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      Partial Pulpotomy in Mature Permanent Molars with Symptoms Indicated Irreversible Pulpitis Using MTA: A Study of Three Case Reports over Four-Year Follow-Up

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          Abstract

          VPT is vital pulp therapy, a biologically based procedure that combines several therapeutic techniques to maintain the entire or a portion of the dental pulp. Interest in VPT has grown due to recent developments in bioactive materials and an understanding of biological pulp reparative responses. This case report is aimed at evaluating the success rate of partial pulpotomy in permanent molars with symptoms indicating irreversible pulpitis using MTA and presenting with extremely deep carious lesions over four years of follow-up. All patients came with spontaneous and severe pain. Each tooth was isolated with a rubber dam and disinfected with 5.25% NaOCl before caries excavation. After caries removal, a partial pulpotomy was performed on 2–3 mm of the exposed pulp. Bleeding time was recorded after hemostasis was achieved, and then MTA was placed over the exposed pulp. The permanent restoration was placed after pulp capping, and postoperative periapical radiographs were taken. Patients were scheduled for clinical and radiological examinations for four years based on 6-month intervals. All teeth revealed a successful outcome throughout the follow-up periods (clinically and radiographically) with complete resolution of clinical signs and symptoms. Partial pulpotomy using MTA might be an effective long-term management strategy for permanent molars clinically diagnosed with irreversible pulpitis.

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          Most cited references37

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          European Society of Endodontology position statement: Management of deep caries and the exposed pulp.

          This position statement on the management of deep caries and the exposed pulp represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Preserving the pulp in a healthy state with sustained vitality, preventing apical periodontitis and developing minimally invasive biologically based therapies are key themes within contemporary clinical endodontics. The aim of this statement was to summarize current best evidence on the diagnosis and classification of deep caries and caries-induced pulpal disease, as well as indicating appropriate clinical management strategies for avoiding and treating pulp exposure in permanent teeth with deep or extremely deep caries. In presenting these findings, areas of controversy, low-quality evidence and uncertainties are highlighted, prior to recommendations for each area of interest. A recently published review article provides more detailed information and was the basis for this position statement (Bjørndal et al. 2019, International Endodontic Journal, doi:10.1111/iej.13128). The intention of this position statement is to provide the practitioner with relevant clinical guidance in this rapidly developing area. An update will be provided within 5 years as further evidence emerges.
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            Dental Pulp Defence and Repair Mechanisms in Dental Caries

            Dental caries is a chronic infectious disease resulting from the penetration of oral bacteria into the enamel and dentin. Microorganisms subsequently trigger inflammatory responses in the dental pulp. These events can lead to pulp healing if the infection is not too severe following the removal of diseased enamel and dentin tissues and clinical restoration of the tooth. However, chronic inflammation often persists in the pulp despite treatment, inducing permanent loss of normal tissue and reducing innate repair capacities. For complete tooth healing the formation of a reactionary/reparative dentin barrier to distance and protect the pulp from infectious agents and restorative materials is required. Clinical and in vitro experimental data clearly indicate that dentin barrier formation only occurs when pulp inflammation and infection are minimised, thus enabling reestablishment of tissue homeostasis and health. Therefore, promoting the resolution of pulp inflammation may provide a valuable therapeutic opportunity to ensure the sustainability of dental treatments. This paper focusses on key cellular and molecular mechanisms involved in pulp responses to bacteria and in the pulpal transition between caries-induced inflammation and dentinogenic-based repair. We report, using selected examples, different strategies potentially used by odontoblasts and specialized immune cells to combat dentin-invading bacteria in vivo.
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              Management of deep caries and the exposed pulp

                Author and article information

                Contributors
                Journal
                Case Rep Dent
                Case Rep Dent
                CRID
                Case Reports in Dentistry
                Hindawi
                2090-6447
                2090-6455
                2023
                17 October 2023
                : 2023
                : 1344101
                Affiliations
                1Department of Endodontics and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
                2Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
                Author notes

                Academic Editor: Sivakumar Nuvvula

                Author information
                https://orcid.org/0000-0003-1086-5588
                https://orcid.org/0000-0001-7759-7720
                Article
                10.1155/2023/1344101
                10598476
                37885448
                128b1fef-74a2-459a-919f-85225e96a7e7
                Copyright © 2023 Rami Zenaldeen et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 6 April 2023
                : 13 July 2023
                : 8 September 2023
                Categories
                Case Report

                Dentistry
                Dentistry

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