Abstract
In an attempt to evaluate the prognosis of pulpotomy with calcium hydroxide, a longitudinal clinical and radiographical follow-up study was made of 64 traumatized immature permanent incisors with crown fracture. The subjects included 60 patients aged 7 to 12 years at the time of the primary visit. The follow-up examination varied from 3 years 3 months to 19 years 2 months, with an average of 10 years 1 month.
The treatment was judged to be successful according to the following criterea: absence of clinical symptoms, continued root development, no radiographically pathologic changes observed, and positive response to electrical stimulation. The treatment was successful in 46 teeth (72%). In 18 teeth (28%), pulpitis or pulp necrosis was found within 5 years. However, the root development seemed to continue as long as the pulp was vital.
Dentin bridges were found radiographically in 58 teeth (91%), mostly within one year, and observed in 12 (19%) teeth which had pulpitis or pulp necrosis.
In 33 of the successfully treated teeth, calcium hydroxide paste was re-apployed. The removed paste was examined with a conventional microscope. There were dead spaces, remnants of calcium hydroxide and necrotic tissue between the filling materials and the dentin bridge. The dentin bridge was directly investigated by probing, measuring the electrical resistance and electrical stimulation. No perforation was evident on the dentin bridges with the probing. However, the values of the electrical resistance on the dentin bridge varied widely. The sensitivity to electrical stimulation on the dentin bridges was higher than on the crown surfaces in many teeth.
This seemed to justify recommending re-application with calcium hydroxide after pulpotomy, and the results suggest that dentin bridge formation does not always assure the success of pulpotomy, and pulpotomized teeth need follow-up for at least 5 years.
