Coronal Pulpotomy Using MTA for Management of Irreversible Pulpitis in Mature Permanent Mandibular Molar: A Case Report

INTRODUCTION

Root canal treatment is considered as the most common method for management of vital mature permanent teeth with irreversible pulpitis or carious pulpal exposure.¹ Alternatively, vital pulp therapy procedures like pulpotomy have proven to be successful for treatment of immature permanent teeth, eventually leading to complete root formation (apexogenesis). However, there is extensive research which suggests that inflammation of pulp can be controlled allowing the tissue to heal, regardless of root formation, thus paving the way for more conservative and minimally invasive treatment protocols, apart from RCT.²

A pulpotomy is defined as “the removal of the coronal portion of the vital pulp as a mean of preserving the vitality of the remaining radicular portion”.³

With the help of biomimetic materials, conservative procedures like pulpotomy offer great advantages over root canal treatment such as: less challenging treatment protocol, minimal removal of tooth structure, preservation of proprioception sensation of the tooth, retention of regenerative and repair potential of the pulp, less time consuming and cost effective procedure for the patient as well as the dental practitioner.^1,4

Calcium hydroxide was the most common material used for vital pulp therapy procedures due to it’s ability to stimulate reparative dentin formation. However, studies have reported tunnel defect formation leading to microleakage and failure of treatment. In the last few decades, bioactive calcium silicate-based materials, such as MTA and Biodentine, have become popular owing to their biocompatibility and excellent sealing ability and are considered as more suitable materials for pulpotomy in mature teeth.

This case report presents a successful pulpotomy performed using MTA in a mature permanent molar with carious exposure.

CASE REPORT

A 22 year old patient reported to the Department of Dentistry, GTB Hospital, New Delhi with the chief complaint of pain on food lodgement in lower left back tooth region. Clinical and radiographic examination revealed carious lesion in mandibular first molar, involving coronal portion of the pulp. (Fig 1)

The patient had no significant medical history. The patient was explained about the procedure and informed consent was taken for the same.

Local Anesthesia was given followed by rubber dam isolation. Access cavity was prepared after caries removal using a carbide round bur and an Endo Z bur to refine the cavity. (Fig 2)

Pulp excavation was performed till the level of canal orifices. Hemostasis was achieved using a cotton pellet saturated with sodium hypochlorite. MTA was mixed in the ratio of 3:1 (powder to liquid) and placed in the access cavity. (Fig 3)

It was then covered with a moist cotton and temporary restoration was placed to allow the setting of MTA.

In the next appointment, 2 days later, patient reported with no pain or discomfort, following which the temporary material was removed and the cavity was restored using composite. (Fig 4 and 5)

DISCUSSION

In the last few decades, there has been immense research in the field of pulp biology and regeneration in response to calcium silicate materials, paving the way for conservative treatment protocols such as coronal pulpotomy in cases even with irreversible pulpitis.^5,6

MTA is a bioactive material with good physical characteristics and excellent sealing ability. Multiple studies have reported successful management of deep carious lesions using MTA.^7,8 Hence it was chosen as an ideal material for pulp capping in this case.

Coronal pulpotomy has been proven to be highly successful offering an alternate treatment option compared to full pulpectomy owing to the less invasive nature along with utilisation of the pulp’s innate potential for regeneration using materials which promote the formation of a protective barrier to preserve the vitality of the radicular pulp. However, the success of the treatment depends on proper diagnosis of the case along with age and previous dental history. So proper case selection and strict guidelines for diagnosis and treatment is imperative for favourable treatment outcome.

CONCLUSION

In the current case, a successful coronal pulpotomy was carried out to manage a deep carious lesion in a mandibular first molar using MTA. Given the rise of minimal invasive procedures in everyday dental practice, coronal pulpotomy offers a great solution as a definitive treatment modality for cases with irreversible pulpitis, overcoming the need for more invasive endodontic treatment.

REFERENCES