MTA pulpotomy on immature permanent molar
Jon Richards DDS MS
This is an interesting case that included treatment desinged to preserve the vitality of the radicular pulp and encourage continued root maturation – rather than proceed with root canal therapy.
8 yowf referred for evaluation of tooth #19. Hx of recent restorative appointment where deep caries was removed but procedure stopped due to proximity to the pulp. At time of eval #19 was asymptomatic but pt reports onset of spontaneous pain for the past 3 days (required ibuprofen at night). Excellent behavior.
Clinical/Radiographic exam: #19 extensive coronal resin restoration near the pulp. Incomplete eruption (very high tissue level), immature apical formation. #19 WNL to perc and palp, responds WNL to cold.
Primary hope is to preserve pulpal vitality and allow continue root development and eruption. MTA pulpotomy and restoration will be first option. Pt returned 3 weeks later for treatment.
Anesthesia, rubber dam isolation (this is critical, but was difficult due to partial eruption), access. Pulp vital, very hyperemic. Removed coronal pulp, challenging hemostasis because of the volume of pulp tissue. Disinfected chamber, placed white MTA over canals, covered with RMGIC (Fuji triage). Etch, bond, placed composite core in access.
At 5 month recall, the radiographic appearance of the periapical bone had me bery concerned. We decided to wait and monitor. She came in again yesterday and it looked much more favorable. Hopefully it continues to be asymptomatic and I plan to see her yearly for recalls.