Pulpotomy For Irreversible Pulpitis In Immature Permanent Tooth

Acute pulpitis caused by fracture of an abnormally central cusp in tooth 45 was managed with pulpotomy to preserve healthy radicular pulp and promote continued root development. A 10-year-old patient presented with spontaneous pain, nocturnal pain, and cold/heat sensitivity in the mandibular right second premolar (tooth 45). Clinical examination revealed a fractured abnormally central cusp with pulp exposure, pain on probing, percussion tenderness (±), and lingering severe pain on thermal testing. Radiographic examination demonstrated a short root with thin canal walls, an open "flared" apex (Nolla stage 8). The diagnosis was acute pulpitis secondary to fractured abnormally central cusp. Under local anesthesia, pulpotomy was performed using a dental operating microscope: inflamed coronal pulp was excised, healthy radicular pulp was preserved, and the pulp stump was covered with bioceramic material, followed by resin composite restoration. Three-year follow-up confirmed normal pulp vitality in tooth 45, with radiographic evidence of root elongation, thickened canal walls, and apical closure. The diagnosis of irreversible pulpitis remains based on clinical symptoms and signs, which may not fully reflect the actual histological status of the pulp. This case suggests that for immature permanent teeth clinically diagnosed with irreversible pulpitis, pulpotomy can still be attempted if hemorrhage at the amputation site is controllable, thereby preserving vital radicular pulp tissue. Pulpotomy effectively preserves radicular pulp vitality and promotes root development in immature permanent teeth with irreversible pulpitis, demonstrating significant clinical value.