Tag Archives: vital pulp therapy

The Little Devil Horn – part II

In my previous post “The Little Devil Horn,” I showed a case of fractured Dens Evaginatus (DE) that had resulted in pulpal necrosis in an 11 years old girl.  In almost all cases the tubercles fracture off as soon as the teeth come into occlusion.  The resultant pulp exposure goes unnoticed until patient develops pain and symptoms and a combined endodontic-restorative procedures would then be necessary.  Therefore, just observing what does not belong to a proper occlusion is not a good choice.

The endodontic treatment for necrotic teeth with immature roots is either regenerative endodontics or MTA apexogenesis depending on many factors.  The latter was used to treat the case of fractured DE with pulpal necrosis.

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So, what should we do if we face a vital tooth with an intact tubercle?

Some evidence suggest a gradual shaving off the tubercle over a period of few months in order to allow tertiary dentin formation is the treatment of choice.  However, tertiary dentinogenesis may not provide a complete seal of the pulp chamber as this process lays down an irregularly formed dentinal structure.

Another approach would be to remove the tubercle mechanically under RD isolation and to seal off the resultant mechanical exposure, if any, with bonding material. This approach was performed for the same young patient for tooth #3-5.

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Office website: vanendo ,  FaceBook page: @endospecialists


The Young & The Resilient

When deciding on an endodontic-restorative plan for a tooth, one should always keep in mind the age of the dental pulp (i.e. patient’s age). Younger dental pulp = more cellular, vascular, defensive and therefore resilient.  This fact can help us decide on a more appropriate and conservative treatment for a tooth when facing pulp exposure as a result of trauma or caries excavation.

Vital Pulp Therapy (VPT) techniques is attempted in order to remove the reversible pulpal injury, to preserve the vitality of the pulp and to ultimately allow continued root/tooth growth.  The technique comprises: a) good isolation, b) complete caries removal, c) disinfection of the access cavity with NaOCl, d) stopping the bleeding with a moist cotton pellet, e) applying pulp capping material such as ProRoot® MTA or Biodentine™, and f) restoring the access cavity with permanent restoration after confirming the setting of the capping material.

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In the above case Direct Pulp Capping with MTA, irrespective of the size of carious exposure, was performed because this 13 year-old patient presented with non-lingering, non-spontaneous and reversible pulpitis symptoms.  In addition, carious exposure resulted in fresh bleeding from pulp horns that could be stopped with applying moist cotton pellet.  If a patient presents with irreversible pulpitis symptoms, other VPT techniques should be considered.


Office website: vanendo ,  FaceBook page: @endospecialists


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