Vital Pulp Therapy — ORE Part 1 MCQ

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ModerateEndodonticsVital Pulp TherapyORE Part 1

A vital immature permanent tooth has a carious pulp exposure. Following coronal pulp removal and haemostasis, which pulpotomy dressing is most appropriate to maximise the likelihood of maintaining pulp vitality and allowing continued root development?

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Correct answer: C — Hydraulic calcium-silicate cement

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

A is correct. A hydraulic calcium-silicate cement, such as MTA or Biodentine, is the contemporary material of choice for pulpotomy in a vital permanent tooth with carious exposure. These materials are biocompatible, provide a seal and are associated with favourable pulpotomy success; they support retention of vital radicular pulp, permitting apexogenesis in an immature tooth. Calcium hydroxide is a credible historical alternative, but comparative evidence shows lower success than MTA. Formocresol and ferric sulphate have chiefly been used as pulpotomy medicaments in primary teeth and do not provide the same bioactive pulp-capping role. Zinc oxide-eugenol is not an appropriate pulp dressing because eugenol may adversely affect pulp healing. The stem specifies a vital immature permanent tooth, so preservation of the radicular pulp and continued root development are central treatment aims.

Reference: Li W, Yang B, Shi J. Efficacy of pulpotomy for permanent teeth with carious pulp exposure: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2024. https://pubmed.ncbi.nlm.nih.gov/38968236/