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Conservative approach of a symptomatic carious immature permanent tooth using a tricalcium silicate cement (Biodentine): a case report.

Villat C, Grosgogeat B, Seux D, Farge P - Restor Dent Endod (2013)

Bottom Line: At both 3 and 6 mon follow up, it was noted that the tooth was vital, with normal responses to thermal tests.Radiographic examination of the tooth indicated dentin-bridge formation in the pulp chamber and the continuous root formation.The use of tricalcium silicate cement should be considered as a conservative intervention in the treatment of symptomatic immature teeth.

View Article: PubMed Central - PubMed

Affiliation: Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Department of Conservative Dentistry and Endodontics, Faculté d'Odontologie, Université de Lyon, Hospices Civils de Lyon, Lyon, France.

ABSTRACT
The restorative management of deep carious lesions and the preservation of pulp vitality of immature teeth present real challenges for dental practitioners. New tricalcium silicate cements are of interest in the treatment of such cases. This case describes the immediate management and the follow-up of an extensive carious lesion on an immature second right mandibular premolar. Following anesthesia and rubber dam isolation, the carious lesion was removed and a partial pulpotomy was performed. After obtaining hemostasis, the exposed pulp was covered with a tricalcium silicate cement (Biodentine, Septodont) and a glass ionomer cement (Fuji IX extra, GC Corp.) restoration was placed over the tricalcium silicate cement. A review appointment was arranged after seven days, where the tooth was asymptomatic with the patient reporting no pain during the intervening period. At both 3 and 6 mon follow up, it was noted that the tooth was vital, with normal responses to thermal tests. Radiographic examination of the tooth indicated dentin-bridge formation in the pulp chamber and the continuous root formation. This case report demonstrates a fast tissue response both at the pulpal and root dentin level. The use of tricalcium silicate cement should be considered as a conservative intervention in the treatment of symptomatic immature teeth.

No MeSH data available.


Related in: MedlinePlus

(a) Immediate post-operative radiograph following silicate cement (Biodentine) placement and glass ionomer cement (Fuji IX) restoration; (b) Three months follow-up radiograph: formation of pulpal roof dentin bridge (white arrow) and root edification (black arrow); (c) Six months follow-up radiograph.
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Figure 2: (a) Immediate post-operative radiograph following silicate cement (Biodentine) placement and glass ionomer cement (Fuji IX) restoration; (b) Three months follow-up radiograph: formation of pulpal roof dentin bridge (white arrow) and root edification (black arrow); (c) Six months follow-up radiograph.

Mentions: Following caries removal, a partial pulpotomy was performed using a round low-speed carbide bur (H1.204.021, Komet France, Paris, France) under constant irrigation until a normal bleeding was obtained (Figure 1b). The hemostasis was obtained by irrigation with saline solution and application of sterile cotton pellets. Biodentine was processed according to the manufacturer's instruction by mixing a single-unit powder part (tricalcium silicate-dicalcium silicate-zircon dioxide) and 5 drops of a single-unit liquid part (calcium chloride-distilled water) for 30 seconds (Figure 1c). Figure 2a displays the immediate post treatment X-ray which shows the pulp capping material located at the roof of the pulp chamber. Direct pulp capping was performed with a 2 mm-thickness layer of the tricalcium silicate cement (Biodentine). The tooth #45 was restored with conventional glass ionomer cement (Fuji IX extra, GC Corp., Tokyo, Japan) and checked for centric occlusion. At a postoperative phone call the following day, the patient reported complete cessation of the painful episode within 12 hours after completion of the treatment. At seven day follow-up, a clinical examination found responses to thermal pulpal tests within normal limits for a non-inflammatory pulp (hot and cold were discriminated and the response did not exceed the stimulus duration). At a three months recall, a clinical examination showed a normal pulpal sensitivity. There were no clinical or radiographic signs of root resorption or apical periodontitis. A radiograph showed morpho-differentiation of a dentin bridge immediately under the tricalcium silicate cement. (Figures 2b and 2c). Root formation had occurred and a thickening of the root dentin walls was noted. At 6 month recall, the bevel-shaped ends of the dentin at 3 months appeared to change to thicker round-shaped root-dentin walls.


Conservative approach of a symptomatic carious immature permanent tooth using a tricalcium silicate cement (Biodentine): a case report.

Villat C, Grosgogeat B, Seux D, Farge P - Restor Dent Endod (2013)

(a) Immediate post-operative radiograph following silicate cement (Biodentine) placement and glass ionomer cement (Fuji IX) restoration; (b) Three months follow-up radiograph: formation of pulpal roof dentin bridge (white arrow) and root edification (black arrow); (c) Six months follow-up radiograph.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3843039&req=5

Figure 2: (a) Immediate post-operative radiograph following silicate cement (Biodentine) placement and glass ionomer cement (Fuji IX) restoration; (b) Three months follow-up radiograph: formation of pulpal roof dentin bridge (white arrow) and root edification (black arrow); (c) Six months follow-up radiograph.
Mentions: Following caries removal, a partial pulpotomy was performed using a round low-speed carbide bur (H1.204.021, Komet France, Paris, France) under constant irrigation until a normal bleeding was obtained (Figure 1b). The hemostasis was obtained by irrigation with saline solution and application of sterile cotton pellets. Biodentine was processed according to the manufacturer's instruction by mixing a single-unit powder part (tricalcium silicate-dicalcium silicate-zircon dioxide) and 5 drops of a single-unit liquid part (calcium chloride-distilled water) for 30 seconds (Figure 1c). Figure 2a displays the immediate post treatment X-ray which shows the pulp capping material located at the roof of the pulp chamber. Direct pulp capping was performed with a 2 mm-thickness layer of the tricalcium silicate cement (Biodentine). The tooth #45 was restored with conventional glass ionomer cement (Fuji IX extra, GC Corp., Tokyo, Japan) and checked for centric occlusion. At a postoperative phone call the following day, the patient reported complete cessation of the painful episode within 12 hours after completion of the treatment. At seven day follow-up, a clinical examination found responses to thermal pulpal tests within normal limits for a non-inflammatory pulp (hot and cold were discriminated and the response did not exceed the stimulus duration). At a three months recall, a clinical examination showed a normal pulpal sensitivity. There were no clinical or radiographic signs of root resorption or apical periodontitis. A radiograph showed morpho-differentiation of a dentin bridge immediately under the tricalcium silicate cement. (Figures 2b and 2c). Root formation had occurred and a thickening of the root dentin walls was noted. At 6 month recall, the bevel-shaped ends of the dentin at 3 months appeared to change to thicker round-shaped root-dentin walls.

Bottom Line: At both 3 and 6 mon follow up, it was noted that the tooth was vital, with normal responses to thermal tests.Radiographic examination of the tooth indicated dentin-bridge formation in the pulp chamber and the continuous root formation.The use of tricalcium silicate cement should be considered as a conservative intervention in the treatment of symptomatic immature teeth.

View Article: PubMed Central - PubMed

Affiliation: Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Department of Conservative Dentistry and Endodontics, Faculté d'Odontologie, Université de Lyon, Hospices Civils de Lyon, Lyon, France.

ABSTRACT
The restorative management of deep carious lesions and the preservation of pulp vitality of immature teeth present real challenges for dental practitioners. New tricalcium silicate cements are of interest in the treatment of such cases. This case describes the immediate management and the follow-up of an extensive carious lesion on an immature second right mandibular premolar. Following anesthesia and rubber dam isolation, the carious lesion was removed and a partial pulpotomy was performed. After obtaining hemostasis, the exposed pulp was covered with a tricalcium silicate cement (Biodentine, Septodont) and a glass ionomer cement (Fuji IX extra, GC Corp.) restoration was placed over the tricalcium silicate cement. A review appointment was arranged after seven days, where the tooth was asymptomatic with the patient reporting no pain during the intervening period. At both 3 and 6 mon follow up, it was noted that the tooth was vital, with normal responses to thermal tests. Radiographic examination of the tooth indicated dentin-bridge formation in the pulp chamber and the continuous root formation. This case report demonstrates a fast tissue response both at the pulpal and root dentin level. The use of tricalcium silicate cement should be considered as a conservative intervention in the treatment of symptomatic immature teeth.

No MeSH data available.


Related in: MedlinePlus