More high-quality RCTs are needed in this field in future studies. Fifty traumatized immature anterior permanent teeth with exposed pulps were included in the study. J Oral Implantol 2002;28(5):220-5. Home > Pulpal bleeding after removal of inflamed pulpal tissue must be controlled. A comparison of glass-ionomer cement and calcium hydroxide liners in amalgam restorations. There should be no radiographic evidence of external root resorption, lateral root pathosis, root fracture, or breakdown of periradicular supporting tissues during or following therapy. Conclusions: Partial pulpotomy, performed with MTA or CH used as the pulp-capping material following hemostasis with SH or SS solutions, provided comparable and favorable outcomes in carious pulp exposures of immature permanent teeth. doi: 10.1002/14651858.CD003220.pub2. Long term clinical assessment of direct pulp capping. Ferric sulfate pulpotomy in primary molars: A retrospective study. Pediatr Dent 2012;34(5):120-8. Compend Contin Educ Dent 2007;28(10):548-50. Teeth were equally divided and randomly assigned to two groups MTA or Biodentine. Smaïl-Faugeron V, Courson F, Durieux P, Muller-Bolla M, Glenny AM, Fron Chabouis H. Cochrane Database Syst Rev. Pulp therapy for the primary dentition. Corpus ID: 12742793. Int J Periodontics Restorative Dent 2006;26(6):596-605. de Souza Costa CA, Teixeira HM, Lopes do Nascimento AB, Hebling J. Biocompatibility of resin-based dental materials applied as liners in deep cavities prepared in human teeth. Conclusions: Vargas KG, Packham B. Radiographic success of ferric sulfate and formocresol pulpotomies in relation to early exfoliation. Murray PE, About I, Franquin JC, Remusat M, Smith AJ. 353-361. Am J Dent 1990;3:67-70. 2011;27:836–844. Indications: The pulpotomy procedure is indicated when caries removal results in pulp exposure in a primary tooth with a normal pulp or reversible pulpitis or after a traumatic pulp exposure. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Menezes JP, Rosenblatt A, Medeiros E. Clinical evaluation of atraumatic restorations in primary molars: A comparison between 2 glass ionomer cements. * In 2017, the AAPD published a separate document, clinical practice guideline: Dhar V, Marghalani AA, Crystal YO, et al. Pediatr Dent 2017;39(5):E146-E159. Foley J, Evans D, Blackwell A. for immature permanent teeth should be reevaluated radio- graphically six and 12 months after treatment and then periodically at the discretion of the clinician. Quintessence Int 2001;32(9):717-36. doi: 10.1016/j.dental.2011.04.010. Comparison of mineral trioxide aggregate and calcium hydroxide as pulpotomy agents in young permanent teeth (apexogenesis). Quintessence Int 2006;37(4):297-303. Patients were assessed for clinical and radiographic outcomes by 2 examiners. Coll JA, Sadrian R. Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition. ALI NOSRAT, AMIR SEIFI, SAEED ASGARY, Pulpotomy in caries‐exposed immature permanent molars using calcium‐enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial, International Journal of Paediatric Dentistry, 10.1111/j.1365-263X.2012.01224.x, 23, 1, (56-63), (2012). doi: 10.1016/j.dental.2011.02.001. Keywords: : Mosby Elsevier; 2011:808-57. Radiographic assessment of primary molar pulpotomies restored with resin-based materials. Critical to both steps of excavation is the placement of a well-sealed restoration.17,18  The decision to use a one-appointment caries excavation or a step-wise technique should be based on the individual patient circumstances since the research available is inconclusive on which approach is the most successful over time.36,37, Direct pulp cap. A randomized study of sodium hypochlorite versus formocresol pulpotomy in primary molars. Clinical evaluation of Dycal under amalgam restorations. Pediatr Dent 2008;30(1):34-41. Lo EC, Holmgren CJ, Hu D, Van Palenstein Helderman W. Six-year follow up of atraumatic restorative treatment restorations placed in Chinese school children. The clinical guidance in that publication supersedes any conflicting recommendations which may be found in this document. Caicedo R, Abbott PV, Alongi DJ, Alarcon MY. Duque C, Negrini Tde C, Hebling J, Spolidorio DM. There should be no harm to the succedaneous tooth. Kubota K, Golden BE, Penugonda B. Root canal filling materials for primary teeth: A review of the literature. Post-operative clinical assessment generally should be performed every six months and could occur as part of a patient’s periodic comprehensive oral examinations. "MTA"-an hydraulic silicate cement: review update and setting reaction. Community Dent Oral Epidemiol 1998;26(2):122-8. 1:42. A protective liner is a thinly-applied liquid placed on the pulpal surface of a deep cavity preparation, covering exposed dentin tubules, to act as a protective barrier between the restorative material or cement and the pulp. The root canals are debrided and shaped with hand or rotary files.21  Since instrumentation and irrigation with an inert solution alone cannot adequately reduce the microbial population in a root canal system, disinfection with irrigants such as one percent sodium hypochlorite and/or chlorhexidine is an important step in assuring optimal bacterial decontamination of the canals.70-72  Because it is a potent tissue irritant, sodium hypochlorite must not be extruded beyond the apex.73  After the canals are dried, a resorbable material such as nonreinforced zinc/oxide eugenol,5,74 iodoform-based paste (KRI),75 or a combination paste of iodoform and calcium hydroxide (Vitapex®, Endoflax®) 76-78 is used to fill the canals. The first step is the removal of carious dentin along the dentin-enamel junction (DEJ) and excavation of only the outermost infected dentin, leaving a carious mass over the pulp. Smaïl-Faugeron V, Glenny AM, Courson F, Durieux P, Muller-Bolla M, Fron Chabouis H. Cochrane Database Syst Rev. Pulpectomy in apexified permanent teeth is conventional root canal (endodontic) treatment for exposed, infected, and/or necrotic teeth to eliminate pulpal and periradicular infection. Anatomy of sodium hypochlorite accidents. after trauma. The clinician should monitor the internal resorption, removing the affected tooth if perforation causes loss of supportive bone and/or clinical signs of infection and inflammation. Pediatric endodontics: Endodontic treatment for the primary and young permanent dentition. Caries Res 1997;31(6):411-7. The partial pulpotomy for carious exposures is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of one to three millimeters or deeper to reach healthy pulp tissue. Effectiveness of 4 pulpotomy techniques – Randomized controlled trial. What is the most effective endodontic medicament for pulpotomies in immature permanent teeth? In: Andreasen JO, Andreasen FM, Andersson L, eds. This case report aimed to present the long-term clinical performance of mineral trioxide aggregate (MTA) pulpotomies in immature permanent teeth. In: Pinkham JR, Casamassimo PS, Fields HW Jr., McTigue DJ, Nowak A, eds. Electronic databases including MEDLINE (via Pubmed), EMBASE, the Cochrane library (CENTRAL) and the clinicaltrials.gov database were searched. The aim of this meta-analysis and systemic review is to synthesize the available evidences to compare different pulpotomy dressing agents for pulpotomy treatment in immature permanent teeth. There is little difference in success rate between mineral trioxide aggregate (MTA) and calcium hydroxide (CH) at 6-month follow-up (risk ratio (RR) 1; 95% confidence interval (CI) 0.94 to 1.06) and 12-month follow-up (RR 1.04; 95% CI 0.96 to 1.13). Am J Dent 2006;19(6):382-6. A prospective clinical study of mineral trioxide aggregate for partial pulpotomy in cariously exposed permanent teeth. For any tooth that has undergone pulpal therapy, clinical signs and/or 36,37 symptoms may prompt a clinician to select a … Indications: A pulpectomy is indicated in a primary tooth with irreversible pulpitis or necrosis or a tooth treatment planned for pulpotomy in which the radicular pulp exhibits clinical signs of irreversible pulpitis (e.g., excessive hemorrhage that is not controlled with a damp cotton pellet applied for several minutes) or pulp necrosis (e.g., suppuration, purulence). Objectives: This procedure should induce root end closure (apexification) at the apices of immature roots or result in an apical barrier as confirmed by clinical and radiographic evaluation. 2014 Nov;42(11):1390-5. doi: 10.1016/j.jdent.2014.06.007. Pediatr Dent 2004;26(1):44-8. J Clin Pediatr Dent 2005;29(4):307-11. Adverse post-treatment clinical signs or symptoms of sensitivity, pain, or swelling should not be evident. The pulp capping procedure in primary teeth “revisited”. There should be no radiographic evidence of internal or external root resorption or other pathologic changes. There should be no radiographic signs of internal or external resorption, abnormal canal calcification, or periapical radiolucency post-operatively. Indirect pulp capping in the primary dentition: A 4 year follow-up study. Bacterial microleakage and pulp inflammation associated with various restorative materials. There should be no postoperative radiographic evidence of pathologic external root resorption. Clipboard, Search History, and several other advanced features are temporarily unavailable. Pediatr Dent 2004;26(4):302-9. Light-cured calcium hydroxide vs formocresol in human primary molar pulpotomies: A randomized controlled trial. Dent Mater. Overall, the results of several studies show that MTA plugs are effective in treating immature permanent teeth with necrotic pulps. Also, the studies should have at least 6 months of follow-up, report clinical and radiographic success in detail and publish in English. Ames, Iowa: Blackwell Munksgaard; 2007:598-657. Only randomized controlled trials (RCTs) comparing two or more pulp dressing agent in permanent teeth with open apex would be included. Pulp-dentin biology in restorative dentistry. Davidovich E, Weiss E, Fuks AB, Beyth N. Surface antibacterial properties of glass ionomer cements used in a traumatic restorative treatment. Indications: Indirect pulp treatment is indicated in a permanent tooth diagnosed with a normal pulp with no symptoms of pulpitis or with a diagnosis of reversible pulpitis. Keywords: Pulpotomy, Immature permanent teeth, Pulp exposure, Randomized controlled trials, Systematic reviews Background Immature permanent teeth, also known as young permanent teeth, are used to describe teeth with incomplete root forma-tion. Formation of the apex in vital, young, permanent teeth can be accomplished by implementing the appropriate vital pulp therapy described in this section (i.e., indirect pulp treatment, direct pulp capping, partial pulpotomy for carious exposures and traumatic exposures). Oral Health Policies & Recommendations (The Reference Manual of Pediatric Dentistry), The Reference Manual of Pediatric Dentistry2019-2020/P. Fuks AB. Ames, Iowa: Blackwell Munksgaard; 2007:658-68. The ITR can be removed once the pulp’s vitality is determined and, if the pulp is vital, an indirect pulp cap can be performed.34,35 Current literature indicates that there is no conclusive evidence that it is necessary to reenter the tooth to remove the residual caries.36,37  As long as the tooth remains sealed from bacterial contamination, the prognosis is good for caries to arrest and reparative dentin to form to protect the pulp.32,33,36-40  Indirect pulp capping has been shown to have a higher success rate than pulpotomy in long term studies.7,9,20,22-27,35  It also allows for a normal exfoliation time. See this image and copyright information in PMC. Mehdipour O, Kleier DJ, Averbach RE. Apexogenesis is a histological term used to describe the continued physiologic development and formation of the root’s apex. Am J Dent 2007;20(5):283-6. Pulp healing and reparative dentin formation should result. Objectives: The placement of a liner in a deep area of the preparation is utilized to preserve the tooth’s vitality, promote pulp tissue healing and tertiary dentin formation, and minimize bacterial microleakage. Placement of a thin protective liner such as calcium hydroxide, dentin bonding agent, or glass ionomer cement is at the discretion of the clinician.13,14  The liner must be followed by a well-sealed restoration to minimize bacterial leakage from the restoration-dentin interface.17,18. There should be no adverse clinical signs or symptoms such as sensitivity, pain, or swelling. Objectives: The restorative material should seal completely the involved dentin from the oral environment. J Endod 2006; 32(8): 731-5. Holan G, Fuks AB. Treatment of crown fractures with pulp exposure. Comparison of ferric sulfate, formocresol, and a combination of ferric sulfate/formocresol in primary tooth vital pulpotomies: A retrospective radiographic survey.
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