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| Title |
A Partial Pulpotomy is an Effective Treatment for patients with Complicated Crown Fractures (CCFs) of Young Permanent Incisors |
| Clinical Question |
In a young patient with a complicated crown fracture of a developing permanent incisor, does a partial pulpotomy offer a better prognosis than a direct pulp cap? |
| Clinical Bottom Line |
Reports indicate that a partial pulpotomy is a highly successful treatment for complicated crown fractures, but there are no studies directly comparing it to direct pulp capping. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 12519051 | Blanco/2002 | 36 patients with 40 anterior crown fractures treated with partial pulpotomy | Case Series | | Key results | In patients with traumatic crown fractures, a partial pulpotomy, at a depth of 1 to 2 mm below the pulp exposure point, followed by application of calcium hydroxide appropriate sealing of the cavity, was deemed a successful treatment in nearly every treated case in the study, with clinical and radiographic follow-up occurring from one to 12 years post-treatment. | | #2) 23128488 | Gudkina/2012 | Lit Review of 36 different studies and no Meta-Analysis completed | Narrative Review | | Key results | Of the 36 studies laid out in the review, 21 directly studied the effectiveness of partial pulpotomies in traumatically exposed teeth followed by application of calcium hydroxide or MTA, and found it to be successful at rates ranging from 85-100%, with about half of them reporting a 100% success rate. | |
| Evidence Search |
("dental pulp"[MeSH Terms] OR ("dental"[All Fields] AND "pulp"[All Fields]) OR "dental pulp"[All Fields] OR "pulp"[All Fields]) AND exposure[All Fields] AND permanent[All Fields] AND ("incisor"[MeSH Terms] OR "incisor"[All Fields] OR "incisors"[All Fields]) AND ("pulpotomy"[MeSH Terms] OR "pulpotomy"[All Fields]) AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) |
Comments on
The Evidence |
The studies above represent an acceptable level of clinical evidence supporting partial pulpotomies as a preferred treatment. Adequate follow-up occurred—ranging from one to 12 years, and there were no reported competing interests. There were not, however, any recent studies that specifically compared direct pulp caps to partial pulpotomies. Such studies should be completed for a more direct comparison. Additionally, the materials used (frequently calcium hydroxide and mineral trioxide aggregate) also play a role worth investigating. |
| Applicability |
This is applicable to oral health care professionals treating patients with complicated crown fractures, specifically young patients with developing permanent dentition. Providers often need to make a quick decision with regards to the treatment of patients with exposed pulp who have experienced facial trauma. |
| Specialty/Discipline |
(Endodontics) (General Dentistry) (Pediatric Dentistry) |
| Keywords |
partial pulpotomy, crown fracture, pulp exposure, permanent incisor, direct pulp cap, pulp prognosis, cvek pulpotomy.
|
| ID# |
2674 |
| Date of submission: |
03/06/2014 |
| E-mail |
hanksb@livemail.uthscsa.edu |
| Author |
Benjamin Hanks |
| Co-author(s) |
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| Co-author(s) e-mail |
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| Faculty mentor/Co-author |
Maria Mendez Cervantes, DDS |
| Faculty mentor/Co-author e-mail |
cervantesMen@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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