Histological and CBCT evaluation of a pulpotomised primary molar using calcium enriched mixture cement

Abstract

Background: Pulpotomy is one of the most commonly used treatments for retaining pulpally involved primary molar teeth in order to prevent tooth extraction and maintain space within the jaws. A recent randomised clinical trial found that calcium enriched mixture (CEM) cement demonstrated favourable 2-year treatment outcomes for pulpotomy of carious primary molars comparable with mineral trioxide aggregate (MTA). The use of cone beam computer tomography (CBCT) has not previously been used to evaluate pulpotomy and histological outcomes.

Case report: A coronal pulpotomy was performed on a carious maxillary first primary molar in a 7-year-old child with non-contributory medical history. Following haemostasis, the radicular pulp was covered with 2-3 mm of CEM and the tooth restored.

Follow-up: At the 2-year follow-up appointment, clinical/radiographic examinations of the pulpotomised tooth revealed that vital pulp therapy was successful in maintaining the tooth asymptomatic; however, the first maxillary molars had to be extracted for orthodontic reasons. CBCT and histological examinations showed thick/complete calcific bridges with tubular dentine at the amputation sites. The underlying dental pulp had normal structure and was un-inflamed.

Conclusion: Based on these findings, it seems that CEM cement can induce a favourable biological response in dental pulps of primary teeth and CBCT may be useful to evaluate pulpotomy outcomes.