Preserving the vitality of traumatically injured and mechanically exposed immature teeth is one of the major treatment aims in endodontics. Partial pulpotomy (Cvek pulpotomy) and deep (cervical) pulpotomy selleck bio techniques are the choices of treatment for immature permanent teeth with exposed pulps.1,2 These techniques can maintain pulp vitality and provide continuation of tooth root development in association with the formation of a hard tissue bridge across the exposed pulp surface.3 Calcium hydroxide (CH) materials have long been used as the agents of choice for treating exposed pulp, due to the short-term antimicrobial effect and the stimulation of hard-tissue bridge formation.4 Coagulation necrosis produced by releasing hydroxyl ions from CH materials has been believed to induce bridge formation at the exposed area.
4,5 Higher calcium levels and alkalinity provided by CH were also shown to lead to increased bone morphogenetic protein-2 expression and solubilization of bioactive molecule tissue growth factor-��1 from dentin tissue.6,7 TGF-��1 and BMP-2 may play roles in dentin bridge formation.8 Moreover, calcium ions in association with necrotic cell debris may contribute to the formation of dystrophic calcification, to which fibronectin can bind and thereby initiate differentiation of odontoblast-like cells.9 Mineral trioxide aggregate (MTA) has been used as an alternative agent to CH materials in direct pulp capping and pulpotomy treatments. CH is one of the major hydration products during setting reactions of MTA, and CH is soluble from MTA in decreasing rates over time.
10 Calcium and OH ion release from MTA may be essential for pulp tissue healing with bridge formation, which is similar to CH materials.8 MTA generally showed better sealing ability as a root-end filling material than conventional zinc-oxide eugenol cements, and it induced the formation of more and thicker dentin bridges than CH.11�C14 Clinical reports also demonstrated very successful results such as the maintenance of pulp vitality over longer periods of time and the continuation of root formation with MTA as a pulpotomy agent.15�C17 In recent years, the use of MTA has been popular in pulpotomy of permanent teeth showing symptoms of reversible and irreversible pulpitis and in complicated crown fractures of immature teeth and mature teeth.
18,19 Contrarily, the high solubility, Brefeldin_A high price and dis-coloring effect of both gray and white forms are among the disadvantages of MTA, when used as a pulpotomy agent.15,20 The present case report demonstrates long-term clinical performance of MTA pulpotomies in six immature permanent teeth. CASE REPORT Diagnosis and treatment procedures Four patients with complicated crown fractures of 5 maxillary immature central incisor teeth were referred to the Department of Endodontics, Istanbul University, between 2005 and 2006.