Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (1): 179-184. doi: 10.19723/j.issn.1671-167X.2024.01.028

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Application of bioactive ceramics iRoot BP Plus® in pulpotomy for complicated crown fracture of immature permanent anterior teeth in children

Jiajia ZHENG1,Xue YANG2,Quan WEN1,Yuan FU2,Xiao SHAO2,*(),Meili DING1,*()   

  1. 1. First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100034, China
    2. Department of Oral Emergency, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2023-10-10 Online:2024-02-18 Published:2024-02-06
  • Contact: Xiao SHAO,Meili DING E-mail:bluesky408210@163.com;majoriesxx@163.com
  • Supported by:
    the Program for New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT-23B09);the Program for New Clinical Techniques and Therapies of First Clinical Division, Peking University School and Hospital of Stomatology(YMZXJ-1605)

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Abstract:

Objective: To analyze the clinical and radiographic effectiveness of a calcium silicate-based bioactive ceramic iRoot BP Plus® pulpotomy of immature permanent teeth with complicated crown fracture and to evaluate the factors influencing its long-term success rate. Methods: The digital medical records of patients under 13 years old who had undergone iRoot BP Plus® pulpotomy in the Department of Oral Emergency or the First Clinical Division, Peking University School and Hospital of Stomatology from March 2017 to September 2022 due to complicated crown fracture of anterior teeth, and had taken at least one post-operation apical radiograph were reviewed. The clinical and radiographic information at the initial examination and follow-up period were obtained, including crown color, mobility, percussion, cold test (partial pulpotomy teeth), dental restoration, fistula, swelling or inflammation of the gingival tissue, the formation of apical foramen, pathologic radiolucency and calcification of pulp chamber or root canal obliteration. Data were tested by Fisher exact test and a multiple comparison. Results: In the study, 64 patients including 37 males (57.8%) and 27 females (42.2%) with a mean age of 9.1 years : ere finally enrolled. The total number of permanent teeth that received pulpotomy was 75, and the average follow-up time was 19.3 months. The success rate was 93.1% with the time interval between dental injury and treatment in 24 h, while the success rate dropped to 88.2% with the time intervals beyond 24 h. The time intervals did not significantly affect the pulp survival rate (P=0.61) after pulpotomy (partial or coronal). The success rate 6 months after pulpotomy was 96. 0%, and one-year success rate was 94. 7%. A total of 23 cases were reviewed for more than 2 years after pulpotomy, and 6 cases failed. The mobility had no significant effect on the success rate (P=0.28). Pulp chamber calcification and pulp canal obli-teration were not observed in all the post-operative radiographs. Conclusion: The one year clinical and radiographic success rates obtained in this study indicate that iRoot BP Plus® is an appropriate pulp capping material option for pulpotomy treatment of complicated crown fracture in immature permanent teeth without displacement injuries. This technique has broad promotional value.

Key words: Pulpotomy, Complicated crown fracture, Immature permanent teeth, Bioactive ceramics

CLC Number: 

  • R788.4

Table 1

Position of traumatic teeth"

Items Position Total
11 21 31
Number 41 33 1 75
Percentage 54.7% 44.0% 1.3% 100.0%

Table 2

Comparison of the results at different follow-up time points"

Post-operative factors T1 (n=42) T2 (n=42) T3 (n=39) T4 (n=33) ≥2 years (n=23)
Clinical and radiographic
    Success 41 42 38 31 22
    Fail 1 0 1 2 1
Mobility
    0 39 42 38 31 22
    1 1 0 0 1 0
    2 1 0 1 1 1
Percussion test
    - or ± 39 40 38 31 22
    + to +++ 2 2 1 2 1
Coronal restoration
    Presence 40 42 39 31 23
    Fall off 1 0 0 2 1

Table 3

Comparison of the results of cold test in partial pulpotomy teeth at different follow-up time points"

Cold test T1(n=6) T2(n=6) T3(n=7) T4(n=4) ≥2 years follow-up
Normal response 6 3 3 4 7
Heightened but not lengthened 0 0 1 0 0
Positive 0 1 0 0
Prolonged reaction 0 2 2 0 0
No response 0 1 0 0 0

Table 4

Clinical data of 6 cases of pulpotomy failure"

Case no. Age/years Gender Tooth number Procedure Fail time/months
1 12 Male 11 Complete pulpotomy 26.2
2 10 Female 11 Complete pulpotomy 0.5
3 8 Female 21 Complete pulpotomy 20.2
4 9 Female 11 Partial pulpotomy 10.4
5 9 Female 21 Complete pulpotomy 5.4
6 8 Male 21 Complete pulpotomy 1.4

Figure 1

18-month follow-up after partial pulpotomy with iRoot BP Plus® in 11, 21 complicated crown fracture, the periapical radiograph showed no abnormality A, 11, 21 pre-operative periapical radiograph; B, the 3-month follow-up periapical radiograph after partial pulpotomy with iRoot BP Plus®; C, the 10-month follow-up; D, the 18-month follow-up."

Figure 2

Periapical periodontitis was found in 5.4 months after pulpotomy with iRoot BP Plus® in a 21 complicated crown fracture A, 21 pre-operative periapical radiographs; B, the 2-week follow-up periapical radiograph after partial pulpotomy with iRoot BP Plus®; C, the 5-month follow-up; D, the 11-month follow-up."

Table 5

The treatment results in different visiting time"

Items Duration time Total
≤ 24 h > 24 h
Failure 4 2 6
Success 54 15 69
Total 58 17 75

Table 6

The treatment results of teeth with different mobility at the first visit"

Mobility Success Failure Total
0 58 4 62
11 1 12
0 1 1
Total 69 6 75
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