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Management of Exposed Vital Pulp

Treatment Options for Exposed Vital Pulp The exposure of dental pulp generally occurs as the result of accidental trauma or preparation techniques utilized during the restoration of carious lesions. While frank carious exposures are optimally treated with pulpectomy and root canal therapy, the ideal treatment of mechanically exposed pulps has remained controversial. 2012-03-19 Edward J. Swift, Jr. DMD, MS 104
Figure 1 1A. Diagram of maxillary incisor with pulp-involved fracture. 1B. The exposed pulp is capped with calcium hydroxide. Glass ionomer liner, dentin adhesive, and composite resin are also used in the restoration of the tooth. /uploadedImages/The_Next_DDS/Clinical_Images/Swift1.jpg illustration
Figure 2 Preoperative facial view of the fractured tooth #9(21). The partial pulpotomy technique will be used to treat the traumatically exposed pulp. /uploadedImages/The_Next_DDS/Clinical_Images/02 Swift.jpg photo
Figure 3 The central incisor is isolated with a rubber dam and superficially disinfected. /uploadedImages/The_Next_DDS/Clinical_Images/03 Swift.jpg photo
Figure 4 Utilizing a surgical diamond cut, 1 mm to 2 mm of superficial pulp tissue is removed. /uploadedImages/The_Next_DDS/Clinical_Images/04 Swift.jpg photo
Figure 5 Once the pulp tissue has been removed, calcium hydroxide is placed as a pulp cap. /uploadedImages/The_Next_DDS/Clinical_Images/05 Swift.jpg photo
Figure 6 6A Preoperative radiograph of the fractured incisor 6B. The 1-year postoperative radiograph demonstrates continued root development. /uploadedImages/The_Next_DDS/Clinical_Images/Swift6.jpg photo
Figure 7 Diagram of carious pulp exposure. The pulp contains a microabscess (necrosis and infection) and a zone of inflammation overlying normal tissue. /uploadedImages/The_Next_DDS/Clinical_Images/Swift7.jpg illustration
Figure 8 Preparation involves the removal of the abscessed and inflamed pulpal tissue. /uploadedImages/The_Next_DDS/Clinical_Images/Swift8.jpg illustration
Figure 9 The pulp is capped with calcium hydroxide. A bacteria-tight seal is provided by a glass-ionomer base, dentin adhesive, and restorative material. /uploadedImages/The_Next_DDS/Clinical_Images/Swift9.jpg illustration
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