Pulp Therapy
Kathryn J. Kiskaddon, DMD
Resident
University of Florida —Gainesville and Naples, Naples, FL
Tarpon Springs, Florida, United States
Marcio Guelmann, DDS
Program Chair
University of Florida - Gainesville
Gainesville, Florida, United States
Marcio Guelmann, DDS
Program Chair
University of Florida - Gainesville
Gainesville, Florida, United States
Abimbola O. Adewumi, BDS, FDSRCS
Program Director
University of Florida
Gainesville, Florida, United States
Purpose: To intentionally perform pulpotomy and pulp chamber seal on decayed, vital primary molars with lesion margins at or below the cementoenamel junction. Under these circumstances, a stainless-steel crown (SSC) restoration may end up short of the tooth margin potentially leading to leakage and treatment failure.
Methods: Healthy and cooperative 5 to 10-year-old patients with deep proximal lesions at or below the cementoenamel junction were recruited. Clinically, pulpal diagnosis was normal or reversible pulpitis with no signs or symptoms of pulp degeneration. Radiographically, there was no evidence of furcal, periapical, or periodontal pathology and at least 1-2mm of sound dentin separating the deepest portion of the lesion and the pulp. After complete caries removal, the pulp was intentionally exposed and pulpotomy performed. Upon hemostasis, a bioceramic putty-based cement was used as pulp medicament covering pulpal floor and canal orifices followed by a reinforced glass-ionomer chamber restoration and SSC coverage. Teeth were assessed clinically and radiographically at 6- and 12-months post-treatment.
Results: Sixteen patients with 19 lesions were treated. Seventeen teeth completed the 6-month recall visit with one failure diagnosed, most likely due to inadequate packing of pulp medicament. Successful 12-month evaluation was completed for 10 teeth with the remaining scheduled for early 2023. Three patients with 3 lesions were lost due to relocation.
Conclusions: When restoration gingival margin seal is questionable due to cervical extension of decay, the bioceramic/glass-ionomer pulp chamber restoration provided satisfactory insulation, maintained radicular pulp vitality and preserved treated teeth in function for 12 months.