Dental pulp inside your tooth can incur damage due to untreated cavities, trauma and prolonged toothaches (pulpitis). Vital pulp therapy is treatment that aims to preserve and maintain compromised pulp tissue that isn’t dead. Endodontists treat dental pulp disease with vital pulp therapies such as indirect and direct pulp capping, pulpotomy when inflammation is limited to the crown, or pulpectomy when inflammation has spread to the tooth root.
At Advanced Endodontics of New York, our skilled endodontists combine advanced technology with a compassionate touch to deliver tooth-saving pulp capping, pulpectomy and pulpotomy in New York, NY. For both pediatric and adult patients, we offer sedation in addition to local anesthesia.
Pulpotomy techniques for primary (baby) teeth have been standard practice in pediatric endodontics for decades. The procedure is sometimes referred to as a “baby root canal.” The goal of a pulpotomy is to preserve the pulp, prevent pain and swelling and ultimately prevent tooth extraction. In a partial pulpotomy in New York, NY, our endodontists remove superficial infected or irreversibly injured pulp, followed by direct capping of the residual healthy pulp. A complete pulpotomy is often required when the coronal pulp is heavily inflamed or has questionable vitality. During this procedure, inflamed pulp is removed from the chamber, thoroughly disinfected, protected with a layer of bioactive material and then the tooth is sealed with a composite restoration. After a pulpotomy in primary back molars, a stainless steel crown is placed to re-establish normal oral function and continue to hold the space until the child’s permanent tooth erupts. On upper front teeth, either a stainless steel crown or a white esthetic stainless steel crown is used.
In mature permanent teeth with irreversible pulp inflammation, root canal is typically the treatment of choice. Yet studies confirm that pulpotomy is a safe and predictable alternative treatment option for permanent teeth with irreversible pulpitis. One study concluded the success rate was up to 90% in MTA pulpotomy performed in permanent teeth in children that were indicated for root canal therapy. Another study reported success rates of 100% at one year and 92.7% at three years after MTA pulpotomy in mature permanent teeth in which pulp was exposed due to decay.
In some cases, healthy (non-infected) pulp tissue is exposed or nearly exposed, even when decay hasn’t penetrated all the way into the pulp chamber. Pulp capping is considered prior to removing decay in deep cavities. Direct and indirect pulp capping has been used for many years to preserve the health and vitality of pulp and enhance its ability to form new dentin.
Indirect pulp capping: When decay is close to the pulp, this procedure preserves dentin in vital, otherwise healthy teeth to prevent pulp exposure. During one-stage pulp capping techniques, all or the majority of decay is removed, bioactive material is placed near but not in direct contact with the pulp and the final restoration is placed in one visit. In two-stage or stepwise pulp capping, all decay in tooth enamel is removed, but decayed dentin adjacent to the pulp chamber is left untouched. A medicament is placed over the remaining decay, a temporary restoration is installed and the final restoration is placed two months later. Recent studies show survival rates of greater than 90% for permanent teeth after indirect pulp capping, without adverse clinical symptoms or issues on X-rays. A 2020 study determined that stepwise pulp capping was a safer technique in permanent teeth in children.
Direct pulp capping: This method is reserved for permanent teeth with exposed pulp. The AAPD recommends using direct pulp capping on primary teeth only when exposure results from mechanical trauma. During this procedure, decay is removed and a sedative material is used to protect the pulp from bacteria until dentin repairs itself. Then a temporary or permanent filling is placed to strengthen the tooth and restore function.
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