Clinical and radiographic assessment of direct pulp capping and pulpotomy in young permanent teeth.

Seventy-six vital permanent incisors with complicated crown t’ractures in 72 children were assessed clinically and radiographically for the healing of pulp exposures treated by direct pulp capping or by pulpotomy. Thirty-eight of these teeth had pinpoint exposures, complete roots, and were treated by pulp capping. Pulpotomy was the treatment for the other 38 teeth that had incomplete root development, regardless of the size of the exposure. A success rate of 92% was observed in the teeth which were treated by pulpotomy, and 81.5% was the success rate of those treated by ch’rect pulp capping. Traumatic injuries resulting in pulp exposure in young patients present a challenge in treatment. The immediate objective would be the selection of a procedure designed to maintain the vitality of the pulp.1 An exposed vital pulp can be treated by capping, pulpotomy, or pulpectomy, depending on several factors such as: degree of pulp exposure, the interval between the accident and examination, and the stage of root development. A partial pulpotomy technique has been recently described as another choice for successfully treating vital exposures. ~ The exact indication of pulp capping has not yet been established. It is currently accepted that this treatment should only be performed in teeth where the exposure is confined to a small area, where exposure occurred not more than a few hours before, and when there are no associated injuries to the supporting structure2 Incompletely formed teeth with vital pulps exposed by trauma that presented the above conditions have been also treated by pulp capping, but a vital pulpotomy has been considered the treatment of choice. 4 The rationale for pulpotomy is based on the assumption that inflammation and impaired vascularity caused by the injuries would be confined to the superficial part of the coronal pulp, while the radicular pulp would be normal. 3 It is important to emphasize that the pulpotomy procedure has been considered the first step in endodontic therapy? When apicalroot formationis completed, a conventional root canal filling has been recommended, thus preveuting calcific degeneration and obliteration of the pulp canal2,~ This has been accepted policy followed by both general practitioners and endodontists. Evidence of long-term successful outcome of vital pulpotomy has been presented by Bodenham2 Krakov et al., suggested that root canal treatment subsequent to pulpotomy which has resulted in completion of the root is indicated only when a post and core are required to adequately restore the tooth2 The purpose of the current investigation was to assess clinically and radiographically the healing of pulp exposures treated by direct pulp capping or by pulpotomy, and the effect on the results of the interval between the accident and treatment. Methods and Materials The study sample consisted of 76 vital permanent incisors with a complicated crown fracture in 72 children. These patients, whose age varied from 7 to 14 years, received emergency treatment at the Department of Pedodontics of the Hadassah Faculty of Dental Medicine in Jerusalem. Preoperative examination revealed that the teeth showed no mobility or slightly increased mobility, and all of them were sensitive to the electric pulp tester" stimulation. Pulp capping was performed in 38 teeth with pinpoint exposures and with complete roots; pulpotomy was the treatment of choice for another 38 teeth that had incomplete root development, regardless of the size ~Vitapulp: The Pelton & Crane Company, Box 3664, Charlotte, NC. 240 PULPOTOMY Vs DIRECT PULP CAPPING: Fuks et at. Sucessful follow up period in months , Table 1. Distribution of teeth treated by pulp capping with calcium hydroxide in traumatized incisors with closed apices. Time elapsed from trauma to treatment Up to 12 hrs. 13 24 hrs. 1 4 days 5 7 days Total Number of teeth treated