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Partial Pulpotomy on Permanent Incisor with Biodentine™ Dr Guzman De Hoyos Editorial

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Partial Pulpotomy on Permanent Incisor with Biodentine™ Dr Guzman De Hoyos Editorial aseSeptodont tudies CNo. 19 - January 2020 S Collection Ridge augmentation and simultaneous implant placement with RTR Dr Bozidar Brkovic Alveolar ridge preservation with RTR Prof. Bozidar Brkovic Partial pulpotomy on permanent incisor with Biodentine™ Dr Guzman de Hoyos Editorial Since its foundation Septodont has developed, manufactured and distributed a wide range of high quality products for dental professionals. Septodont recently innovated in the field of endodontics, dentine care, bone grafting and gingival preparation with the introduction of BioRoot™ RCS, Biodentine™, RTR and Racegel which are appreciated by clinicians around the globe. Septodont created the “Septodont Case Studies Collection” - a series of case reports - in 2012 to share with you their experience and the benefits of using these innovations in daily practice. Over the past 6 years, authors from more than 15 countries have generously contributed to the success of our magazine that is now distributed on the 5 continents. Each new issue of the Case Studies Collection is the opportunity to discover new clinical challenges and their treatment solutions. This 19th issue features two RTR case and one Biodentine™ cases : RTR Bone grafting aims at preserving bone dimensions especially when tooth removal is discussed. It is fully resorbable & osteoconductive. Its remarkable properties promotes formation of patient’s new bone & paves the way for future successful treatment plans. Biodentine™, the first biocompatible and bioactive dentin replacement material. Biodentine™ uniqueness not only lies in its innovative bioactive and “pulp-protective” chemistry, but also in its universal application, both in the crown and in the root. 2 Content Partial pulpotomy on permanent molar with Biodentine™ 04 Dr Guzman de Hoyos Ridge augmentation & simultaneous implant placement with RTR 09 Prof. Bozidar Brkovic Alveolar ridge preservation with RTR Prof. Bozidar Brkovic 15 3 Partial pulpotomy on a lower permanent incisor with complicated fracture of the crown and open apex using Biodentine™. 13 months follow-up: a Case report Authors: Guzman de Hoyos A.I., Rodríguez Villarreal O., Reyes Martell Casale P., Yañez Pérez C., Molina Montoya D.E.. Abstract Traumatology in pediatric dentistry is an The objective of this article is to present a important issue due to the early eruption of the trauma case in which a permanent lower incisor permanent dentition and its consequences. is involved. Based on the radiographic analysis Trauma in pediatric dentistry often involves and the anamnesis we decided to perform a permanent tooth and the treatment needs to partial pulpotomy. The biomaterial used was be carefully selected by the clinician. There Biodentine™ and the tooth fragment was reat- are several factors that are determinant in the tached. This is a 13-month partial pulpotomy prognosis and/or success of the treatment, follow-up. such as duration of pulpal exposure, irrever- sible pulpitis signs, root development and the clinical scenario. (1,2) 4 Introduction Crown fractures and luxations occur more The aim of apexogenesis is the preservation of frequently of all dental injuries. An appropriate vital healthy pulp tissue so that continued root diagnosis and treatment plan are important for development with apical closure occurs.(6,7) a good prognosis, the IADT (International asso- Historically, calcium hydroxide used to be the ciation of dental traumatology) has developed a material of choice for vital pulp therapy. Later, consensus about the procedures that enhance upon introduction of mineral trioxide aggregate the prognosis and treatment success.(4) (MTA), this bioactive material became the gold Complicated fractures of the crowns should be standard. Recently, some other calcium-silicate managed as follows: based cements from this aggregate were In young patients with immature, still developing invented such as calcium-enriched mixture teeth, is advantageous to preserve pulp vitality (CEM) cement and Biodentine™ that can be by pulp capping or partial pulpotomy. This favorable vital pulp therapy agents.(6,7) treatment is also the choice in young patients Biodentine™ (Septodont, Saint-Maur-des-Fossés, with completely formed teeth.(4) France) is a calcium-silicate based material and If too much time elapses between accident and has several clinical applications. Biodentine™ treatment and the pulp becomes necrotic, root is a bioactive inorganic calcium silicate-based canal treatment is indicated to preserve the cement that increases biomineralization and tooth.(4) pulp cell proliferation.(8) Partial pulpotomy is defined as the removal Biodentine™ presentation consists of powder of a small portion of coronal pulp tissue after and liquid components. The powder contains exposure, followed by application of a bioma- tricalcium silicate, dicalcium silicate, and calcium terial directly onto the remaining pulp tissue oxide; The liquid consists of calcium chloride prior to placement of a permanent restoration.(3) and a carboxylate-based hydro-soluble polymer Partial pulpotomy it is a Vital pulp therapy that serves as the water reducing agent.(8) (VPT). Vital pulp therapy of immature teeth is Biodentine™ is a very practical product, after performed to encourage physiological deve- 12 minutes a final restoration can be over it to lopment and formation of the root end and promote the restoration seal and enhance the apical closure; this procedure is also referred to prognosis avoiding leaking and contamination as apexogenesis.(5,6) of the pulp. Case report Female patient 7 years and 6 months old arrives to the office with a dental trauma history. After Fig. 1: Initial situation. the informed consent was signed we perform our clinical review protocol. On the clinical exploration we found a lower incisor with complicated fracture of the crown, according with the mother testimony it had been 2 hours since trauma occurrence (Fig 1, Fig 2). Then we proceed to periapical X Ray and it was confirmed the communication of the pulp and the open apex. According the IADT Fig. 2: Initial situation. 5 when a complicated fracture of the crown is presented and there is no signs of irreversible pulpitis we should maintain the pulpal vitality performing partial pulpotomy. In this case the partial pulpotomy has 2 objectives: to maintain the pulp vitality and promote the apex closure (Fig 3, Fig 4). After the anesthesia (Scandonest, Septodont) was infiltrated weFig. 3: First radiograph. Fig. 4: Clinical situation, incisal view. proceed to tooth isolation with on the white capsule holder, the liquid container rubber dam (Nictone, México), and Hu Friedy was detached and then 5 drops were poured into clamp. Partial pulpotomy was performed with the capsule, capsule was mixed for 30 seconds, diamond ball bur, high speed with water irrigation Biodentine™ was placed direct on the amputated handpiece. The bleeding was controlled with pulp and was gently packed with a sterile pellet sterile cotton pellets. Disinfection was made (Fig 5-8). with sodium hypochlorite for 1 minute. After Biodentine™ was placed, adhesive A Biodentine™ capsule was used as per the procedures were done, the tooth fragment manufacturer instructions: capsule was placed was beveled with a high speed diamond bur to Fig. 5: Isolation achieved. Fig. 6: Partial pulpotomy. Fig. 7: Biodentine™ capsule and liquid. Fig. 8: Biodentine™ setting after 12 minutes. 6 enhance adhesion, selective enamel etch was then finishing and polishing were done(Fig 9-12) . performed with phosphoric acid (Ultra Etch) The first radiograph was done immediately for 15 seconds, after rinsing and drying, a postoperatively, the second radiograph was Premio Bond (GCAmerica) was placed and after done 30 days after treatment. radiograph and 20 seconds was light cured, reattachment was follow-up pictures were done after 13 months. done with fluid resin (Brilliant Flow, Coltene) and (Fig 13-16). Fig. 9: Tooth was beveled. Fig. 10: GC Premio bond after enamel Fig. 11: Picture after light curing: frontal selective etch. view. Fig. 12: After finish and polish. Fig. 13: Inmediatly after treatment. Fig. 14: After 30 days. Fig. 15: 13 Months radiographic control. Fig. 16: 13 Months clinical control. Discussion As literature suggest the treatment for compli- exposure time, partial pulpotomy could be cated fractures of the crown depends on several done with a biomaterial as Biodentine™ that factors as root development, pulpal exposure promotes the pulpal health, apex closure and duration, irreversible pulpitis among others. In allows us to perform a definitive restoration on cases with open apex, healthy pulp and short top of it. 7 Conclusion Biodentine™ is a biomaterial with several on a lower central incisor and after 13 months indications, in cases of trauma specially follow up it has promoted the apex closure and when pulp is involved can be used in order kept the pulp vitality. to preserve the pulp vitality and allow the The use of Biodentine™ in cases like this can correct development of the tooth. In this case, be done with excellent clinical and radiographic Biodentine™ was used in a partial pulpotomy results. Author: M.C.O.: Aldo Ivan Guzman de Hoyos. Master in pediatric dentistry by the Universidad Autónoma de Coahuila U.T. Teacher at the Universidad Autónoma de Durango Campus Monclova. Teacher at Universidad AME, Monterrey Nuevo León. Private Office since 2011. [email protected] Corregidora 1001 L 26 - Nueva Rosita - Monclova, Coahuila, México. Zip Code 25710 - tel. +52 1 8666354893 (Office) - +52 1 8661360415 (Personal) References 1. Luca Boschini F, Home management of crown fractures of two Home management of crown fractures of two central incisors complicated by exposure of the pulp, Giornale Italiano di Endodonzia (2018) 32, 76-79 2. Viduskalne I, Care R. Analysis of the crown fractures and factors affecting pulp survival due to dental trauma. Stomatol Baltic Dent Maxillofac J 2010;12:109-15. 3. Duncan HF, Galler KM, Tomson PL, Simon S, El-Karim I, Kundzina R, Krastl G, Dammaschke T, Fransson H, Markvart M, Zehnder M, Bjørndal L, European society of endodontology position statement: Management of deep caries and the exposed pulp.
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