ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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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) 12519051Blanco/200236 patients with 40 anterior crown fractures treated with partial pulpotomyCase Series
Key resultsIn 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) 23128488Gudkina/2012Lit Review of 36 different studies and no Meta-Analysis completedNarrative Review
Key resultsOf 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: 03/06/2014spacer
E-mail hanksb@livemail.uthscsa.edu
Author Benjamin Hanks
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Maria Mendez Cervantes, DDS
Faculty mentor/Co-author e-mail cervantesMen@uthscsa.edu
Basic Science Rationale
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