A partial pulpotomy for traumatic exposures is also called a Cvek Pulpotomy. When a baby tooth or. Pulpotomy is the term for removal of the coronal pulp with the intent of maintaining .. The Cvek pulpotomy procedure involves the removal of contaminated pulp. The partial pulpotomy can offer a superb outcome for the treatment of complicated crown fractures of the young permanent tooth.
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Preserving the dental pulp, or part of it, is important when treating a vital tooth with an exposed pulp, particularly if the tooth is immature and root formation is incomplete.
The partial pulpotomy can offer a superb outcome for pulpotomu treatment of complicated crown fractures pulpotom the young permanent tooth. The procedure is often used for traumatic injuries in children where the major aim of treatment is to preserve tooth vitality while providing a favorable environment for continued root development.
Cvek pulpotomy – revisited.
In following article, a review of partial pulpotomy and management of case of a vital permanent maxillary incisor with lulpotomy crown fracture and pulp exposure is discussed. This was treated by partial pulpotomy with calcium hydroxide and assessed clinically through pulpal sensitivity tests and radiographically for periapical healing and continued root end closure.
A tooth fracture involving enamel and dentine that exposes the pulp is defined as complicated crown fracture. An exposed pulp in a young permanent tooth with crown fracture is usually treated with either pulp capping or pulpotomy, depending on the pulpoomy of pulp exposure, the interval between accident and examination, the area size of exposed pulp, and the stage of root development [ 2 ]. The key determinants of success are the extent of pulp damage puppotomy the length of time after exposure of the pulp to the oral environment [ 3 ].
The partial pulpotomy advocated by Cvek has become a viable alternative for treating pulp exposures in vital teeth with incomplete root end closure [ 2 ]. Cvek pulpotomy is indicated for the management of traumatic pulpal exposure in a young permanent tooth with an incomplete root end closure.
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 [ 4 ]. We report a case of complicated crown fracture who was treated with partial pulpotomy. A year-old boy was referred to our department clinics two days after falling while taking bath. Clinical examination revealed a complicated crown fracture of tooth 21 FDI [Fig.
The tooth was not mobile and gave a vital pulpal response on hot and cold pulp testing.
Cvek pulpotomy – revisited.
There was no apparent periapical abnormality or alveolar bone fracture. It was decided to treat the tooth by partial pulpotomy, using the technique recommended by Cvek Briefly, after local anaesthesia, the tooth was isolated with rubber dam and saliva ejector. The exposed area was cleaned with sterile saline solution. The pulp was amputated to a depth of mm using a diamond bur on a high-speed turbine with water cooling [Fig.
The wound surface was irrigated with a sterile saline solution and dried with cotton pellets to avoid clot formation. Calcium hydroxide powder mixed with distilled water was applied to the wound surface [Fig.
Pulpotomy – Wikipedia
The cavity was sealed with glass—ionomer cement [Fig. The tooth was examined clinically and radiographically at 1-month interval [Fig. Healing was considered to have taken place when the following criteria were observed: The tooth was then restored with composite [Fig. This procedure is known widely as the Cvek pulpotomy, deriving its name from Dr. Miomir Cvek, who in reported a high success rate for partial pulpotomies following complicated crown fractures in permanent incisors [ 5 ].
Cvek examined 60 complicated crown fractures with follow-up times ranging from 14 to 60 months, with an average follow-up of 31 months. He concluded that healing occurred in 96 percent of the cases when complicated crown fractures were treated within 30 hours of the accident [ 6 ]. 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 [ 4 ].
In our present case, we performed partial pulpotomy procedure as it was quick and easy to perform. It allowed the tooth to maintain its vitality and continue its root development. After Hemostasis, a pulpal medicament containing biologically available calcium hydroxide is applied to the wound surface [ 7 ]. It should be noted that for the partial pulpotomy technique as described by Cvek, a dressing of calcium hydroxide paste Calasept, Scania Dental AB, Knivsta, Sweden was used as the pulp dressing [ 6 ].
Calcium hydroxide gives the pulp the biologic condition for dentin bridge formation. At the same time, it protects the pulp against thermoelectric stimulus and antibacterial growth.
Due to its high pH, calcium hydroxide causes a coagulation necrosis of the tissue in contact with the pulp-capping material. By raising the local pH environment, calcium hydroxide possibly neutralizes osteoclastic activity and activates the molecules that mediate tissue repair, such as alkaline phosphatases and calcium-dependent ATP-ase.
This necrotic zone leads to the odontoblast-like cells turning to odontoblasts and then dentin formation starts promoting the pulpal normality. The initially formed calcified layer in association with fibronectin mediates the differentiation of pulp cells into odontoblasts, which produce a tubular dentin layer.
However, if inflammation is puplotomy under the capping material, it creates an inadequate environment plpotomy odontoblast-like cell differentiation, interfering with pulpal healing and bridging [ 2 ]. Its therapeutic and chemical properties include bacteriostatic and hemostatic activity, acid neutralization puloptomy caustic action.
The prognosis for pulp capping with calcium hydroxide depends on the stage of pulp inflammation and its contact with the pulp tissue.
The complete removal of blood clot, dentin debris, and contaminants is mandatory for a good pulpotlmy [ 2 ]. Fong and Davis suggested care should be taken to avoid a significant blood clot developing between the wound surface and the dressing medicament. Dry, sterile cotton pellets are used carefully with modest pressure to adapt the medicament to the prepared cavity and to remove excess water from the paste.
The remaining coronal cavity is then restored with a material that provides a long-term hermetic seal. It is critical to avoid bacterial contamination to the pulp tissue during the procedures and to avoid any subsequent leakage following restoration [ 7 ]. They also reviewed the indications of partial pulpotomy in permanent teeth, which included teeth with no history of spontaneous pain or with acute minor pain that subsides with analgesics, absence of discomfort to percussion, no vestibular swelling and no mobility, normal radiographic appearance of periodontal attachment, pulp exposed during caries removal or subsequent to recent trauma, and finally, tissue that appears vital and bleeding from the pulp excision site that stops with isotonic saline irrigation within 2 minutes [ 7 ].
We conclude that partial pulpotomy is an alternative technique that promotes pulp healing of vital crown-fractured permanent teeth. It was observed that neither the size of the exposure nor the time interval between accident and treatment are critical factors for success.
However, pulp vitality and absence of pain were important factors related to the good results of this treatment. A careful technique, paying particular attention to hemorrhage control, material placement and a well-sealed restoration are essential for success. S aroglu SI, Sonmez H. Long-term follow-up of a complicated crown fracture treated by partial pulpotomy.
Partial pulpotomy pulpptomy tooth reconstruction of a crown-fractured permanent incisor: H eide S, Mjor IA. Pulp reactions to experimental exposures in young permanent monkey teeth. Am erican academy of pediatric dentistry.
A pulpotom Academy of Pediatric Dentistry. Guideline on management of acute dental trauma. Two case reports of complicated permanent crown fractures treated with partial pulpotomies. Partial pulpotomy for immature permanent teeth, its present and future.
Journal of Case Reports. Introduction A tooth fracture involving enamel and dentine that exposes the pulp is defined as complicated crown fracture. Case Report A year-old boy was referred to our department clinics two days after falling while taking bath. Conclusion We conclude that partial pulpotomy is an alternative technique that promotes pulp healing of vital crown-fractured permanent teeth.
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