A healthy 67-year-old woman came in for her regular dental examination. During routine recall visits, we typically ask patients if there is anything they are unhappy with or want to change. This patient replied, “Just these black lines along my gums when I smile.” She was referring to the old existing PFMs on teeth Nos. 8, 9, and 10. We told her that we can do all-ceramic crowns to replace these unesthetic restorations. She was very excited to hear this option, agreed to the treatment, and scheduled the preparation appointment right away.
During the procedure everything went well, until the preparation of No. 10. While refining the underlying preparation of No. 10, I experienced a pulp ex- posure, which I believe to be due to a high pulp horn. I can only assume that the tooth was positioned slightly facial originally, and therefore required more facial reduction for the original PFM—putting the pulp horn even closer to the surface.
Upon exposure, we cleaned the area with hydrogen peroxide and confirmed there was no bleeding. Next, MTA (ProRoot, DENTPSLY Tulsa) was mixed and placed into the exposure. The MTA takes about 3 hours to set, so we usually re-appoint patients after using it and complete the procedure another day. But in this case, I used a series of steps that allowed me to finalize my crown preparation that same day.
Because TheraCal LC (BISCO) resin-modified calcium-silicate-filled liner is a light-cured material, I was able to place it over my minimal liner of ProRoot to seal in the MTA. (Incidentally, TheraCal LC is also excellent for both direct and indirect pulp capping). Then, I also used CLEARFIL SE Protect (Kuraray) and MicroPrime G (Danville) in an immediate dentin sealing technique to help reduce possible sensitivity and seal everything up. Then I removed the oxygen-inhibited layer with alcohol prior to taking the impression.
Impressions were taken and sent off to the lab for fabrication of all-ceramic crowns for the anterior 3 teeth, requesting a shade match to tooth No. 7.
The patient reported no symptoms on a follow-up call 4 days later, and the tooth tested normal and vital at the seating appointment 3 weeks after the pulp-capping procedure.