Artúcilo sobre pulpotomías en dentición temporaldra. ana fuks

PEDIATRIC DENTISTRY

V 30 / NO 3

MAY / JUN 08 08

Conference Paper
Vital Pulp Therapy with New Materials for Primary Teeth: New Directions and Treatment Perspectives
Anna B. Fuks, DDS

Abstract: Vital pulp therapy aims to treat reversible pulpal injury and includes 2 therapeutic approaches: (1) indirect pulp treatment for deep dentinal cavities and (2) direct pulp capping or pulpotomyin cases of pulp exposure. Indirect pulp treatment is recommended as the most appropriate procedure for treating primary teeth with deep caries and reversible pulp inflammation, provided that this diagnosis is based on a good history, a proper clinical and radiographic examination, and that the tooth has been sealed with a leakage-free restoration. Formocresol has been a popular pulpotomymedicament in the primary dentition and is still the most universally taught pulp treatment for primary teeth. Concerns have been raised over the use of formocresol in humans, and several alternatives have been proposed. Controlled clinical studies have been critically reviewed, and mineral trioxide aggregate and ferric sulfate have been considered appropriate alternatives to formocresol for pulpotomies inprimary teeth with exposed pulps. In most of the studies reviewed, the caries removal method has not been described. The use of a high-speed handpiece or laser might result in an exposure of a “normal” pulp that would otherwise not be exposed. (Pediatr Dent 2008;30:211-9)
KEYWORDS: FERRIC SULFATE, FORMOCRESOL, MINERAL TRIOXIDE AGGREGATE, PRIMARY TEETH, PULP THERAPY

The aim of vital pulptherapy is to treat reversible pulpal injuries in both permanent and primary teeth, maintaining pulp vitality and function.1 In addition to these, in primary teeth it is important to preserve the tooth until its natural exfoliation time, thus preserving arch integrity.2 Vital pulp therapy includes 2 therapeutic approaches: indirect pulp treatment (IPT) in cases of deep dentinal cavities and direct pulpcapping (DPC) or pulpotomy in cases of pulp exposure.1 Advances in biomedical research open avenues for the design of new methods of dental treatment, aiming at regeneration of the dentin-pulp complex. New approaches have been based on the understanding of the molecular and cellular mechanisms regulating dentinogenesis during dental tissue repair and their potential for clinical exploitation.1The dental pulp possesses the ability to form a dentin-like matrix (tertiary dentin) as part of the repair in the dentin-pulp organ.3 Vital pulp therapy aims to treat reversible pulpal injury in cases in which dentin and pulp are affected by caries, restorative procedures, or trauma. Whenever the dentin-pulp complex is affected by injury, 3 different physiopathologic conditions might be observed atthe dentin-pulp border:

Dr. Fuks is professor emeritus, Department of Pediatric Dentistry, Hadassah School of Dental Medicine, Hebrew University, Jerusalem, Israel. Correspond with Dr. Fuks at fuks@cc.huji.ac.il

1. In the case of mild injuries as in noncavitated enamel caries or slowly progressing dentinal caries, the odontoblasts might survive, and the odontoblastic layer is stimulated toform a tertiary dentin matrix beneath the injury (reactionary dentin). Reactionary dentin shows many similarities to the primary and secondary dentin and can effectively oppose exogenous destructive stimuli to protect the pulp.4 2. With severe dentinal injuries without pulp exposure as in rapidly progressing carious lesions or in severe tissue damage caused by cavity preparation, odontoblasts aredestroyed subjacent to the affected dentin.5,6 In an appropriate metabolic state of the dentin-pulp complex, a new generation of odontoblast-like cells might differentiate and form tubular tertiary dentin (reparative dentinogenesis).3,7 It must be emphasized that under clinical conditions, the matrix formed at the pulp-dentin interface often comprises reactionary dentin, reparative dentin, or...