Cvek Pulpotomy — ORE Part 1 MCQ

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ModeratePaediatric DentistryCvek PulpotomyORE Part 1

An 8-year-old boy presents with a fractured upper right central incisor. The tooth has a large pulp exposure (4 mm) sustained 6 hours ago. The apex is open (immature root). The exposed pulp is vital with normal bleeding. What is the most appropriate pulp treatment?

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Correct answer: C — Partial pulpotomy (Cvek pulpotomy) with MTA or Biodentine

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

Answer: **A – Partial pulpotomy (Cvek pulpotomy) with MTA or Biodentine** For a vital, traumatic pulp exposure in an immature permanent incisor, Cvek pulpotomy with calcium-silicate materials (MTA or Biodentine) is the evidence-based choice. This procedure removes 1–3 mm of inflamed coronal pulp while preserving radicular vitality, allowing continued root development (apexogenesis). A 4 mm exposure is within the prognostically favourable range, and early treatment (6 hours post-injury) optimises outcome. **Formocresol (B)** is outdated and contraindicated owing to toxicity and systemic absorption risk—it has been superseded by vital pulp therapies. **Direct pulp cap (C)** is only appropriate for exposures <1–2 mm without inflammation; this exposure size and traumatic inflammation require pulpotomy. **Pulpectomy (D)** is excessively destructive for vital pulp and forfeits apexogenesis. **No treatment (E)** allows necrosis and infection. Vital pulp therapy preserves the tooth's structural integrity and biological potential in immature dentition.

Reference: NHS England Dentistry: Care Pathways Guidance (2024); https://www.england.nhs.uk/long-read/nhs-dentistry-care-pathways-guidance/