Dental case report on vital pulp therapy

Case report on a patient who has exposed pulp due to caries lesion. Direct pulp capping plus composite restoration were done.

1. Patient Information 26 y/o male Chief complaint: Lower left sensitivity when drinking cold water Present illness: This patient suffers from lower left sensitivity when drinking cold water with 35 previous amalgam restoration and 36 MO previous resin restoration Past Medical history: denied any major systemic disease Smoking: denied Betel nut: denied Drinking: Seldom

2. 2023.01

3. 2023.01

4. Overview of Tooth Information Missing: 18, 28, 38, 48 Restoration: 16, 26, 35, 36 Caries: 16, 26, 36 Previously Endodontically treated: Nil Crown & bridge, implant: Nil

5. 2023.10

6. Clinical findings Cold test : positive w/o linger pain after stimulus removal (over 10s) EPT test : positive Percussion test: negative Periapical lesion: negative Diagnosis : reversible pulpitis, normal apical tissue

7. Example of exposed pulp Signs of fresh pulp Elastic mechanical feedback Pinkish Bleeding could be stopped Signs of diseased pulp Soft mechanical feedback Dark red Bleeding with difficulty to stop Signs of necrotic pulp No active bleeding Dark or yellowish black

8. Direct pulp Capping Direct capping procedures should only be carried out on fresh, traumatic or mechanical exposures, before bacterial plaque has established on the exposure and the underlying pulp has become inflamed ( Ørstavik & Pitt Ford 2008)

9. 2024.01 – Post direct pulp capping + filling

10. Reference Ørstavik D., fitt Ford TR. Essential endodontology: prevention and treatment of apical periodontitis. Blackwell Science, Oxford, 1998; pp. 192-2 10 Glickman, GN. Endodontic Diagnosis , www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/endodonticdiagnosisfall2013.pdf.