Friday, December 5, 2008

Preventing Coronal Leakage in A Pediatric Patient After Endodontic Treatment


This 10 year old patient had a carious pulp exposure on tooth #19. The tooth was diagnosed with a reversible pulpitis and normal periapex. Upon excavation, a carious pulpal exposure occurred. With root developement completed and a cooperative patient, endodontic treatment was completed.
In a case like this, knowing that she will not have a permanent crown for about 8 more years, I become concerned about preventing coronal leakage. In an effort to create another barrier to prevent coronal leakage, I use MTA to seal the canal orifaces.

MTA (Mineral Trioxide Aggregate) is placed into the canal oriface. The MTA will provide a better coronal seal than a bonded restoration alone. The gray color of the MTA makes it easy to remove if the GP ever needs to place a post. Patient's parents are informed of the risk of coronal leakage during the adolescent years and proper preventive care is encouraged to protect the investment made in the tooth.

Patient is referred back to general dentist for comprehensive care. This may include a provisional type crown which will be monitored closely over time.

4 comments:

dan r. said...

I'm just curious: Does MTA really provide a better coronal seal than a bonded restoration? Whats the reason for that suggestion?

Best regards from Switzerland

Robert Salehrabi,DDS said...

If the diagnosis was reversible pulpitis with a carious exposure, you could have tried placing MTA on the pulp exposure. This would have prevented the need for endodontic therapy in such a young patient.Upon setting of the MTA tooth could be restored with a bonded composite.

This is a great article regarding this topic:
Direct pulp capping with mineral trioxide aggregate: an observational study.

Bogen G, Kim JS, Bakland LK.

J Am Dent Assoc. 2008 March



all the best,
robert salehrabi,DDS

Jason J. Hales D.D.S., M.S. said...

That is an excellent point. That exact point was one that was discussed prior to treatment. I typically explain to parents that the final decision will be made at the time of excavation.

At the time of treatment, the clinical judgement was made to complete treatment for the following reasons...apices were completely formed, the patient was completely cooperative, and the decay was extensive, pulp hyperemic.

Your point is well taken. Thank you for your comment.

Anonymous said...

I agree w robert - should have pulp capped the exposure w MTA!!!!!!!!