Calcium-enriched mixture pulpotomy of a human permanent molar with irreversible pulpitis and condensing apical periodontitis

Abstract

This case report describes a pulpotomy treatment of a permanent mature molar tooth with established irreversible pulpitis and condensing apical periodontitis, using calcium-enriched mixture (CEM) cement. Clinical examination revealed that the first right lower molar had a large carious lesion with history of spontaneous/lingering pain; radiographic examination showed condensing apical periodontitis. Pulpotomy was opted as the treatment; cervical pulpotomy was carried out. Following hemostasis, the radicular pulp stumps were covered with ~2-mm-thick layer of the prepared CEM cement; the tooth was restored with amalgam. Two-year follow-up showed that the treated tooth had been symptomless, and there were no clinical signs/symptoms of either inflammation or infection. Radiographically, the periradicular lesion was completely healed with reconstruction of bone structures to normal appearance; the root canals were not calcified. According to chemical, physical, and biological properties of the CEM cement, this novel biomaterial may be suitable for endodontic treatment.

A Review of Criteria for the Evaluation of Pulpotomy Outcomes in Mature Permanent Teeth

“…Finally, 31 articles were included: 15 case reports or case series (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), 9 cohort studies (15,(31)(32)(33)(34)(35)(36)(37)(38), and 3 clinical trials and 4 randomized clinical trials (39)(40)(41)(42)(43)(44)(45).…”

Indirect pulp therapy in a symptomatic mature molar using calcium enriched mixture cement

“…Conversely, recent reports have demonstrated that teeth with irreversible pulpitis showed favorable treatment outcomes with pulpotomy using CEM/MTA as pulp cappings. [3–57] Though the diseased pulps in these cases were inflamed, they were still vital; that is they still maintained a blood supply and therefore the most important factor for healing. In the light of recent high-level evidences,[7] the inflammatory process should be re-examined to recognize its possible or probable positive effect on pulpal healing.…”

“…[12] An in vitro study revealed that the anti-bacterial properties of CEM are similar to calcium hydroxide. [13] CEM has been employed as a root-end filling material,[14] as well as direct pulp capping agent,[15] pulpotomy agent,[561617] apical plug,[18] in the repair of furcal perforations,[19] management of root resorption,[20] and regenerative endodontics. [21] Recently, an interesting report demonstrated favorable treatment outcomes of direct pulp capping with CEM for management of a permanent mature molar with irreversible pulpitis and associated apical periodontitis.…”

W`Vital pulp therapy using calcium-enriched mixture: An evidence-based review

“…[84] In a case series study of 12 permanent mature molars with irreversible pulpitis, CEM was used for pulpotomy, and resulted in complete success at a follow-up after16 months. It was also shown that to enable improved regeneration, the pulp-dentin complex had isolated itself by forming a calcified bridge.…”