In young patients, the aim of treatment should be to
maintain a healthy pulp to permit closure of the root
apex and to encourage development of lateral root
dentine. Partial pulpotomy or pulp-capping procedures
are indicated for complicated crown fractures in these
teeth. The partial pulpotomy procedure described by
Cvek
(i.e., removal of a portion of the pulp using a
“gentle technique” (high speed diamond bur with
copious water spray), elimination of the blood clot (by
irrigation) and capping with calcium hydroxide or
MTA followed by regular recall), has been regarded as
the treatment of choice.
Since resin-based quick-
setting calcium hydroxide preparations inhibit
polymerization of composite resin materials, their use
in these circumstances should probably be avoided.
Should deep pulpotomy (rather than partial pulpotomy)
procedures be necessary due to major crown loss in
immature teeth, the problem of calcific bridge
formation at the pulpotomy site, which may obstruct
pulpectomy procedures at a later date, can be overcome
by the use of a corticosteroid/antibiotic combination
(e.g., Ledermix® Paste or Endopaste®) rather than a
calcium hydroxide material.
As with any conservative
pulp therapy procedure, it is important that the
medicament is placed directly onto healthy non-
inflamed tissue and that the exposure site is protected
against bacteria. In older patients, where the success
rate for conservative pulp therapy on mature
traumatized teeth is less predictable and tooth
formation is complete, routine endodontic therapy is
more likely the treatment of choice. Nevertheless, since
it has been shown that partial pulpotomy procedures
can still be successful in older patients, the decision
whether or not to retain the pulp is more often
governed by the amount of remaining root dentine and
the requirements for crown retention rather than
whether the pulp is exposed or not. Although the out-
come may not be as predictable in the long term, partial
pulpotomy procedures can provide an expedient and
much cheaper treatment option for some patients,
particularly if there is sufficient tooth structure
remaining for the crown to be restored with a
composite resin material or by re-cementation of the
fractured segment.