Dr. Cohn is a general dentist, devoted solely to the practice of dentistry for children. She maintains a private practice in Winnipeg, Manitoba, Canada and is a part-time clinical instructor in undergraduate pediatric dentistry at the University of Manitoba. Dr. Cohn is proud to be an active member of several dental organizations and societies and an invited fellow of Pierre Fauchard Academy and the International College of Dentists. She enjoys teaching continuing education on all aspects of children’s dentistry for the general practitioner.
Puloptomies are not new to dentistry, but the steps and materials used to approach this vital pulp therapy have evolved significantly over the past several years. While formocresol was considered the material of choice for pulpotomies for many years, the industry turned away from it when news came out that chronic exposure to high levels of formaldehyde, a component of formocresol, could cause cancer. Then came the MTA and MTA-like materials, which worked well but were expensive, difficult to mix, and had a long setting time. Over time, manufacturers started developing better materials that were easier to work with, such as TheraCal PT, a unique option that is dual cured, syringeable, and immediately curable.
Of course, not every primary tooth is a candidate for vital pulp therapy. We need a responsive pulp that will react normally to pulp stimuli and that isn’t giving the child spontaneous pain. The inflammation must be capable of healing, and the tooth also must be restorable.
Case in Point
A 4-year-old girl presented with gross caries in all 4 quadrants, including asymptomatic gross caries extending to the pulp on tooth No. 20, her lower right second primary molar (Figure 1). I used rubber dam isolation and prepared the tooth for full coverage, as it would receive a stainless-steel crown at the end of the pulpotomy procedure (Figure 2). I opened up the roof of the chamber with a coarse diamond bur in a highspeed handpiece to uncover the pulp that was not visible in the carious exposure (Figure 3). Then, I used a slow-speed #8 round bur to amputate the coronal pulp, irrigated out the amputated coronal pulp remnants, and used cotton pellets moistened with saline to apply pressure and stop the bleeding (Figures 4-6).
Next, TheraCal PT was extruded into the coronal pulp chamber to ensure contact with the radicular pulp stumps (Figure 7). I gave a flash cure to the initial 1-mm layer of TheraCal PT and then checked to make sure the material was tapped down. Once I was sure the TheraCal PT was in contact with the radicular pulp stumps without any voids, I gave it a full cure, and then added more TheraCal PT, ending at a layer of about 2 to 4 mm in the coronal pulp chamber (Figure 8).
Speedier Procedures
The whole procedure takes only about 6 minutes—a couple minutes of crown prep and then the pulpotomy procedure, depending on how long it takes to achieve hemostasis. The beauty of using TheraCal PT compared with similar materials designed for pulpotomies is that you can cure it and carry on with the procedure right away without waiting for the material to cure.
It gives the dentist the flexibility to, if the clinical situation is appropriate, do a composite resin over the top of the pulpotomy rather than doing a crown. Most dentists are much more comfortable placing a composite resin vs a stainless-steel or zirconia crown. And because TheraCal PT is radiopaque, it’s easy to see on radiographs and to monitor at recall visits.
References
*BISCO has, on file, data for TheraCal PT.
1. Okabe T, Sakamoto M, Takeuchi H, Matsushima K. Effects of pH on mineralization ability of human dental pulp cells. J Endod. 2006; 32(3):198-201.
