Permanent molar pulpotomy with a new endodontic cement: A case series

Abstract

The aim of this case series was to determine the clinical and radiographic success rate of pulpotomy, with new endodontic cement (NEC), in human mature permanent molar teeth. Twelve molars with established irreversible pulpitis were selected from patients 14 - 62 years old. The selection criteria included carious pulp exposure with a positive history of lingering pain. After isolation, caries removal, and pulp exposure, pulpotomy with NEC was performed and a permanent restoration was immediately placed. At the first recall (+1 day) no patients reported postoperative pain. One wisdom tooth had been extracted after two months because of failure in coronal restoration. Eleven patients were available for the second recall, with a mean time of 15.8 months. Clinical and radiographic examination revealed that all teeth were functional and free of signs and symptoms. Histological examination of the extracted teeth revealed complete dentin bridge formation and a normal pulp. Although the results favored the use of NEC, more studies with larger samples and a longer recall period were suggested, to justify the use of this novel material for treatment of irreversible pulpitis in human permanent molar teeth.

Keywords: Mature; pulpitis; pulpotomy.

Figure 1

Preoperative radiograph of the second and third lower left molars shows deep interproximal carious lesions. The patient's chief complaint was severe lingering pain with sensitivity to percussion in both involved teeth. A periradicular lesion in the mesial root of the third molar is clear

Figure 2

Pulpotomy treatment with new endodontic material was performed on the third lower molar accompanied by permanent restoration. Emergency treatment for the second molar was carried out in the same session

Figure 3

Immediate postoperative radiograph of the second molar after a week. Note the periradicular lesion in the mesial root of the third molar

Figure 4

Twelve-month follow-up radiograph showing favorable outcomes. The treated teeth are in function and the periapical tissues are normal. An important finding is the complete healing of the periradicular lesion in the mesial root of the third molar

Figure 5

Postoperative radiograph showing pulpotomy with new endodontic material

Figure 6

Two-month follow-up radiograph showing pulpotomized tooth without coronal filling. The patient had extracted the tooth because it was not restorable

Figure 7

Center: a view of the pulpotomy area of a twomonth sample capped with NEC. There is no inflammatory reaction. A complete calcified bridge (CCB) was formed and normal pulpal tissue was completely excommunicated from the exterior. A few irregularities in the dentinal walls (arrows) indicated old internal resorption (H & E, ×100). Left and right: higher magnification of resorption areas (black arrows). A few cells being embedded (arrow heads) against resorption lacunae, demonstrating new predentin deposition and the end of the resorption process (H & E, ×400)