent Teeth ◽

Functional Position

This case report presents two cases of delayed replantation of avulsed maxillary central incisors after an extended dry extra-alveolar period. Eight-year-old boy and 10-year-old boy presented with avulsed maxillary central incisors due to trauma occurring 27 and 7 hours earlier, respectively. Treatment guidelines for avulsed mature/immature permanent teeth with prolonged extra-oral time were carried out for the teeth and the extra-oral endodontic treatment was completed. After having been repositioned, the teeth were stabilized for 4 weeks and prophylactic antibiotic was prescribed. Clinical and radiographic controls were done after 18 months for Case I and 12 months for Case II. During the follow-up periods the teeth reported in these cases have remained in a stable, functional position but revealed clinical initial replacement resorption and ankylosis.

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Pulp therapy in immature traumatized incisor using tricalcium silicate cement – a case report

Pomeranian Journal of Life Sciences ◽

10.21164/pomjlifesci.697 ◽

2020 ◽

Vol 66 (2) ◽

Author(s):

Magdalena Gońda-Domin ◽

Alicja Nowicka ◽

Karolina Węsierska ◽

Anna Jarząbek

Keyword(s):

Present Report ◽

Tricalcium Silicate ◽

Endodontic Treatment ◽

Permanent Teeth ◽

Timely Manner ◽

Traumatic Injuries ◽

Tooth Structure ◽

Sensitivity Tests ◽

Irreversible Pulpitis

Introduction: Traumatic injuries to immature permanent teeth are one of the most recurrent and urgent emergency treatment cases in pediatric dental practice. In many instances, the protocol for responding to this kind of emergency is not correct, and is not performed in a timely manner. Delays in seeking treatment following a complicated crown fracture in young individuals can result in irreversible pulpitis or pulp necrosis. It can leave a wide-open apex and brittle dentinal walls that are unfavorable to manage with conventional endodontic treatment (apexification).Materials and methods: The present report describes the clinical case of a complicated crown fracture in young permanent central incisor, with 18 months of clinical and radiographic follow-up. The traumatized incisor was successfully treated using a coronal pulpotomy technique and tricalcium silicate cement – BiodentineTM.Results: The presented treatment approach provided elimination of the symptoms, an absence of pain episodes, and positive reactions to pulp sensitivity tests. The follow up radiological assessment revealed evidence of a dentin bridge formation and continuation of root maturation.Conclusions: Coronal pulpotomies using tricalcium silicate cement are quick and easy to perform, and unlike endodontic treatment, preserve the tooth structure for the reattached tooth fragment. The restorative technique, the reattachment of fractured tooth fragment, and tooth restoration with a composite resin, represents an aesthetic, functional approach, and is an excellent and easy restorative option for clinicians and young impatient patients.Keywords: BiodentineTM; complicated crown fracture; immature permanent teeth; pulpotomy.

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Autotransplantation of a Premolar with Incipient Root Development, an 18-Year Follow-Up

European Endodontic Journal ◽

10.14744/eej.2017.170080 ◽

2017 ◽

Author(s):

José Luis Mejía- Cardona

Keyword(s):

Root Development ◽

Traumatic Injury ◽

Young Patients ◽

Anterior Maxilla ◽

Maxillary Central Incisor ◽

Normal Limits ◽

Points Of View ◽

Dental Professional ◽

Initial Root

In young patients, premature tooth loss in the anterior maxilla after trauma is challenging for the patient and the dental professional, with serious implications from aesthetic and functional points of view, as well as from a craniofacial growth aspect perspective. Premolars autotransplanted into the maxillary anterior region have been shown to be a biological alternative in this situation. This report describes the clinical management of a case of premature loss of a maxillary central incisor after traumatic injury. A mandibular premolar at the stage of initial root development was transplanted into the alveolar socket of the lost incisor. After 18 years, the transplanted tooth remained responsive to pulp sensibility tests and the periradicular bone and soft tis- sues were within normal limits. Autotransplantation of premolar teeth into the maxilla could be considered an excellent treatment choice with many biological advantages over implants or fixed dentures as long as proper case selection is followed.

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Induction of Maturogenesis by Partial Pulpotomy: 1 Year Follow-Up

Case Reports in Dentistry ◽

10.1155/2013/975834 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

A. Bacaksiz ◽

A. Alaçam

Keyword(s):

Calcium Hydroxide ◽

Male Patient ◽

Root Development ◽

Root Canal ◽

Pediatric Dentistry ◽

Permanent Teeth ◽

Radiographic Examination ◽

Root Dentin ◽

Deep Caries Lesion

In cariously exposed immature permanent teeth, the treatment choice is controversial in pediatric dentistry. Radical root canal treatment usually appears to be the solution for these teeth. Even partial pulpotomy is a vital treatment for traumatically exposed immature permanent teeth; extending the borders of indication towards cariously exposed immature permanent teeth with reversible pulpitis may abolish the necessity of pulpectomy. This article describes the partial pulpotomy of a cariously affected immature permanent teeth and the follow-up for 1 year. A healthy 11-year-old male patient was referred to Gazi University Faculty of Dentistry Department of Pediatric Dentistry. The patient had reversible pulpitis symptoms on teeth numbered 45. At radiographic examination, immature apex and deep caries lesion were observed and partial pulpotomy was performed by using calcium hydroxide to maintain vitality of the pulp and allow continued development of root dentin expecting the root will attain full maturity. Clinical and radiographic follow-up demonstrated a vital pulp besides not only closure of the apex (apexogenesis), but also physiologic root development (maturogenesis) after 1 year. Partial pulpotomy is an optional treatment for cariously exposed immature permanent teeth for preserving vitality and physiological root development.

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Regenerative Endodontics

Journal of Veterinary Dentistry ◽

10.1177/0898756417722022 ◽

2017 ◽

Vol 34 (3) ◽

pp. 161-178 ◽

Cited By ~ 2

Author(s):

Kristina Feigin ◽

Bonnie Shope

Keyword(s):

Patient Selection ◽

Root Development ◽

Animal Studies ◽

Case Reports ◽

Permanent Teeth ◽

Regenerative Endodontics ◽

Successful Case ◽

Infected Root ◽

Canal Systems ◽

Infected Root Canal

Regenerative endodontics has been defined as “biologically based procedure designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp–dentin complex.” This is an exciting and rapidly evolving field of human endodontics for the treatment of immature permanent teeth with infected root canal systems. These procedures have shown to be able not only to resolve pain and apical periodontitis but continued root development, thus increasing the thickness and strength of the previously thin and fracture-prone roots. In the last decade, over 80 case reports, numerous animal studies, and series of regenerative endodontic cases have been published. However, even with multiple successful case reports, there are still some remaining questions regarding terminology, patient selection, and procedural details. Regenerative endodontics provides the hope of converting a nonvital tooth into vital one once again.

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Does Apical Papilla Survive and Develop in Apical Periodontitis Presence after Regenerative Endodontic Procedures?

Applied Sciences ◽

10.3390/app9193942 ◽

2019 ◽

Vol 9 (19) ◽

pp. 3942 ◽

Cited By ~ 5

Author(s):

Paulo J. Palma ◽

João Martins ◽

Patrícia Diogo ◽

Diana Sequeira ◽

João Carlos Ramos ◽

...

Keyword(s):

Root Development ◽

Root Canal ◽

Case Reports ◽

Sinus Tract ◽

Apical Periodontitis ◽

Endodontic Treatment ◽

Spontaneous Pain ◽

Endodontic Infection ◽

Apical Papilla

Regenerative endodontic procedures (REPs) have emerged as a treatment option for immature necrotic teeth to allow the reestablishment of a newly formed vital tissue and enable continued root development. The apical papilla stem cells (SCAPs) play an important role in physiologic root development and may also contribute to further root development during REPs. The goal of these case reports is to show evidence of the apical papilla survival and development, in human teeth with apical periodontitis, after REPs, with 5-year clinical and radiographic follow-up. In the first case, an 11-year-old girl with acute apical abscess of tooth 15 was referred for a REP. Treatment was performed with an intracanal medication followed by induction of a blood clot and a Mineral Trioxide Aggregate (MTA) cervical barrier. The 5-year follow-up showed an appreciable increase in root length as well as root canal thickness. In case 2, a 16-year-old girl was referred for endodontic treatment of tooth 21. The parents of the patient recalled a previous dental trauma (no specified on the patient records) on tooth 21 at age 7. The dental history reports a previous endodontic treatment failure and presence of a long-standing sinus tract. A mineralized tissue beyond the root apical portion could be seen at the preoperative X-ray. Nonsurgical root canal retreatment with an apical barrier was suggested as the treatment plan and accepted by the patient. After 2 weeks, the patient was recalled for a follow-up appointment presenting spontaneous pain, swelling, and sinus tract. Apical surgery was performed. Histopathological assessment of the apical root fragment collected showed the presence of dentin, cementum and pulp tissue, including odontoblasts. The 5-year follow-up depicted complete apical healing. The present case reports support survival and continued potential differentiation of the apical papilla after endodontic infection.

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Biodentine Total Pulpotomy as an Effective Alternative to Conventional Endodontic Therapy for Young Permanent Teeth – A Study from Calicut, India

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/332 ◽

2021 ◽

Vol 10 (21) ◽

pp. 1593-1597

Author(s):

Amith Adyanthaya ◽

Prathyusha P ◽

Risana K ◽

Aparna Sivaraman ◽

Nazreen Ayub K ◽

...

Keyword(s):

Treatment Options ◽

Clinical Signs ◽

Effective Alternative ◽

Permanent Teeth ◽

Pulp Tissue ◽

Term Survival ◽

Pulp Therapy ◽

Vital Pulp Therapy ◽

Permanent Molars

BACKGROUND The vitality of dental pulp is essential for long-term survival of the tooth. Vital pulp therapy (VPT) intends to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. There are many treatment options for vital pulp therapy in extensively decayed teeth. Pulp capping or pulpotomy procedures rely upon an accurate assessment of the pulp status, and careful management of the remaining pulp tissue. We wanted to evaluate as to whether biodentine total pulpotomy is an effective alternative to conventional endodontic therapy for young permanent teeth. METHODS Full coronal pulpotomy was performed in young permanent molars diagnosed with acute irreversible pulpitis with Biodentine as the pulpotomy medicament. Follow up evaluation was done clinically and radiographically at 3, 6 and 12 months. RESULTS During follow-up periods clinical signs/symptoms were absent including pulpal pain, swelling or presence of sinus and percussion pain. Continuous root development and healing of periapical radiolucency were noticed in the study which were indicative of maintenance of vitality of the pulp. CONCLUSIONS Within the limitations of this clinical study, it is concluded that total pulpotomy with Biodentine has a promising scope in regenerative approaches in the treatment of carious young permanent teeth. KEY WORDS Biodentine, Coronal Pulpotomy, Permanent Teeth, Total Pulpotomy

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Ameloblastic fibroma: A rare case report with 7-year follow-up

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1504190a ◽

2015 ◽

Vol 143 (3-4) ◽

pp. 190-194 ◽

Cited By ~ 2

Author(s):

Araújo de ◽

Adna Barros ◽

Cássia de ◽

Arlei Cerqueira ◽

Dos Nunes

Keyword(s):

Malignant Transformation ◽

Rare Case ◽

Case Reports ◽

Permanent Teeth ◽

Proliferation Index ◽

Ameloblastic Fibroma ◽

Rare Case Report ◽

Long Term Follow Up

Introduction. Ameloblastic fibroma (AF) is a rare benign odontogenic tumor that usually occurs in the first two decades of life. It affects adolescents and young adults and is found in the mandible and with a higher frequency in the posterior region of this segment. There are rare case reports with a long-term follow-up. Case Outline. We report the case of a 6-year-old boy with extensive ameloblastic fibroma in the mandible. Treatment consisted of enucleation and bone curettage, with the preservation of permanent teeth adjacent to the tumor. Clinical and radiographic follow-up of the patient over a period of 7 years showed no signs of recurrence or malignant transformation. Conclusion. Patients with AF should be under follow-up for prolonged periods of time, even in cases exhibiting a low proliferation index, because of the potential for recurrence and malignant transformation of this tumor.

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