Case Report: Immediate pain relief after partial pulpotomy of cariously exposed young permanent molar using mineral trioxide aggregate and root maturation, with two years follow-up

Abstract

Carious exposure of immature first permanent molar is a widespread issue faced in paediatric dentistry. This may be the result of the early eruption of this molar, so parents may think it is replicable to the rest of the deciduous teeth. Preserving pulp vitality is the primary goal in treating those teeth to allow maturation of roots both in length and width. Mineral trioxide aggregate (MTA) is considered a perfect dressing material for pulpotomy (both partial and complete) due to its bio computability and sealing property. We present a case that describes treatment and two years follow-up of a symptomatic immature first permanent molar with a deep carious lesion. For treatment, we started with anaesthesia and rubber dam isolation. After that, the carious lesion was removed, and we performed partial pulpotomy, then applied MTA-Angelos on the fresh wound. Moistened cotton then was lightly packed over MTA for 15 minutes to allow initial setting, followed by application of glass ionomer and final restoration with composite. The following day, the tooth was asymptomatic with the patient reporting pain relief. After three months follow-up, the tooth normally responds to thermal test. After 12 months, a periapical radiograph of the tooth showed root maturation, and after 24 months also, the tooth was clinically and radiographically successful. MTA partial pulpotomy should be considered in the treatment of symptomatic young permanent teeth.

Effectiveness of TheraCal LC versus MTA in Vital Pulp Therapy of Cariously-Exposed Young Permanent Molars: Five-Year Follow up of a Randomised Clinical Trial

“…The method used to calculate a confidence interval for the difference between two proportions is the Newcombe-Wilson method without continuity correction. Also, the average time of application was calculated and published in the preliminary report after 1-year [6]. The significance level was set at p< 0.05 within all tests.…”

“…To compare tooth survival rate (clinical and radiographic) following pulpotomy of cariouslyexposed vital young molars using TLC and MTA both short term after 1-year and long term after 5years. Secondary outcomes, including root maturation and time laps till final restoration, were also compared [6].…”

“…Taking into consideration the easy manipulation of the TLC syringes and the controlled setting time, the comparable properties to MTA, and the lower cost (about 1/3 the price of MTA at the time of conducting the trial), we compared these two materials in pulpotomy of young permanent teeth. A preliminary report was published after 1-year as partial fulfilment of one of the authors' (PN) postgraduate degrees [6]. Null hypothesis TLC pulpotomy had a similar survival success rate (clinically and radiographically) as MTA pulpotomy in cariously exposed FPMs, short term after 1-year and long term after 5-years, with a shorter chair side time of application.…”

Clinical and Radiographic Success Rate of Theracal Pt Versus Mta in Pulpotomy of Primary Molars: A Randomised Clinical Pilot Study

“…TLC was presented in 2011 as "a novel light-curable MTA-like material" with controlled setting time (light cured) and not reported to cause discolouration [7]. However, TheraCal LC has controversial biological properties, which hinder its recommendation as a pulp capping materials [8][9][10]. Also, TLC showed unfavorable outcomes when used in pulpotomy procedures for primary and permanent teeth [10,11].…”

“…However, TheraCal LC has controversial biological properties, which hinder its recommendation as a pulp capping materials [8][9][10]. Also, TLC showed unfavorable outcomes when used in pulpotomy procedures for primary and permanent teeth [10,11].…”