Vital Pulp Therapy in Carious Teeth With Hypomineralization
Dental Caries Extending to Pulp, Molar Incisor Hypomineralization
About this trial
This is an interventional treatment trial for Dental Caries Extending to Pulp focused on measuring Vital pulp therapy, Indirect pulp treatment, Partial (Cvek) pulpotomy, Complete (cervical) pulpotomy, Enamel hypomineralization defects, Molar incisor hypomineralization, Children
Eligibility Criteria
Inclusion Criteria:
- Healthy patient between 6-16 years.
- Tooth with enamel hypomineralization defect
- Molar tooth with deep caries
- Restorable molar tooth
- No soft tissue swellings, mobility or tenderness to percussion
- Bleeding from all canals (when performing cervical pulpotomy)
- Reversible / Irreversible pulpitis (as indicated by positive response to pulp testing using cold test)
Exclusion Criteria:
- Medically compromised patient
- Non-restorable tooth
- Presence of dental abcess / sinus tract
- Periodontally compromised teeth
Sites / Locations
- Jordan University of Science and Technology
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
IPT (Indirect pulp treatment) group
Cvek/partial pulpotomy group
Cervical pulpotomy group
In this group, complete caries excavation from the dentin-enamel junction will be done. Caries near the pulp will be removed with caution until the remaining dentin shows increased resistance to manual instrumentation. A layer of resin-modified glass ionomer (RMGI) dressing material will be placed (Vitrebond; St.Paul, MN), followed by resin-modified glass ionomer (RMGI) build-up material (Vitremer; St. Paul, MN), and the final restoration of choice for MIH involved teeth; a preformed Stainless Steel Crown (SSC).
In this group, partial pulpotomy will be attempted first, inflamed pulp tissue will be removed until healthy pulp tissue is reached (2-4mm depth), as indicated by healthy bleeding and arrest of hemorrhage upon pressure with a cotton pellet moistened with 2.5% NaOCl for 2-5 minutes and repeated twice if required; otherwise, cervical pulpotomy will be done. Gray MTA (Mineral Trioxide Aggregate, Dentsply, Canada) will be placed in the pulp chamber (2-3mm thickness), a moist cotton pellet will be placed and Intermediate Restorative Material (IRM) to ensure setting. Patient will be reviewed after 1 week. If the tooth is asymptomatic, final restoration with RMGI (Vitremer; St. Paul, MN) and stainless steel crown will be placed , and a post-op radiograph will be taken.
In this group, a cervical pulpotomy procedure will be done where all pulp chamber tissue shall be removed until healthy pulp tissue is reached, as indicated by bleeding from all canals and arrest of hemorrhage upon pressure (for maximum 6 minutes). Gray MTA (Mineral Trioxide Aggregate, Dentsply, Canada) will be mixed according to manufacturer instructions and will be placed in the pulp chamber in 2-3 mm thickness, moist cotton pellet will be placed to ensure setting and the tooth will be temporized with Intermediate Restorative Material (IRM), the patient will be reviewed after 1 week. If the tooth is asymptomatic, final restoration with RMGI (Vitremer; St. Paul, MN) and stainless steel crown will be placed , and a post-op radiograph will be taken.