Super Minimally Invasive Pulp Therapy for Severe Pulpitis: A Report of Two Cases

Abstract

In regions where preventive dentistry is widespread, tooth loss due to root fracture occurs approximately 10 times more frequently than that due to caries and periodontal disease. Root fracture is most likely to occur in non-vital teeth, where the dental pulp has been removed, often through a procedure known as pulpectomy. However, super minimally invasive pulp (SMIP) therapy has recently been reported as a novel treatment approach for pulpitis of any degree. In this study, SMIP therapy was performed to preserve the vitality of teeth in two patients with severe pulpitis. Case one involved a 35-year-old man with a history of hypertension who presented with intense spontaneous pain in tooth #34. The pain was particularly severe while sleeping at night and on exposure to cold water or heat, but it was absent on percussion. Following the detection of cervical caries and severe pulp exposure, SMIP therapy was administered, and the tooth was subsequently restored using glass ionomer cement. Case two involved an 18-year-old woman with no significant medical history who had deep caries in tooth #46. She experienced mild tooth pain when exposed to cold water, and examination revealed pulp exposure. We applied mineral trioxide aggregate over the dental pulp and restored the tooth using composite resin. The vitality of both teeth was maintained at the three-month follow-up. To our knowledge, this is the first report of SMIP therapy for teeth with severe pulpitis. SMIP therapy is an innovative treatment that may cause a paradigm shift from conventional dental treatment.

Keywords: caries; dental pulp; periodontal disease; preventive dentistry; pulpectomy; root fracture; super minimally invasive pulp therapy; teeth vitality; tooth loss.

Figure 1. Schematic representation of (A) ultrasound-guided trigeminal nerve block. (B) Rubber dam isolation before removal of dental caries. (C) Dental pulp exposure after removal of dental caries. (D) Placement of mineral trioxide aggregate cement over the dental pulp. (E) Restoration of the tooth using composite resin.

Figure 2. Clinical images and intraoral periapical radiographs of Case one. (A) Before treatment. (B) After removal of dental caries. (C) After placement of mineral trioxide aggregate cement over the dental pulp. (D) Preoperative radiograph. (E) Radiograph taken three months postoperatively.

Figure 3. Clinical images and intraoral periapical radiographs of Case two. (A) Before treatment. (B) After removal of dental caries. (C) After placement of mineral trioxide aggregate cement over the dental pulp. (D) Preoperative radiograph. (E) Radiograph taken three months postoperatively.