Pulpal management of permanent first molars with open apices: case history.

,An eight-year-old with extensive decay in both mandibular first permanent molars was examined in October, 1970. Both molars were found to have immature roots. ,4 nonvital molar was treated to achieve apical closure followed later by conventional endodontic therapy. A vital molar was treated with a formocresol pulpotomy followed by conventional endodontic therapy. After 10 years, both molars showed no signs or symptoms of failure. A difficult treatment problem in pedodontics is pulpal management of vital and nonvital young first permanent molars with incomplete root development. Frank described a technique for apical closure of nonvital teeth in 1966 and 1967.1’ 2 His technique achieved apical closure, followed by removal of the resorptive seal and replacement with a permanent root canal filling. Frank, Day, Van Hassel, Zander, and Stark all have advocated calcium hydroxide as the drug of choice to induce a calcific barrier at the root apex. ~-6 In 1969 Dylewski evaluated the effect of a calcium hydroxide-camphorated parachlorophenol paste on apical closure in a histologic exam.7 Nonvital rhesus monkey anterior teech were used in his study. Dylewski stated that his study supported the concept that apical bridging is possible in the nonvital, incompletely developed tooth when the necrotic contents of the canal are removed and a suitable dressing is placed. Dylewski concluded that both within the canal and just beyond the apex, a proliferative activity of connective tissue occurred with some differentiation of a calcified material identified as osteodentin. Prior to 1970 very little clinical research regarding the use of the vital formocresol pulpotomy on permanent molars was available. Some clinical observations were available to indicate that the formocresol pulpotomy was an excellent emergency procedure for permanent molars with large cariously exposed pulps. Since 1970, Trask has reported success in treating eight badly decayed permanent molars with formocresol pulpotomies. 8 All of the eight permanent molars were from children 10 years of age or younger. Fiskio, in a five-year study, found that a formocresol pulpotomy did not preclude conventional endodontic therapy at a later date. 9 Nishimo stated that the success of the formocresol pulpotomy on primary teeth could not be completely similar to the situation found in permanent teeth since the life span of the primary and permanent dentitions were so vastly different. ~°