AAPD’s guidelines on pulp therapy for primary and immature permanent teeth

[drsnehamaheshwari]

Partial pulpotomy for traumatic exposures (Cvek pulpotomy)

The partial pulpotomy for traumatic exposures is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1 to 3 mm or more to reach the deeper healthy tissue. Pulpal bleeding is controlled using bacteriodical irrigants such as sodium hypochlorite or chlorhexidine, and the site then is covered with calcium hydroxide or MTA. White, rather than gray, MTA is recommended in anterior teeth to decrease the chance of discoloration. The 2 versions have been shown to have similar properties.

While calcium hydroxide has been demonstrated to have long-term success, MTA results in more predictable dentin bridging and pulp health. MTA (at least 1.5 mm thick) should cover the exposure and surrounding dentin, followed by a layer of light-cured resin-modified glass ionomer. A restoration that seals the tooth from microleakage is placed.

• Indications: This pulpotomy is indicated for a vital, mtraumatically-exposed, young permanent tooth, especially one with an incompletely formed apex. Pulpal bleeding after removal of inflamed pulpal tissue must be controlled. Neither time between the accident and treatment nor size of exposure is critical if the inflamed superficial pulp tissue is amputated to healthy pulp.

• Objectives: The remaining pulp should continue to be vital after partial pulpotomy. There should be no adverse clinical signs or symptoms of sensitivity, pain, or swelling. There should be no radiographic signs of internal or external resorption, abnormal canal calcification, or periapical radiolucency post-operatively. Teeth with immature roots should show continued normal root development and apexogenesis.

Apexogenesis (root formation)

Apexogenesis is a histological term used to describe the continued physiologic development and formation of the root’s apex. Formation of the apex in vital, young, permanent teeth can be accomplished by implementing the appropriate vital pulp therapy previously described in this section (ie, indirect pulp treatment, direct pulp capping, partial pulpotomy for carious exposures and traumatic exposures).