Partial Vital Pulpotomy On Immature Permanent Teeth With Crown Fracture Involving Pulp

Aim:To study the effects of partial vital pulpotomy in treatment of immature permanent teeth with crown fracture involving pulp.Methods:Partial vital pulpotomy were taken on thirty-three immature permanent teeth with pulp exposure due to crown fracture. Under local anaesthesia with 4% Articaine hydrochloride and 1:100000 adrenalin, about 2mm pulp were removed by a diamond bur in high speed. After flushing out the dentin debris with physiologic saline and blotting with cotton ball, the pulp were covered wth calcium hydroxide pasta with a thickness of lmm. Then the teeth were restored with glass ionomer cement. After that, the crowns were restored with the breakdown-crown or light-cured resin. All these patients were recalled for clinical and radiographic evaluations after 2 weeks,1,3,6,12months.Results:Among the 33 immature permanent teeth, succeeded 28 teeth and failed 5 teeth, with 84.8% and 15.2% respectively. In 28 successful cases, radiographic images showed root development, and irregularity calcified plaque forming at the cross-section after 1 month,and calcified bridge forming after 3 months. As the time going, the images of calcified bridge became clear and pycnotic. There was no evidence of either resorption (internal or external) or periradicular pathologic changes. In 5 failed cases,2 cases were deal with partial vital pulpotomy with most coronal pulp exposure and large raw surface, 2 weeks later, the teeth went with spontaneous pain.1 case failed because of restoration falling off without coming for visit in time, when the patient came, the tooth had became dark.2 cases showed internal resorption of roots after 1 month and the crown became dark, suggesting the necrosis of pulp. In statistics, there was no statistically significant difference in the success rate with pulp exposure time more or less than 24 hours, with pulp exposure size larger or smaller than 1 mm (p>0.05)Conclusions:Partial vital pulpotomy is an effective treatment to deal with exposed pulp of immature permanent teeth with crown fracture.It can help preserve more healthy pulp to make the roots continue to develop. The exposure time and the exposure size of pulp have no direct correlation with the success rate of partial vital pulpotomy.