Giving the pulp another chance: a case report of vital pulp therapy retreatment
A new General Dentistry article that peer reviewers found “extremely compelling” and “one of the best case studies I have ever read” reminds readers that the regenerative potential of dental pulp should be harnessed whenever possible, allowing maintenance of its formative, nutritive, protective and reparative functions. Presented in what one peer reviewer called “a clear, easy-to-read narrative,” the case report details successful vital retreatment after the failure of partial pulpotomy in a young permanent molar and reviews factors influencing vital pulp therapy outcomes.
Case report
The report describes the case of a 10-year-old boy who sought treatment of his permanent mandibular right first molar because of pain caused by cold stimuli. The molar was diagnosed with reversible pulpitis and initially treated with partial pulpotomy. The patient did not present for the 6-month recall, but radiographs taken 19 months after partial pulpotomy revealed no detectable lesions. At 34 months, the composite resin restoration had dislodged without causing symptoms, and a stainless steel crown was placed on the tooth. Approximately 15 months later (49 months after partial pulpotomy), the patient returned with symptoms in the treated tooth. The tooth was diagnosed with irreversible pulpitis and asymptomatic apical periodontitis but responded positively to cold testing, and the pulp appeared clinically vital on direct inspection. The tooth was re-treated with coronal pulpotomy, which included a mineral trioxide aggregate dressing, and examination 21 months posttreatment revealed successful resolution of the periapical lesion.
Summary
As this case highlights, failure of conservative vital pulp therapy may not be an absolute indication for root canal treatment when the tooth still has vital pulp, especially in pediatric patients with high potential for pulpal healing. Preservation of the pulp may be feasible if the tooth is given a second chance to survive via renewed removal of infection and inflammation, placement of a bioactive pulp dressing material on the remaining healthy pulp, and establishment of an effective coronal seal to foster successful healing. The treated tooth must be examined regularly to ensure tooth survival and early detection of problems that may adversely affect treatment outcomes.
Read a synopsis of the full article here.
Case report
The report describes the case of a 10-year-old boy who sought treatment of his permanent mandibular right first molar because of pain caused by cold stimuli. The molar was diagnosed with reversible pulpitis and initially treated with partial pulpotomy. The patient did not present for the 6-month recall, but radiographs taken 19 months after partial pulpotomy revealed no detectable lesions. At 34 months, the composite resin restoration had dislodged without causing symptoms, and a stainless steel crown was placed on the tooth. Approximately 15 months later (49 months after partial pulpotomy), the patient returned with symptoms in the treated tooth. The tooth was diagnosed with irreversible pulpitis and asymptomatic apical periodontitis but responded positively to cold testing, and the pulp appeared clinically vital on direct inspection. The tooth was re-treated with coronal pulpotomy, which included a mineral trioxide aggregate dressing, and examination 21 months posttreatment revealed successful resolution of the periapical lesion.
Summary
As this case highlights, failure of conservative vital pulp therapy may not be an absolute indication for root canal treatment when the tooth still has vital pulp, especially in pediatric patients with high potential for pulpal healing. Preservation of the pulp may be feasible if the tooth is given a second chance to survive via renewed removal of infection and inflammation, placement of a bioactive pulp dressing material on the remaining healthy pulp, and establishment of an effective coronal seal to foster successful healing. The treated tooth must be examined regularly to ensure tooth survival and early detection of problems that may adversely affect treatment outcomes.
Read a synopsis of the full article here.