Vital Pulp Therapy Of Mature Permanent Teeth With Irreversible Pulpitis

In this case, full pulpotomy was performed on a mature permanent tooth with irretrievable pulpitis. After 2 years’ follow-up, the result was satisfactory, indicating that VPT can be a prospective option for irretrievable pulpitis in mature permanent teeth. A 22-year-old patient complained of sensitive to cold and hot stimuli for 3 months and spontaneous dull pain for 2 weeks in the lower left posterior teeth. On examination, the left mandibular second molar had a deep mesial caries, a prolonged reaction to cold stimuli lasting for minutes, and was sensitive to percussion. The tooth was diagnosed as irreversible pulpitis, and treated with full pulpotomy with the patient’s content to preserve pulp vitality. After caries excavation, the pulp was amputated to the level of the canal orifices. A calcium silicate-based bioactive ceramic iRoot BP Plus was placed as the capping agent after hemostasis. The cavity was finally restored with composite resin. At 2 years’ follow-up, the tooth was asymptomatic and responded to cold and electric test. Radiographic examination also showed a normal periapical image. Research has found that pulp inflammation in some cases of irreversible pulpitis was limited to the coronal pulp, and the surrounding pulp tissue was normal and reversible, which makes VPT treatment for irreversible pulpitis possible. The success rate for VPT in mature permanent teeth of irreversible pulpitis in our team is over 90%. This case successfully demonstrates the promising prospects of VPT in the treatment of irretrievable pulpitis in mature permanent teeth.