Abstract
Maintenance of pulp functional integrity should be aimed by the treatment of trauma affected immature permanent teeth. The prognosis of vital pulp therapies (VPT), when well indicated and correctly performed, not only preserves pulp vitality but also provides the immature root development. This case reports the treatment of a patient with a crown fractured immature maxillary right central incisor. Clinical examination, radiographic inspection and sensitivity tests confirmed tooth vitality. In spite of the superficial micro abscess presence, pulpotomy was the treatment of choice according to the pulp vitality characteristics found during the undergoing surgery. Root development and apical closure were verified at the 1st year radiographic control. After 3 years of follow-up, even with the occurrence of 3 new traumatisms, the treated tooth showed radiographic sound characteristics. Nevertheless, on the fourth-year return, the conventional endodontic treatment had to be carried out due to radiographic signal of initial root obliteration. It was concluded that pulp vitality diagnosis step and clinical-radiographic follow-up are extremely important for the pulpotomy outcome. This conservative approach resulted in success since it induced root development and apical closure, permitting the posterior execution of the endodontic therapy.
Highlights
High rates of violence, traffic accidents and extreme sports activities make dental trauma a public health problem (Caldas & Burgos, 2001; Lee & Divaris, 2009)
The selection of a coherent treatment plan should enable the preservation of normal functions of the pulp (Shabahang, 2013; Sonmez & Sonmez, 2007; Martens et al, 2015; Tuloglu & Bayrak, 2016), which will bring about immature root development, apical closure and root structure strengthening (Katebzadeh et al, 1998; El-Meligy & Avery, 2006)
The vital pulp therapy (VPT) is a conservative treatment that aims to promote the healing of pulp tissue and the formation of hard tissue to preserve pulp vitality (Cvek, 1978; Haikal et al, 2020; Çaliskan & Güneri. 2017) and whenever possible this therapy is the treatment of choice for immature complicated crown fractures (Nosrat et al, 2013; Chueh et al, 2009; Garcia-Godoy & Murray, 2012; Eppa et al, 2018)
Summary
Traffic accidents and extreme sports activities make dental trauma a public health problem (Caldas & Burgos, 2001; Lee & Divaris, 2009). There has been some controversy about VPT durability, while some researches consider it a definitive treatment (Fuks et al, 1993; Robertson et al, 1996; Rafter, 2005), others recommend a conventional root canal filling after tooth complete apical foramen formation to prevent calcific degeneration and obliteration of the pulp canal (Cvek, 1978; Bergenholtz & Spångberg, 2004). In spite of this disagreement, the VPT has demonstrated satisfactory results on root maturation, even better than pulp revascularization treatment (Forghani et al, 2013)
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