Bioceramic cements in pulpotomy. MTA and bioceramic repair cements in general are the gold standard for pulpotomy in the treatment of teeth with pulp vitality and incomplete rhizogenesis.
The following is a basic guide to using the material, recommended in our postgraduate courses in endodontics.
In: Santos & Machado. Pulpotomy in permanent teeth. UNIUBE,2019.
- INTRODUCTION
The dental pulp is a loose, vascularized tissue located inside the
dentin walls. This tissue plays a very important role in the
longevity of the tooth, whose functions are: formative, sensitive, nutritive and defensive.
Exposure of the pulp can be caused by various factors, such as caries, fracture,
cracks or an open restoration margin, which will cause inflammation of the
pulp tissue and may result in necrosis if intervention is not carried out
soon (SOLOMON et al.. 2015), 2015).
It is important to note that studies have been carried out in these cases and
one of the proposed interventions is pulpotomy, which is nothing more than the removal
of part or all of the crown pulp, which has suffered reversible
or irreversible pathological changes, thus maintaining the vitality of the rest of the dental
remnant. The benefit of maintaining the vitality of the pulp is extremely important,
since it maintains all of the tooth's proprioception functions (ZANINI;
HENNEGUIN; COUSSON, 2016).
There is controversy regarding the effectiveness of pulpotomy as a treatment for
permanent teeth, given that, in most cases, this type of
treatment is indicated for deciduous teeth or permanent molars without
apicification. However, recent studies have shown success rates when
carried out on permanent teeth (KUMAR et al., 2016).
The success behind pulpotomy procedures is based on
several factors, such as the ability to restructure the remaining root pulp,
removal of all infected pulp tissue and the placement of a suitable
medication for the treatment to be carried out. When choosing the medication to be used, it is
important to look at its biocompatibility, sealing capacity and antimicrobial
activity when it is placed in contact with the inflamed pulp
(SOLOMON et al., 2015).
Studies have shown that Calcium Hydroxide and Trioxide
Mineral Aggregate have been the most effective medications used in this type
of treatment. Calcium hydroxide shows positive results, but due
to its restrictions, it has fallen out of favor in pulpotomy in recent years (TAHA;
AHMAD; GHANIM, 2017).
Calcium hydroxide has bactericidal properties and great capacity
to form mineralized tissue in human teeth, but studies show
several disadvantages, such as poor adhesion to dentin, poor sealing capacity
, unpredictable dentin bridge formation and the presence of defects, which
can act as infiltration pathways (NOSRAT; PEIMANI; ASGARY, 2013).
On the other hand, MTA (Mineral Trioxide Aggregate) has been widely
used, obtaining favorable studies ever since it was introduced into endodontics.
Due to its advantages over other materials used, for example,
has excellent marginal adaptation, induces cell proliferation,
biocompatibility, as well as good dentin bridge formation in cases of
direct capping and pulpotomy (BARNGKGEI; HALBOUB; ALBONI, 2013).
Currently, MTA (Mineral Trioxide Aggregate) is considered the ideal material
for treating vital pulp in permanent teeth, but some professionals report
difficulty in handling and mixing MTA (Mineral Trioxide Aggregate
) and tooth discoloration after treatment. Consequently, more recent calcium silicate-based
materials, such as Biodentine, have the same
properties as the original MTA, but with easier handling and without
discoloration. Biodentine has several advantages including good sealing capacity
adequate compressive strength and a relatively short initial setting time
(TAHA, 2018).
According to the studies presented, pulpotomy has emerged as a
treatment option for permanent teeth with irreversible pulpitis, with an
acceptable medium-term clinical success rate. However, the long-term effectiveness rate
remains questionable, depending on various factors surrounding the
treatment (KUMAR et al. 2016).
