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Pulpotomy as an Alternative to the Root Canal Treatment in Closed Apex

Permanent Teeth with Carious Exposure

Article · May 2019

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Nawras Mostafa
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Mini Review Article Dental & Oral health International Journal
Pulpotomy as an Alternative to the Root Canal Treatment in Closed Apex Permanent Teeth
with Carious Exposure

Nawras Maher Mostafa

Corresponding author
*

Dr. Nawras Maher Mostafa BDS. MSc Restorative and Aesthetic

Dentistry. Privet sector -Iraq (PHCC\QATAR).
Restorative and Aesthetic Dentistry. Privet sector -Iraq (PHCC\ E-mail: nawrasmaher19771@hotmail.com
QATAR).
Submitted: 27 Apr 2019; Accepted: 7 May 2019; Published: 17 May 2019

Keyword: Vital Pulp Therapy, Pulpotomy, Root Canal Treatment
Introduction
Vital pulp therapy maintain tooth vitality, and functionality by
eliminating the bacteria from the dentino-pulpal complex.1-4
The European Endodontic Society position statement stated
“Preserving the pulp in a healthy state with sustained vitality,
preventing apical periodontitis and developing minimally invasive
biologically based therapies are key themes within contemporary
clinical endodontic”. One of the vital pulp therapy approaches is
the pulpotomy.5
Pulpotomy is a vital pulp therapy in which all or a portion of
coronal pulp tissue is removed surgically, and the remaining
radicular tissue is covered with a suitable material that protects
the pulp from further injury and promotes healing.6-8 It’s aimed
to remove of inflamed tissue restricted to the pulp chamber and
prevent bacterial penetration by an adequate coronal seal. The
rationale behind pulpotomy procedures is based on the ability of
the remaining radicular pulp to recover following the removal
of the infected coronal pulp tissue and placement of a suitable
medicament.9-10.
Which are two approaches, partial pulpotomy is consist of removal
of a small portion of coronal pulp tissue after exposure, followed
by application of a biomaterial directly onto the remaining
pulp tissue prior to placement of a permanent restoration.3 This
procedure indicated when we have large exposure (more than
1mm) and the bleeding cannot be controlled to perform direct pulp
capping so the treatment extended by removal of the superficially
inflamed pulpal tissues to the level of healthy coronal pulp tissues.5
Partial pulpotomy is the favorable treatment outcomes for teeth
with reversible pulpitis due to caries in the vast majority of young
patients after 2 years follow up period for Eighty-four teeth of
young patients had the treatment (Chailertvanitkul P et al 2014).11
Another approach is full coronal pulpotomy which has complete
removal of the coronal pulp and application of a biomaterial directly
onto the pulp tissue at the level of the root canal orifices, prior
to placement of a permanent restoration. This approach indicated
when the inflammation extended deep in coronal pulp tissues when
the dymptomes indicate irreversible pulpitis.3,5 (Alqaderi H et al
2015)12 concluded in their systematic review and meta-analysis the
full coronal pulpotomy treatment could increase tooth retention by
providing a potential option particularly for low-income patients
or in underserved areas worldwide. This procedure indicated as
; an interim procedure for permanent teeth with immature root
formation to allow continued root development, an emergency
procedure in permanent teeth until root canal treatment can be
accomplished in trauma cases, Exposed vital pulps or irreversible
pulpitis of primary teeth. However this approach can be used
to treat the exposed vital pulp due the deep carious lesion in
permanent teeth because this exposed pulp showed the ability to
repair and heal and remain vital after removing the inflamed pulp
tissue.12-16
The permanent teeth pulpotomy has many advantages compared
with root canal treatment such as; maintain the tooth vitality,
less technique sensitive, minimally invasive where only coronal
pulp tissues removed, cost effective for the people whom cannot
afford the root canal treatment, maintain the intraradicular tooth
structure so it does not mechanically compromised the tooth and
also reducing side effects such as discoloration, fracture or residual
periapical inflammation.1,12Traditionally irreversible pulpitis is due
to deep caries involving the pulp the treatment of choice is the
root canal treatment, but with the improvement of understanding
the pulp tissue regeneration and the advancement of new materials
and technical use, the choice of treatment directed toward pulp
tissue regeneration to maintain pulp vitality using minimal
invasive endodontic therapies.9,12 According to (Shahnaz N et al
2015)17 the Pulpotomy with MTA treating human permanent teeth
with irreversible pulpitis, relieving associated pulpal symptoms
and preserving pulp vitality. It is able to stimulate hard tissue
bridge formation, making the MTA pulpotomy as an alternative
in these cases. (Barngkgei I. et al 2013)1 found the Pulpotomy
using MTA could be a good alternative for root canal therapy
for managing symptomatic mature permanent teeth with carious
exposure when they were evaluated clinically and radiographic
of 11 permanent symptomatic teeth and the pulpotomy. similar
results achieved by (Verma N et al 2016)6 when evaluation the
clinical and radiographic outcome of pulpotomy procedure done
for 10 permanent teeth by using MTA with 12 months period, they
reported no signs of patients discomfort or abnormalities seen in
radiographs and positive response to the electrical pulp testing for
all teeth during the follow up period making the pulpotomy could

Dental & Oral health Int Journal, 2019 Volume 1 | Issue 1 | 1 of 3

be considered an alternative to root canal treatment in permanent
teeth with irreversible pulpitis. When teeth with either reversible
or irreversible pulpitis are treated, the most complicating factor is
that clinicians do not know the degree of pulpal damage to teeth
with clinical diagnoses and There is no decisive definition that can
clearly differentiate between reversible and irreversible pulpitis
making assessing the condition of the pulp is very difficult task.18,19
The carious exposed vital pulp not necessary to be completely
infected which depend on the carious lesion severity and extension
that could be localized and adjacent to the carious lesion in some
cases that making the maintenance of the healthy tissues possible
by eliminating the infected tissues.(L-H Chueh et al 2010)18 were
found when the caries and bacterial contamination can be mostly
eliminated from the dentin-pulp complex and a hermetic coronal
seal is built, the inflamed pulp of a human permanent tooth with
irreversible pulpitis may have a chance to return to a healthy,
functional status after MTA pulpotomy.
The success of vital pulp therapy approaches in cariously exposed
teeth generally depend on many factors such as; healthy periodontal
tissues, adequate blood supply to maintain tooth vitality, control
of hemorrhage from pulpal tissues, adequate coronal seal and
suitable dressing materials which should be biocompatible,
noncytotoxic and antibacterial.10,20,21,22 Therefore many materials
introduced to do this job such as; Calcium Hydoxide , Silicate
cements (MTA,Biodentin and Theracal LC) ,Zinc Oxide Eugenol
(ZOE), Laser application, Glassionomer(GI), Resin Modified
Glassionomer (RMGI) and Adhesive Systems.3,25 Patient age
influence of the treatment it’s a controversial issue whether
performed in both young and old adults patients.1,10,12 However
younger dental pulp is more cellular and has better potential for
healing and regeneration after removing the infected pulp tissue
that making the pulpotomy in this age group more predictable
outcome.12,23,24
In conclusion the pulpotomy for permanent teeth with carious
exposed pulp with reversible or irreversible pulpitis seems to be
good alternative to the root canal treatment and the success of
this approach depends on many factors as we mentioned above.
However many well designed randomizes control trail with long
term follow up are needed to give conclusive evidences.
The author has no conflict of interest
References
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Copyright: Dr. Nawras Maher Mostafa, ©2019 This is an open-access

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