Molar Incisor Hypomineralization Clinical Trial
Official title:
Outcome of Vital Pulp Therapy in Carious Teeth With Hypomineralization Defects: a Clinical Study
Vital pulp therapy (VPT) is a general term for multiple procedures (indirect pulp cap, direct pulp cap and pulpotomy) all directed toward preserving pulp vitality and enable complete root development in immature teeth. The aim of this study is to evaluate the clinical, radiographic and histologic (if any teeth later are doomed for extraction for orthodontic or other reasons) success rate of VPT on treating cariously exposed permanent teeth with developmental defects of enamel. This will be a a prospective case series study including children between 6-16 years old having tooth with enamel hypomineralization defect with deep caries, restorable teeth , and no signs of infection. The teeth will be followed up both clinically and radiographically for 1 year after treatment. It is expected that the teeth will maintain vitality with resolution of symptoms (if present) and completion of root development in immature teeth after vital pulp therapy.
Background: One of the greatest challenges that may affect the integrity of teeth is dental
caries. If left untreated, pulpal involvement may occur leading to irreversible damage and
eventually necrosis. This risk is greatly increased in the presence of developmental defects
affecting tooth enamel such as molar-incisor hypomineralization (MIH). Despite having high
success rate, root canal treatment will lead to loss of proprioceptive function, loss of
stress-reducing damping property and tooth sensitivity in developed teeth and will also
inhibit complete root formation in immature permanent teeth. Vital pulp therapy (VPT) is a
general term for multiple procedures (indirect pulp cap, direct pulp cap and pulpotomy) all
directed toward preserving pulp vitality and enable complete root development in immature
teeth. So, it has been advocated as a better alternative for pulpectomy/root canal treatment
in deep carious vital permanent teeth.
Aim: To evaluate the clinical, radiographic and histologic (if any teeth later are doomed for
extraction for orthodontic or other reasons) success rate of VPT on treating cariously
exposed permanent teeth with developmental defects of enamel.
Materials and methods: The study will be a prospective case series study including children
between 6-16 years old. Inclusion criteria include patients having tooth with enamel
hypomineralization defect with deep caries. Teeth should be restorable tooth. No soft tissue
swellings, mobility or tenderness to percussion should be present. In cases of pulpotomy,
bleeding from all canals should be present after opening the access. Tooth should be
diagnosed with reversible / irreversible pulpitis (as indicated by positive response to cold
testing).
Medically compromised patients will be excluded from the study. Also any tooth that is
non-restorable, having sinus tract or periodontally compromised will be excluded. The
procedure involves taking preoperative compete records (radiograph, vitality tests,
percussion, mobility and photographs). After administration of anesthetic agent, rubber dam
will be placed, caries is removed and appropriate dressing pulp material will be placed and
then the final restoration is placed. A post-operative x-ray will be taken. The teeth will be
followed up both clinically and radiographically for 1 year after treatment.
Expected Results: It is expected that the teeth will maintain vitality with resolution of
symptoms (if present) and completion of root development in immature teeth after vital pulp
therapy.
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