cvek pulpotomy aapd

A good restoration that prevents bacterial penetration into the tooth is essential for the success of a Cvek pulpotomy. The operator's clinical judgement should include not only the size of the exposure and the advantages of a Cvek pulpotomy over a cervical pulpotomy or a pulpectomy, but also the presence of concomitant periodontal injury 19, degree of root development, restorative needs, and patient compliance. It involves removing 1−3 mm of inflamed pulp, leaving the healthy vital cell- rich pulp to aid healing post trauma. Fractures and luxations. Future treatment for the fractured crown may be restoration with other accepted dental restorative materials. Clinical Perspectives of Pulp Regeneration. Partial pulpotomy (Cvek pulpotomy) is the treatment of choice for injured permanent incisor teeth with exposed vital pulp tissue and immature apices. 43. Plus, free two-day shipping for six months when you sign up for Amazon Prime for Students. See our User Agreement and Privacy Policy. Current literature suggests that up to 9 days delay between the time of trauma and treatment may have minimal effect on the outcome of Cvek pulpotomies, The outcome does not appear to be affected by the exposure size as long it is less than 4 mm, A Cvek pulpotomy will have a better prognosis in a tooth with an open apex than in a tooth with a closed apex. I. Fractures and luxations of permanent teeth, Guideline on pulp therapy for primary and immature permanent teeth, Treatment of crown fractures with pulp exposure, Histological appearance of pulps after exposure by a crown fracture, partial pulpotomy, and clinical diagnosis of healing, Partial pulpotomy as a treatment alternative for exposed pulps in crown‐fractured permanent incisors, Partial pulpotomy in crown‐fractured incisors‐results 3‐15 years after trauma, Incidence of pulp necrosis subsequent to pulp canal obliteration from trauma of permanent incisors, Partial pulpotomy for immature permanent teeth, its present and future, Clinical and radiographic assessment of direct pulp capping and pulpotomy in young permanent teeth, Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries – a review article, Dental injuries of permanent teeth treated in private practice in Athens, Pulp capping. 27 studied 889 permanent teeth of 384 children and adult patients, in which 22 teeth were treated with pulpotomy (13 teeth had immature apices and nine had mature apices). Minimal intervention treatment of crown‐root fracture in a mature permanent tooth by MTA pulpotomy and Fragment Reattachment: A Case Report, The ability to treat the tooth as soon as possible to diminish the possibility of pain and prevent necrosis and infection of the pulp. While the literature indicates that pulp exposures of 4 mm or less may have a good prognosis after a Cvek pulpotomy, the prognosis in teeth with pulp exposures of more than 4 mm has not yet been clarified. Journal of clinical pediatric dentistry 2016;40(1):31-5. Therefore, complicated crown fractures should be treated on an emergency basis, to alleviate symptoms, and to reduce the possibility of wound healing complications 13. 6, in a study on 30 teeth in 28 patients undergoing Cvek pulpotomy, concluded that the time period between pulp exposure and treatment did not appear to influence the success rate of treatment. It involves removing 1−3 mm of inflamed pulp, leaving the healthy vital cell-rich pulp to aid healing post trauma. Pulpotomy soothes the pain associated with the damaged tooth to remove any kind of discomfort. Radical root canal treatment usually appears to be the solution for these teeth. Teeth having immature roots should continue wise excavation of deep caries has been revisited70-82 and shown normal root development and apexogenesis. Learn more. AAPD guidelines 2014 47 48. A Complicated Crown Fracture: The Cvek Pulpotomy The Cvek pulpotomy is a useful technique for the management of a complicated crown fracture of vital incisors with open or closed apices. Delay of treatment by 9 days or less may have minimal effect on the outcome of Cvek pulpotomies. Current and Future Views on Disinfection for Regenerative Strategies. AAPD's guidelines on pulp therapy for primary and immature permanent teeth ... (Cvek pulpotomy) The partial pulpotomy for traumatic exposures is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1 to 3 mm or more to reach the deeper healthy tissue. - 6yo patient seen 24h after a trauma involving tooth #21. Furthermore, there was radiographic evidence of continued apical development in all teeth (Table 1). Crossref. It has been suggested that the age of the patient may negatively affect the outcome of conservative pulp treatments as in older patients, the pulp is more fibrotic and has a diminished healing capacity 11. Please check your email for instructions on resetting your password. While on vacation a 10 year old male reportedly falls from bike and fractures the right maxillary central incisor. A therapeutic pulpotomy is a restorative procedure often performed on a primary tooth to arrest decay progressing near, or to, the tooth's pulp (nerve). Pulpotomy, or pulp amputation, is a more intrusive procedure defined as “the removal of the coronal portion of the vital pulp as a means of preserving the vitality of the remaining radicular portion: may be performed as emergency procedure for temporary relief of symptoms or therapeutic measure, as in the instance of a Cvek pulpotomy.” This confirms the conclusions of Cvek, who utilized a partial pulpotomy technique.2 The present results are based Dealing with Endodontic Problems Following Sporting Trauma. MTA partial pulpotomy was successful in 85% of the cases, whereas CH partial pulpotomy was successful in 43% (Figs. There are also different pulpotomy techniques. The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp (nerve) tissues to heal and regenerate plus the availability of advanced endodontic materials. This confirms the conclusions of Cvek, who utilized a partial pulpotomy technique.2 The present results are based Cvek et al. Introduction. Delay of treatment by 9 days or less may have minimal effect on the outcome of Cvek pulpotomies. Number of times cited according to CrossRef: Evaluation of the Efficacy of Erbium, Chromium-doped Yttrium, Scandium, Gallium, and Garnet Laser in Partial Pulpotomy in Permanent Immature Molars: A Randomized Controlled Trial. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. A partial pulpotomy for traumatic exposures is also called a Cvek Pulpotomy. Influence of the exposure site on pulp healing: histologic and radiographic study in dog's pulp, A study on partial pulp removal (pulpotomy) using NaOCl (sodium hypochlorite), Pulp reactions to exposure after experimental crown fractures or grinding in adult monkeys, Pulp reactions to experimental exposure in young permanent monkey teeth, Management of trauma to the teeth and supporting tissues, Combination injuries 2. Management of Dental Emergencies in Children and Adolescents. Cvek’s technique included rubber dam isolation, chlorhexidine antiseptic, and a 2 mm partial pulpotomy covered with a calcium hydroxide mixture on a non-hemorrhaging pulp, followed by a compound of zinc oxide and eugenol and a final resin-bonded restoration [6]. When trying to establish a guideline for pulp exposure size that most likely will have a successful outcome for a Cvek pulpotomy, it has been reported that exposure size of up to 4 mm is not critical for healing of a healthy pulp 3. Jones et al. 8, in a study of children's teeth after Cvek pulpotomy, performed less than 1 h, between 1 and 4 h, and more than 4 h after the trauma reported a success rate of 95.4%, 90%, and 87.5%, respectively, with the number of teeth in each group being 44, 10, and 8, respectively (Table 1). thick dentin bridge; the root apex is almost closed, (d) complete obliteration of root canal is evident 41/z years after pulpotomy. Partial pulpotomy (shallow pulpotomy, or Cvek pulpotomy) is defined as the removal of a small portion of the vital coronal pulp as a means of preserving the remaining coronal and radicular pulp tissues. Name the types of non-vital primary tooth pulp therapy. It is sometimes called a baby tooth root canal, but it's not really a root canal and it can be done is some cases in permanent teeth. Learn vocabulary, terms, and more with flashcards, games, and ... pulpotomy. The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp (nerve) tissues to heal and regenerate plus the availability of advanced endodontic materials. Pulpotomy soothes the pain associated with the damaged tooth to remove any kind of discomfort. Enrique Bimstein Division of Pediatric Dentistry, Interprofessional Education and Global Outreach, University of … However, from a clinical standpoint, it appears that complicated crown fractures yield tooth sensitivity elicited by mechanical insults, such as mastication as well as drying and thermal changes. and you may need to create a new Wiley Online Library account. • Radicular ... [Cvek’s pulpotomy] Type of medicament employed Grossman’s Endodontic Practice 12th Edition 51. Therefore, the operator must make a clinical decision regarding the treatment of a complicated crown fracture based on the following factors: The authors confirm that they have no conflict of interest. The AAPD staff wishes to express sincere thanks to each of these individuals for their time, expertise and commitment to this project. Clinical Approaches in Endodontic Regeneration. Currently available procedures include direct pulp capping, complete pulpotomy and partial pulpotomy. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. The pulp space of one tooth of eight teeth treated 4–7 days after trauma became calcified (12.5%), and one of eight pulps of teeth (12.5%) treated between 8 and 41 days after trauma became necrotic (Table 1). Fuks et al. CVEK,S PULPOTOMY 1. Positive response … A review of the literature revealed that while there is agreement that early treatment (within 24 h) is crucial for the success of a cervical pulpotomy 12, 21, there is no consistency in the opinions regarding the effect of treatment delay of Cvek pulpotomies. Dentin bridge formation was not discernable in the review radiographs; all restorations were functional except the case that had tooth and restoration fracture. A pulpotomy is when the inflamed pulp chamber, usually on a baby molar, is removed, the area is sterilized, and the chamber is sealed. There is no statistical difference between the success rates of teeth treated with calcium hydroxide (91%) and those treated with MTA (93%) when used for partial pulpotomy in permanent teeth with carious exposures 35. 2A–D and 3A–D). Your MTA is then placed above the pulp. Not consistent with these findings, de Blanco 6 reported a 100% success rate of Cvek pulpotomy performed in 30 teeth, 10 of them with open apices and 20 with closed apices at the time of treatment, suggesting that the success rate of Cvek pulpotomies is not affected by the presence of an open or closed apex at the time of treatment. If you do not receive an email within 10 minutes, your email address may not be registered, Few studies have examined the relationship between delay of treatment and pulp and periodontal ligament healing. While some studies support the notion that the time elapsed from coronal fracture and treatment with Cvek pulpotomy in permanent teeth plays an important role in minimizing the possibility of pain and discomfort, microbial pulp invasion, and ensuring pulp and periodontal healing, others consider that neither time between the accident and treatment nor size of exposure is critical if the inflamed … Clearly, it is not critical to perform the treatment of complicated crown fractures immediately after trauma in all cases. Pulp Therapy-guideline Aapd - Free download as PDF File (.pdf), Text File (.txt) or read online for free. CONTENTS Introduction Indication Rationale Procedure Conclusion 3. Lecture 5, Glass Inomer Cements (Script) Conservative and Endodontics MCQs HHHH.docx. If a tooth has a closed apex and requires a post and crown restoration, then pulpectomy is the treatment of choice. This study compares published data in an attempt to assess whether the outcome of Cvek pulpotomies is affected by these factors. Use the link below to share a full-text version of this article with your friends and colleagues. This treatment was usually performed for emergency situations and/or for caries control on a vital pulp until a pulpectomy could be scheduled. In addition to Cvek pulpotomy, an additional treatment option is direct pulp capping which was not mentioned in the article. In primary teeth, most pulpotomies are performed when carious pulp exposures occur and involve complete removal of the coronal pulp 2. According to American Academy of Pediatric Dentistry (AAPD) guidelines, partial pulpotomy for traumatic exposures is a procedure, in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1-3 mm or more to reach the deeper healthy tissue. However, if the patient is in pain, immediate treatment is indicated. Working off-campus? You can view more SlideShares here. Unlike cervical pulpotomy, the Cvek pulpotomy involves preservation of cell‐rich coronal pulp tissue that is more likely to facilitate healing than the radicular pulp; the latter tissue is fibrous and unicellular with less capacity to respond 6. 26 in a study in which monkey tooth pulps were mechanically exposed to the oral environment emphasized the concept that early treatment of complicated crown fractures is required. Learn about our remote access options, Division of Pediatric Dentistry, Interprofessional Education and Global Outreach, University of Kentucky College of Dentistry, Lexington, KY, USA, Correspondence to: Enrique Bimstein, Division of Pediatric Dentistry, University of Kentucky College of Dentistry, 800 Rose Street, Lexington, KY 40356, USA, Division of Endodontics, Orthodontics and General Practice Residency, Herman Ostrow School of Dentistry of USC, University of Southern California, Los Angeles, CA, USA. Among teeth treated 2 days after trauma (n = 17), one pulp (5.9%) became necrotic. Even partial pulpotomy is a vital treatment for traumatically exposed Partial pulpotomy (Cvek pulpotomy) is the treatment of choice for injured permanent incisor teeth with exposed vital pulp tissue and immature apices. Pulpotomy Last updated January 25, 2020. Teeth left open for 24 h and 7 days exhibited pronounced inflammatory infiltration, and several teeth with 7 days exposures showed partial or total necrosis (Table 1). None of the pulps in teeth treated either 3 days after trauma (n = 7) or between 4 and 7 days after trauma (n = 8) became necrotic. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. • Caries removal results in pulp exposure in a primary tooth with a normal pulp or reversible pulpitis or after a traumatic pulp exposure. Studies have shown variation in success based on the relative wetness of the cotton pellet . When performing a partial pulpotomy for a traumatic exposure (Cvek pulpotomy) in a young permanent tooth, which of the following is true? pulpotomy medicament. If haemostasis is achieved, the tooth While the literature indicates that pulp exposures of 4 mm or less may have a good prognosis after a Cvek pulpotomy, the prognosis in teeth with pulp exposures of more than 4 mm has not yet been clarified. The reported success rate of Cvek pulpotomies in permanent teeth with complicated crown fractures ranges from 87.5% to 100% 11. It involves removing 1−3 mm of inflamed pulp, leaving the healthy vital cellrich pulp to aid healing post trauma. On the other hand, pulp exposures resulting from complicated crown fractures in permanent teeth are mostly treated with Cvek pulpotomy. thick dentin bridge; the root apex is almost closed, (d) complete obliteration of root canal is evident 41/z years after pulpotomy. This project was managed by Dental Benefits Manager, Ms. Mary E. Essling. Cvek pulpotomy So what is the protocol? They were then immediately covered with calcium hydroxide 15. Traumatic or carious exposure of a vital pulp in an immature permanent tooth presents a significant clinical challenge to maintain proper vitality. Which procedures and materials could be applied for full pulpotomy in permanent mature teeth? NON-VITAL PULPOTOMY
Ideally, a non-vital tooth should b treated by pulpectomy or root canal filling
However, pulpectomy of a primary molar may sometime be impracticable due to non-negotiable root canals and also due to limited patient co-operation. - Cvek pulpotomy - Traditional root canal therapy - Extract . D3220: Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, I have read and accept the Wiley Online Library Terms and Conditions of Use, Fractured anterior teeth – diagnosis, treatment, and prognosis, Treatment of deep caries, vital pulp exposure, and pulpless teeth, McDonald and Avery's Dentistry for the child and adolescent, A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture, Guidelines for the management of traumatic dental injuries. However, in cases where the trauma involves extensive complicated proximal fractures, a significant direct correlation was found between no treatment and pulp necrosis 33. This treatment preserves pulpal function, thus allowing continued root development. Diagnosis & Case Selection in Endodontics. It is … The glutaraldehyde pulpotomy technique is identical to the formocresol pulpotomy technique with the exception that the solution on the cotton pellet is not expressed. Pulpotomy is one of the most widely used methods in preserving vital pulp in teeth, which is of great significance in achieving continue root formation in immature permanent teeth suffering from dental caries or trauma. In the present review, peer‐reviewed publications were explored to clarify the applicability and limitations of the concept that for Cvek pulpotomy ‘neither time between the accident and treatment nor size of exposure is critical if the inflamed superficial pulp tissue is amputated to a healthy pulp’, and the effect of root development on the success of this treatment. Cvek pulpotomy: Report of a case with five-year. Cvek pulpotomy Partial pulpotomy/ calcium hydroxide pulpotomy Mejare & cvek-1978 Indicated in young permanent tooth where the radicular pulp is judged vital by clinical/ radiological criteria and root formation is incomplete. 17 studied complicated fractures in monkey teeth and found that after 3 h, hemorrhage and damage to the odontoblastic layer did not exceed 2 mm from the pulp exposure surface. A Cvek pulpotomy is indicated on immature incisors, with vital pulps, that have endured a complicated crown fracture. Some authors state that the size of the pulp exposure has no influence on the outcome of direct pulp capping in children, and animal studies have indicated that the size of the pulp exposure plays a limited role in treatment decision of complicated tooth fractures 26, 32. The American Academy of Pediatric Dentistry (AAPD) intends these recommendations to aid in the diagnosis of pulp health versus pathosis and to set forth the indications, objectives, and therapeutic interventions for pulp therapy in primary and immature permanent teeth. Visual of tooth decay. However, the clinician must take into consideration that the vast majority of the teeth were treated ≤100 h (4.2 days) after trauma, the two teeth that did not heal included one tooth treated 17 h after trauma whose pulp became necrotic 4 days after treatment, and the second tooth which was treated 30 h after trauma developed pulp necrosis 40 months after treatment. American Academy of Pediatric Dentistry. While some studies support the notion that the time elapsed from coronal fracture and treatment with Cvek pulpotomy in permanent teeth plays an important role in minimizing the possibility of pain and discomfort, microbial pulp invasion, and ensuring pulp and periodontal healing, others consider that neither time between the accident and treatment nor size of exposure is critical if the inflamed superficial pulp … If you continue browsing the site, you agree to the use of cookies on this website. PARTIAL PULPOTOMY
The partial pulpotomy for traumatic exposures is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1-3 mm to reach the deeper healthy tissue
-Indicated for a vital , traumatically exposed, young permanent tooth, especially one with an incompletely formed apex.
-Calcium hydroxide or MTA is used
Cvek pulpotomy - revisited. Pulpotomy A pulpotomy is performed in a primary tooth with extensive caries but without evidence of radicular pathology when caries removal results in a carious or mechanical pulp exposure. This includes removal of 1–3 ml of the coronal pulp located adjacent to the pulp exposure 2-5. Nevertheless, the benefits of performing a Cvek pulpotomy outweigh the deleterious effects of performing a cervical pulpotomy or a pulpectomy such as crown discoloration, tooth fragility, and the need for apexification or apexogenesis in teeth with open apices. Please contact Ms. Essling by phone at (312)-337-2169 or by email at (messling@aapd.org) with questions or comments concerning this manual. Accordingly, it has been suggested that a direct correlation exists between lack of treatment of extensive proximal fractures with pulp exposures in young permanent teeth and subsequent pulp necrosis 13. Cox et al. As per the reference manual of AAPD “The . However, this guideline cites only one research study on pulp capping in dog's teeth, in which cavity preparations with carbide burs were carried out until 0.5‐mm pulp exposures were created, without penetrating the pulp. McIntyre et al. Furthermore, the inconsistency in the literature suggests that while some teeth may develop a hyperplastic reaction and the inflammation remains superficial, some traumatically exposed pulps may become progressively inflamed and eventually necrotic. The American Academy of Pediatric Dentistry (AAPD) intends this guideline to aid in the diagnosis of pulp health versus pathosis and to set forth the indications, objectives, and thera- peutic interventions for pulp therapy in primary and imma- ture permanent teeth. Cvek pulpotomy: Report of a case with five-year - Free download as PDF File (.pdf), Text File (.txt) or read online for free. puplotomy The success of the Cvek pulpotomy technique is based on the assumptions that: (i) by removing 1–3 mm of the exposed pulp, the inflamed superficial pulp tissue is amputated up to the level of a healthy pulp; (ii) in permanent teeth with complicated coronal fractures, the exposure of the pulp permits salivary rinsing and prevents impaction of contaminated debris; (iii) the young coronal pulp tissue does not become necrotic after a traumatic exposure because of its natural defenses and the rich blood supply that resist bacterial invasion; (iv) the traumatically exposed pulp may have a beneficial defensive hyperplastic tissue reaction; (v) the most coronal pulp is more cellular than the radicular pulp, whereas the radicular pulp is fibrous and unicellular with lower healing capacity; (vi) the pulp dressing material is placed directly (without an intermediate blood clot) over non‐inflamed tissue after easily achieving hemostasis with either a sterile saline solution, chlorhexidine, or sodium hypochlorite; (vii) it allows physiologic apposition of dentin in the coronal area, reducing the risk of cervical fracture that is more likely to occur following cervical pulpotomy; and (viii) a restoration that prevents bacterial contamination of the remaining pulp is achieved (3, 5-7, 9, 16-19). val between the accident and treatment does not seem to be critical for healing (Table 2). Calcium hydroxide became recognized as a valuable pulpotomy material after its use by Miomir Cvek for performing pulpotomy in In addition to that, it is much more cost effective in comparison to similar materials [ 1451011 ]. Pulpotomy is the surgical removal of part of the dental pulp allowing the rest of the pulp to remain alive and continue with normal function (1, 2). Among teeth treated within a day of trauma (n = 138), four pulps (2.9%) became necrotic and two were calcified (1.4%). On the other hand, Cvek 3, in a clinical report of partial pulpotomy in 60 children's teeth with treatment delay between 1 h to 90 days, concluded that time was not critical for healing of an initially healthy pulp, based on treatment success rate of 96.7% (Table 1). Up to 90% off Textbooks at Amazon Canada. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The Use of Glass Ionomer Cements in Both Conventional and Surgical tics. b. Name the types of non-vital permanent tooth pulp therapy ... What are the benefits of partial pulpotomy (Cvek)? While a clinical study 3 indicates that the Cvek pulpotomy may be successful in teeth with pulp exposures sized 0.5–4.0 mm, the outcome of Cvek pulpotomies in teeth with pulp exposures of more than 4 mm has not yet been fully elucidated. When a baby tooth or young permanent tooth is traumatised - say, hitting your teeth on the handlebars of a bike - it can be broken in such a way that the pulp is exposed. Pulps exposed for 0 or 1 h presented damage due to the mechanical exposure alone. Heide & Kerekes 22 studied monkey's teeth with open apices in which pulps were exposed by grinding the teeth with water‐cooled high‐speed burs and treated with pulp capping. Again, a partial pulpotomy may help it to finish developing and be saved. A study by Cvek 9 on the effect of treatment delay on the success of Cvek pulpotomy showed that among 178 pulpotomized teeth, there was no statistical significant difference in success rate between teeth treated within 32 h after the accident and those treated after a longer interval (96% and 87.5%, respectively). The procedure can also be completed on permanent teeth, but when done so, is typically a temporary solution pursued only when pain is acute, and time does not allow for a root canal in the immediate term. The first step is the removal of carious dentin The partial pulpotomy for traumatic exposures is a procedure in along the dentin-enamel junction (DEJ) and excavation of only which the inflamed pulp tissue beneath an exposure is removed the outermost infected dentin, leaving a carious mass over the to a depth of 1 to 3 mm or more to reach the deeper healthy pulp. Contemporary Treatment Techniques in Pediatric Dentistry. Once the pulpotomy is done, the shape of the tooth is restored, typically with the use of a crown. Clinical and histological findings confirm that the Cvek pulpotomy can be used as a permanent treatment modality for mature and immature permanent teeth with complicated crown fractures 6-10. Pulpotomy is the term for removal of the coronal pulp with the intent of maintaining the vitality of the remaining radicular pulp tissue. pulpotomy also may be selected. The American Academy of Pediatric Dentistry (AAPD) Guideline on Pulp Therapy for Primary and Immature Permanent Teeth states that with Cvek pulpotomy ‘neither time between the accident and treatment nor size of exposure is critical if the inflamed superficial pulp tissue is amputated to a healthy pulp’ 5. After 48 h, it ranged from 1.5 to 2 mm, and after 168 h (7 days), it ranged from 0.8 to 2.2 mm. AAPD's guidelines on pulp therapy for primary and immature permanent teeth ... (Cvek pulpotomy) The partial pulpotomy for traumatic exposures is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1 to 3 mm or more to reach the deeper healthy tissue. Some authors have suggested that the time elapsing from the fracture to pulpotomy, followed by coronal restoration of the exposed pulp and dentinal tubuli, was important to minimize the possibility of microbial pulp invasion, thus ensuring pulp and periodontal healing 1, 9, 13, 14, 17, 22-26.

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