PartialpulpotomyinyoungpermanentteethMejareetal1993

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a dia-and a high-speed air-turbine toof about 1.0-1.5 mm, during continuousa water spray from the turbine. There-the pulp wound was flushed with sterile salinehad ceased. When haemostasis hadthe pulpal wound was dressed withwas adapted and driedwas taken to avoidthe wound surface and thethe whole cavity floor hadthe cavity

or composite wasat a later appointment. After 36the formation of a hard tissue barrier wasin 17 teeth , (Fig. 1,2). The teethand 6 months and thereafterThe observation period varied from 24 to= 56 months).The files of the patients were examined for the

P a r t i a l p u l p o t o m v i n c a r i o u s presence of clinical symptoms, such as spontanor provoked pain and sensitivity to percusRadiograhs, taken at the time of treatment, examined separately by bo th au thors with resperoot maturity and periapical conditions. Thereathe teeth were divided into two groups:Group /, consisting of 31 teeth which prtreatment exhibited no clinical or radiograsymptoms. In 17 teeth pulpotomy was perforat the first appointment, after complete remof carious dentin and exposure of the pulp.remaining 14 teeth were primarily treated bywise excavation, i.e. the carious dentin was grally excavated and covered with calcium hydrobefore the pulp was exposed (10-12). The stepexcavation was done during 23 consecutivepointments at inter\ a ls of 2 3 weeks.

Group 2, consisting o i ^ 6 teeth which at theof treatment showed clinical and/or radiograsymptoms. Three teeth exhibited a periapically ened and diffusely outlined periodontal spSpontaneous pain was recorded for 2 of these t

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e & C v e k

A: 36; pulp exposed by caries (arrow). B. Haemostasis after complete removal of carious dentin and partial pulpotomearance of hard tissue barrier 3 months later (arrow). D: Radiograph taken before treatment, showing a temporary filling

lusal cavity, normal pcriapical conditions, E and F: Two and four years after partial pulpotomy.

3 teeth exhibited a productive periapicali.e. a widened periodontal space with in-of the surrounding alveolar bone,ith no other clinical symptoms. Stepwise exca-was performed in one of these teeth.At the end of the observation period, healingif there were no clinical symptoms orain immature teeth.

1. Dis t r ibut ion of p o s t e r i o r p e r m a n e n t t e e t h , t r e a t e d w i t h p a r ti a l p u l p -due to c a r l e s , w i t h r e s p e c t to the ob s e rv a t i on

m a t u r i t y of r o o t s and o c c u r r e n c e of a fa i l u re : (') d e n o t e s ones e p a r a t eof fa i lu re. Group 1: t e e t h w i t h o u t c l i n i c a l or r a d i o g r a p h i c s y m p t o m s and2: t e e t h w i t h s u c h s y m p t o m s b e f o r e t r e a t m e n t .

1: no ol t e e t h

24

31141 7 0

O b s e r v a t i o n p e r i o d ( m o n t h s )2 5 - 3 6

291415

37-48

239140

49-60

1578

61-140

725

The tooth should also be sensible to electric stimtion. The distribution of the teeth within thegroups, with respect to root maturity and lengthe observation time, is shown in Table 1.R e s u l t sThe results are presented in Table 1.

In Group I, healing was found in 29 of 3 1i.e. in 93.5%, (Figs. 1, 2). Failure occurred inteeth; in one, pulpitis developed after 10 daythe other, the occlusal filling was missing anperiapical radiolucency was observed 48 moafter treatment.In Group 2, clinical symptoms ceased after ment and at the end of the observation periodradiographs showed periapically a normal podontal space bordered by lamina dura in 4 tineluding 3 which before treatment had showproductive periapical osteitis (Fig. 3). In thmaining 2 teeth, the widened and diffusely outli


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P a r t i a l p u l p o t o m y i n c a r i o u s t

A: 46; Radi ogra ph taken before p artial pulpo tom y with a te mp orary filling in. the occlusal ca\'ity, periapicalSy widspace and increased den.sity of the alveolar bone . B: Eight mo nths after treatm ent, showing n orm al pe riodon tal condi

were found to be continuous. These teeth alsod healing at the end of observation . All failures

ts should be jud ged thereafter. How ever, the re-

Knowledge about the relationships between vari-

of caries progression, is limited and conflictinghave been expressed (13 -19 ). Ju dg ing from

contaminated dentin, sufficed to ensure healingmost of th e treated teeth. There is no telling wheor not the remaining pulp in these teeth wasflamed before the treatment. However, it hascently been shown that even a severely inflampulp may heal, provided the cause of inflammais removed and the tooth restored in a way prevents microleakage (26-29), i.e. by requiremthat were met with the present treatment. The of a gentle surgical method and the absence ofintermediate blood clot may also have contribulo pulp healing (30, 31).

The number of teeth in Group 2 is too smto warrant conclusions and any discussion of thresults would be purely acad emic. These teeth wincluded in the study partly because the resmight lend some support to the findings in Gr1 . The primary intent was, however, to exempthe ability of t h e pulp and the periodontal tissueheal, after the irritants have been removed. Simobservations on healing of periapical lesions hbeen reported, for example, after indirect cappof teeth with deep carious lesions (32, 33).

In the material as a whole, no failures occurrethe teeth which were treated by stepwise excavaprior to the pulpotomy. This therapy seems towidely practised in paediatric dentistry, altholittle is known about its success. It is thought tthrough the antibacterial effect of calcium hydide on carious dentin, the pulp is given a chancrecover and e\'entually demarcate itself, with fortion of secondary dentin (12, 34). The presentsults make it tempting to speculate that the pulpthe teeth treated with stepwise excavation may h


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a high frequency of pulpalin young posterior teeth when superficiala carious exposure wered that all surrounding carious den-and the coronal cavity was

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The authors wish to express theirto Mrs Catrine Rohdin, Senior

R , BENDER IB. The dental pulp. Philadelphia: L ip-pincott 1984; Ch 14.ToBiN DF. Pulpotom y in pr imary and young permanentteeth. J Dent Child 1954; 21 : 252-4 .G E , PORTEOUS JR. Fractured incisors treated byvital pulpotomy. A report on 100 consecutive cases. Br DentJ 1963; 115: 414-26.K, D O W D E N WE, TRONSTAD L, L A N G E I . A N D LK.Human pulp changes of iatrogenic origin. Oral Surg Oral

.Med Oral Fathol \ 9 7 1 ; 32 : 943-80.EK M . A clinical report on partial pulpotomy and cappingwith calcium hydroxide in permanent incisors with compli-cated crown fracture. J Endod 1978; 4: 232-7 .

CHOXSAK A, EIDELMAN E . Partial pulpotomy as analternative treatment for exposed pulps in crown-fracturedpermanent incisors. Endod Dent Traumatol 1987; 3: 100-2.K . Direct pulp capping on prima ry teeth - a long'term investigation. J In t Assoc Dent Child 1971; 12 : 10-9.SCHRODER U, S Z PR IN G E R -N O D Z AK M , J A N I C H A J , W AC IN S K AM, BuDNY J, LosEK K. A one-year follow-up of partialpulpotomy and calcium hydroxide capping in primary mo-lars. Fndod Dent Traumatol 1987; 3: 304-6 .

U, ELIYAHU M , SARNAT H . Partial pulpotomyin carious permanent molars . Am J Dent 1989; 2: 147-50.DB, LEWIS T M . The effect of calcium hydroxide ondeep carious lesions. Oral Surg O ral Med Oral Pathol 1961;14 : 1130-7.SowDEN JR . A preliminary report on the recalcification oi'carious dentin. ASDC J Dent Child 1956; 23 : 187-8.SO. Stepwise excavation of deepcarious lesions in primary molars. .7 ^ ^ ' ^ Assoc Dent Child 1977;8: 36-40.

S, B E N D E R IB, Z IO N Z M. The dynamics of pulpinflammation: correlations between diagnostic data and ac-

tual histologic fmdings in the pulp. Oral Surg Oral MeFathol 1963; 16 : 846-7 L14. KOCH G , NYBORG H . Correlation between cHnica! and logical indications for pulpotomy of deciduous teeth.Assoc Dent Child 1970; 1: 3-10.15. SCHRODER U, Agreement between clinical and histfindings in chronic coronal pulpitis in primary teeth.J Dent Res 1977; 85 : 583-7 .16. BRANN STROM M , LIND PO. Pulpal response to early dcaries. J Dent Res 1965; 44 : 1045-50.17. BAUME L J . Dental pulp condi tions in relation to clesions. Int Dent J 1970; 20 : 309-37.1 8. L A N G E L A N D K, L A N G E L A N D LK. Indirect capping antreatm ent of deep carious lesions. In t Dent J 1968; 18 : 319. REEV ES R , STANLEY H R . The relationship of bacterial tration and pulpal pathosis in carious teeth. Oral SurMed Oral Pathol 1966; 22 : 59-71 .20. LANGELAND K . M ana gem ent of the inflamed p ulp assowith deep carious lesion. J Fndod 1981; 7; 169-81.21. TRowBRtDGE H O . 2. Pathogenesis of pulpitis resultingdental caries. J Endod 1981; /.- 52-60.22. L IN L , LANGELAND K . L ight and electron microscopic of teeth with carious pulp exposures. Oral Surg Oral M

Pathol 1981; 51 : 292-316.23. ToRNECK CD. I. A report of studies into change.s in thstructure of the dental pulp in human caries pulpitis. J1981; 7: 8-16.

24. LANGELAND K . Tissue response to dental caries, EndoTraumatol 1987; 3: 149-71.25. EIDELMAN E, ULMANSKY M, M I C H A E L I Y, Histopatholothe pulp in primary' incisors with deep de ntinal caries. PDent 1992; 14 : 372-5 ,26. MjOR IA, TRONSTAD L . Healing of experimentally inpulpitis. Oral Surg O ral Med Oral Pathol 1974; 38 : ! 1527 . Cox CF, B E R G E N H O L T Z G, H E Y S DR, SYED SA, FITZGEM , HEYS RJ, Pulp capping of dental pulp mechan

exposed to oral microflora: a 1-2 year observation of whealing in the monkey. J Oral Pathol 1985; 14 : 156-628. WARFINOE J, BERGENHOLTZ G, Healing capacity of hand monkey dental pulps following experimentally-inpulpitis. Endod Dent Traumatol 1986; 2: 256-62,29. BERGEN HOLTZ G, C O X CF, L O E S C H E W J , S Y E D SA, Baleakage around dental restorations: its effect on the pulp, J Oral Pathol 1982; 11 : 439-50.3 0 . G R A N A T H L - E , H A G M A N G. Experimental pulpotomy iman bicuspids with reference to tu t t ing techniqueOdontol Scand 1971; 29 : 155-63.31. SCHRODER U . Effect of extra-pulpal blood clot on hfollowing experimental pulpotomy and capping with

cium hydroxide. Odont Reiy 1973; 24 : 257-68.32. JORDAN RE, SUZUKI M, S K I N N E R DH. Indirect pulp-caof carious teeth with periapical lesions. J Am Dent1978; 97 ; 37-43.

33. COTTON W, L A N G E L A N D K, BURMEISTER J A , F A R E LEvaluation of carious teeth with apical radiolucenciindirect pulp capping. J Dent Re.^ Abstr 1983; 62 : 216,424,

34. FISHER FJ, The effect of a calcium hydroxide/water pasmicro-organisms in carious dentine. Br Dent J 197219-21,


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PartialpulpotomyinyoungpermanentteethMejareetal1993