BiodentineTM Full Pulpotomy in Mature Permanent Teeth with Irreversible Pulpitis and Apical Periodontitis

Xuan Vinh Tran,Tchilalo Boukpessi,Lan Thi Quynh Ngo

doi:10.3390/healthcare9060720

Abstract

Vital pulp therapy, including direct pulp capping and partial and full pulpotomy, is primarily indicated for immature or mature permanent teeth with reversible pulpitis. Mature permanent teeth with irreversible pulpitis are frequently treated with root canal therapy. This report presents two cases of full pulpotomy using BiodentineTM in mature permanent teeth with irreversible pulpitis and acute apical periodontitis. The periapical radiograph illustrated a deep carious lesion extended to the pulp with apical radiolucency lesion or widened periodontal ligament space. Full pulpotomy with a tricalcium silicate-based cement was chosen as the definitive treatment. After decayed tissue excavation under a rubber dam, the exposed pulp tissue was amputated to the level of the canal orifice with a new sterile bur. BiodentineTM was applied as the pulp capping agent after hemostasis was obtained and for temporary restoration. The clinical signs disappeared quickly after the treatment. After one month, the coronal part of the temporary restoration was removed, and a composite resin was placed over the capping agent as a final restoration. At two-year follow-ups, the teeth were asymptomatic. Radiographs showed healing of the periapical lesion and periodontal ligament. BiodentineTM full pulpotomy of mature permanent teeth with irreversible pulpitis and apical periodontitis can be an alternative option to root canal therapy.

Highlights

The maintenance of the vitality of the dental pulp is one of the crucial targets of modern dentistry, based on the concept of minimally invasive dentistry
The dentin can be regenerated as odontoblasts, which are located on the periphery of the mature pulp and solely responsible for dentin synthesis
Reactionary dentin synthesis is promoted by small amounts of pro-inflammatory cytokines and/or biologically active molecules responsible for the induction of embryonic odontoblast differentiation, such as TGF or BMP [2]

Summary

Introduction

The maintenance of the vitality of the dental pulp is one of the crucial targets of modern dentistry, based on the concept of minimally invasive dentistry. If conditions become conducive (e.g., if the carious infection is controlled or arrested), stem/progenitor cells within the pulp are signaled to target the site of the injury and to differentiate into odontoblast-like cells These cells deposit a tertiary reparative dentin matrix, reportedly at a similar rate to that of primary dentinogenesis, and this clinically results in dentin bridge formation [5]. BiodentineTM has been shown to induce odontoblastic differentiation of dental pulp stem cells, and produce more uniform and thicker dentin bridge formations, with less inflammatory response and less necrosis of pulp tissue than calcium hydroxide [23,30]. The two cases below present the outcome of full pulpotomy, using BiodentineTM, of permanent teeth with irreversible pulpitis and periapical lesion/widened periodontal ligament space

Case Presentation

Findings

Conclusions