Cvek Pulpotomy — ORE Part 1 MCQ

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HardPaediatric DentistryCvek PulpotomyORE Part 1

A healthy 10-year-old presents 2 hours after a fall with a complicated crown fracture of the upper left permanent central incisor. The pulp is exposed, the tooth is asymptomatic and responds to sensibility testing, and the radiograph shows an open apex with no associated luxation injury. Which pulp treatment is most appropriate?

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Correct answer: B — Partial pulpotomy with a calcium-silicate cement

Explanation lettering: C = shown as A · A = shown as B · B = shown as C · E = shown as D · D = shown as E

A is correct. A complicated crown fracture in a vital immature permanent incisor is managed by vital pulp therapy to retain radicular pulp vitality and permit apexogenesis. Partial pulpotomy (Cvek pulpotomy) removes the superficially inflamed pulp beneath the exposure and is covered with a calcium-silicate cement, such as MTA or Biodentine, before definitive restoration. The open apex and short exposure interval favour this conservative approach. C is less appropriate because, after traumatic pulp exposure, partial pulpotomy has better reported outcomes than direct pulp capping. B uses formocresol, which is not appropriate for vital pulp treatment of a permanent incisor. D sacrifices a vital pulp and, in an open-apex tooth, would create substantial endodontic management difficulties while forfeiting continued root development. E leaves the exposed pulp untreated and risks bacterial contamination and necrosis.

Reference: Donnelly A, et al. Pulpotomy for treatment of complicated crown fractures in permanent teeth: A systematic review. International Endodontic Journal, 2022. https://pubmed.ncbi.nlm.nih.gov/24745589/