Vital Pulp Therapy of a Mature Molar with Concurrent Hyperplastic Pulpitis, Internal Root Resorption and Periradicular Periodontitis: A Case Report

Abstract

Vital pulp therapy (VPT) of permanent mature teeth is continuously ascertaining to be a more reliable endodontic treatment. The purpose of this case report was to describe successful VPT of a mature mandibular left first molar with concurrent hyperplastic pulpitis, internal root resorption and periradicular periodontitis in a 35-year-old male patient. After complete caries removal and access cavity preparation, the dental pulp was removed from the coronal third of the roots. To protect the remaining pulp, calcium-enriched mixture (CEM) cement was placed and adapted into the cavities; the tooth was then restored with amalgam. Six months after VPT, radiographic examination showed evidence of periradicular healing. Clinically, the tooth was functional without signs and symptoms of infection/inflammation. The successful outcome of this case suggests that diseased dental pulp (i.e. irreversible pulpitis) has the potential to heal after pulp protection with CEM biocement.

Keywords: Apical Periodontitis; Calcium-Enriched Mixture; Endodontic; Hyperplastic Pulpitis; Irreversible Pulpitis; Permanent Teeth; Pulp Polyp; Pulpotomy; Root Resorption; Vital Pulp Therapy.

Figure 1

A) Preoperative radiophotograph showing extensive caries and internal root resorption in coronal part of mesial/distal canals in a mandibular left first molar; B) Clinical photograph after removing the restoration, C) Clinical photograph after pulp tissue removal and hemostasis, D) Clinical photograph after placement of CEM cement, E) Postoperative radiophotography showing placement of CEM in the prepared cavities and amalgam restoration, F) Six-month follow-up showing establishment of periodontal ligament space and lamina-dura