Asgary Saeed, Verma Prashant, Nosrat Ali
Iranian Center For Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Division of Endodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland, USA.
Iran Endod J. 2017 Spring;12(2):261-265. doi: 10.22037/iej.2017.51.
Root canal therapy (RCT) is a common and successful treatment for irreversible pulpitis due to carious pulp exposure in mature permanent teeth. However, it is often an expensive procedure, may require multiple appointments, and requires a high level of training and clinical skill, specifically in molars. Uninsured patients, low-income patients, and patients with limited access to specialist care often elect for extraction of restorable teeth with irreversible pulpitis. There is a need for an alternative affordable treatment option to preserve their teeth and maintain chewing function. A case of pulpotomy using calcium-enriched mixture (CEM) cement in two maxillary molars (#14 and 15) in a healthy 36-year-old patient is presented. Both teeth were diagnosed with symptomatic hyperplastic/irreversible pulpitis. Patient did not have dental insurance, was unable to afford RCT, and refused to extract the teeth. CEM pulpotomy and amalgam build-ups were done as an alternative to extraction. At 2-year recall, both teeth were functional with no signs/symptoms of inflammation/infection. Periapical radiographs and 3D images showed normal PDL around all roots. Pulpotomy with CEM biomaterial might be a viable alternative to tooth extraction for mature permanent teeth with hyperplastic/irreversible pulpitis, and can result in long-term tooth retention and improved oral health.
根管治疗（RCT）是治疗成熟恒牙因龋源性牙髓暴露导致的不可逆性牙髓炎的一种常见且成功的方法。然而，它通常是一个昂贵的过程，可能需要多次就诊，并且需要高水平的培训和临床技能，尤其是在磨牙治疗方面。未参保患者、低收入患者以及难以获得专科护理的患者往往会选择拔除患有不可逆性牙髓炎的可修复牙齿。因此，需要一种经济实惠的替代治疗方案来保留他们的牙齿并维持咀嚼功能。本文介绍了一例在一名36岁健康患者的两颗上颌磨牙（#14和15）中使用富钙混合物（CEM）粘结剂进行牙髓切断术的病例。这两颗牙齿均被诊断为有症状的增生性/不可逆性牙髓炎。患者没有牙科保险，无法承担根管治疗费用，并且拒绝拔牙。于是进行了CEM牙髓切断术和汞合金充填作为拔牙的替代方案。在2年的回访中，两颗牙齿均功能正常，没有炎症/感染的迹象/症状。根尖片和三维图像显示所有牙根周围的牙周膜正常。对于患有增生性/不可逆性牙髓炎的成熟恒牙，使用CEM生物材料进行牙髓切断术可能是拔牙的一种可行替代方案，并且可以实现牙齿的长期保留并改善口腔健康。
