27 JANUARY-APRIL 2002

JOURNAL OF DENTISTRY FOR CHILDREN

Cvek pulpotomy Report of a casewith five-year follow-up

~aziye Sari DDS PhD

Laumatic injury is a cornmon cause of pulpal damagein anterior teeth Crown fractures with pulp exposurerepresents 18 percent to 20 percent of tr~~~tic ~juriesthat involve the teeth The majonty of IDJunes IDvolverecently erupted or young permanent teeth with imma-ture roots and for that reason everything possible shouldbe done to maintain the pulpal vitality12 Treatment pre-serving the pulpal function allows root developmentAny increase in root development in a young toothstrengthens the tooth and increases the likelihood ofretention In addition a tooth with incomplete root for-mation is a poor candidate for root canal treatment Mostof these teeth will be lost due to subsequent trauma orsimply the forces of mastication3 Camp asserted thatalmost all of these young endodontically involved teethhave a good blood supply and there is almost alwaysvital tissue in the apical third of the canal which cannotbe removed with currently used chemicals4 For thesereasons pulp capping and pulpotomy ren~ va~uabletechniques when immature incisors sustam illJunes re-sulting in exposure of coronal pulp tissue

The present report describes the successful tre~~entby Cvek pulpotomy of a traumatized permanent ~clsortooth This tooth was subsequently followed clinicallyand radiographically for five years

Dr Sari is a Research Assistant Department of Pedodontics Facultyof Dentistry University of Ankara Turkey

CASE REPORT

A six-year-old boy was seen in the Department of Pedi-atric Dentistry of the Dental Faculty of Ankara U~ver-sity (Turkey) sixteen hours after a fall from a bl~ycleThe incident resulted in the fracture of both maxillarycentral incisors After the accident the patient wastreated in a private dental office where the fractured te~thwere dressed with calcium hydroxide ( CaOH) and zmcoxide-eugenol (ZOE) cement The temporary restorationin the left central incisor was completely lost after onehour Intraoral examination revealed pulp exposure ofthe maxillary left central incisor and ZOE restoration inthe maxillary right central incisor Both maxillary cen-tral incisors had sustained enamel-dentin fractures Thefractured central incisors were not mobile Periapicalradiographic examination showed that the apices of theincisors were incomplete There was no evidence of frac-tures involving root or alveolar bone (Figure 1)

There was positive response to electric pulp testing inboth of the maxillary central incisors as well as adjacentteeth It was decided to perform a Cvek Pulpotomy onthe exposed left central incisor tooth After a~ini~~a-tion of a local anesthetic (Citanest-Astra SodertolJeSweden) and isolation with cotton rolls the crown wascleaned with iodine solution and the pulp was ampu-tated to a depth of 1-2 rom within dentin with a spoonexcavator Bleeding was controlled by flushing with asterile saline solution to avoid clot formation CaOH2powder mixed with distilled water was applied over

Figure 1 Periapical radiograph of left central incisor with compli-cated crown fracture (pulpdentin exposure) in six-year-old boysixteen hours after trauma

the pulp wound with a sterile port-amalgam The cav-ity was sealed with ZOE (Figure 2) The other centralincisor tooth was restored with a composite resin Thepatient was told not to use his maxillary incisors to eatwith the exception of soft foods

Clinical and radiographical evaluations of the maxil-lary left central incisor were carried out at three monthssix months twelve months and yearly up to five yearsafter the Cvek pulpotomy The treatment was consid-ered clinically successful at follow-up if the treated toothshowed

bull No history of painbull No swelling or sinus tractbull No history of thermal sensitivitybull No tenderness to percussion

The pulpotomy was considered radiographically suc-cessful at follow-up if the radiographs showed

bull No loss of lamina durabull No loss of trabecular bonebull No internal resorptionbull Continued root developmentbull Dentin bridge formation

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JOURNAL OF DENTISTRY FOR CHILDREN

Figure 2 Periapical radiograph of applied CaOH2 for maxillaryleft central incisor

Figure 3 Periapical radiograph at three months after Cvekpulpotomy Dentin bridge is clearly seen

Figure 4 Incisal view of left central incisor A hard tissue barrierwas observed clinically

Three months after treatment the tooth was clinicallysymptomless and radiographically a hard tissue barrierwas present (Figure 3)The temporary filling and CaOH2

were removed with a small spoon excavator and a hardtissue barrier was observed clinically (Figure 4) Thecavity was covered with a CaOH2 cement and the res-toration was completed with a glass ionomer cementand a composite resin material (Figure 5)

Three years post pulpal treatment it was seen thatthe apex of the tooth was closed (Figure 6 ) and by theend of five years the tooth remained clinically andradiographically symptomless (Figure 7)

DISCUSSION

Pulp capping and pulpotomy are the treatments ofchoice for injured teeth with vital exposed pulps andwith open apices These treatment techniques involvethe same procedure but differ at the level at which theprocedure is done4 Direct pulp capping has some dis-advantages when compared with pulpotomybull Direct pulp capping should not be done in the

presence of a blood clot5-8

bull Pulpotomy provides better retention of thedressing material and possible surgical control ofthe wound9

bull The time between the trauma and the treatmentmust be short in direct pulp capping24

In partial pulpotomy the exposure time is a second-ary factor because the well vascularized pulp tissue hasthe ability to produce a defense reaction to resist bacte-rial contaminationlObulln Also Cvek showed that anexposed pulp in a young tooth with an open apex can

29 SARI

CVEK PULPOTOMY

Figure 5 Intraoral view of completed composite restoration ofmaxillary left central incisor

Figure 6 Periapical radiograph at three years after pulpotomy apexof tooth was closed

remain viable for up to three weeks9 Cvek and Lundbergfound that in teeth with open apices that remainedexposed up to three weeks by removing 1-3 rnm of thesurface pulp viable tissue was present12 This allowed avital procedure to be done predictably Five years post-

Figure 7 Periapical radiograph at five years after Cvek pulpotomythere were no pathologic changes

pulp therapy the pulp tissue was extirpated and exam-ined histologically All the specimens had healthyuninfected non-inflamed pulp tissue This uniformresponse strongly indicated that this procedure couldbe done without resulting in calcification in the rootcanals In contrast for years the endodontic communityhad said that if a pulp capping or pulpotomy was donethe pulp was diseased and caused sclerosis that resultedin pulp degeneration and calcificmetamorphosis4 How-ever Camp asserted that the major reason for calcificmetamorphosis problems in pulpotomies was the levelat which they are done (at the cementoenamel junctionor deeper-cervical pulpotomy )4 These procedures needto done in the line of vision so that the practitioner cancontrol the procedure and visualize each step If CaOH2

gets into the pulp it is picked up by the circulation andspreads throughout the pulp Where a molecule of CHcontacts pulpal tissue calcification results Meticulouscontrol of the procedure restricts diffusion of the CaOH2

thus controlling calcification4The other advantages of Cvek pulpotomy versus

Cervical pulpotomy are in the preservation of cell-richcoronal pulp tissue (a necessary element for better heal-ing) forming a dentin bridge and in the physiologicapposition of dentin in the coronal area9bull1314 In contrastcervical pulpotomy removes all the coronal pulp leav-ing the crown without the physiologic apposition of

30 JANUARY-APRIL 2002

JOURNAL OF DENTISTRY FOR CHILDREN

dentin thereby increasing the risk of cervical fracture1516

In addition Cvek at al asserted that partial pulpotomyis conservative of tooth tissue thus facilitating subse-quent restoration of a fractured crown15

Camp concluded that if Cvek pulpotomy was carriedout correctly the canal would not be calcified or sclero-sed and would have a dentinal bridge root formationwould continue4 The same results were seen in thepresent case Camp also asserted that if pulpal pathol-ogy did occur root canal therapy was still an option

CONCLUSION

The present report demonstrates the clinical and radio-graphic success of the Cvek pulpotomy technique fiveyears following treatment

REFERENCES1 Andreasen JOChallenges in clinical dental traumatology Endod

Dent Traumatol 145-55February 19852 Blanco LP Treatment of crown fractures with pulp exposure

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82564-568November 1996

3 Camp HJ Pediatric endodontic treatment In Cohens BurnsRC editors Pathways of the pulp 6th ed St Louis cw MosbyCo 1994

4 Camp JH Management of trauma in child and adolescentPediatr Dent 17 379-383 September-November 1995

5 Tronstad 1 Mjar YACapping of the inflamed pulp Oral SurgOral Med Oral Oral Pathol 34477-485September 1972

6 Fuks AB Bielak S Chosak A A clinical and radiographicassessment of direct pulp capping and pulpotomy in young per-manent teeth Pediatr Dent 4240-244May-June 1982

7 Lirnm Kc Kirr EEJ Direct pulp capping A review EndodDent Traumatol 3213-219October 1987

8 Stanley HR Pulp capping Conserving the dental pulp OralSurg Oral Med Oral Pathol 68628-639November 1989

9 Cvek M A clinical report on partial pulpotomy and cappingwith calcium hydroxide in permanent incisors with complicatedcrown fracture J Endod 4232-237May 1978

10 Jontel M Bergenholtz G Scheynius A et al Immunocompe-tent cells in the normal dental pulp J Dent Res 661l49-1153Sep-tember 1987

11 Trowbridge HO Immunological aspects of chronic inflamationand repair J Endod 1654-61January 1990

12 Cvek M and Lundberg M Histological appearance of pulpsafter exposure by a crown fracture partial pulpotomy and clini-cal diagnosis of healing J Endod 98-11January 1983

13 Avery J Repair potential of the pulp J Endod 7205-212April1981

14 Fuks ABChosak A Klein H et al Partial pulpotomy as a treat-ment alternative for exposed pulps in crown-fractured perma-nent incisors Endod Dent Traumatol 3100-102April 1987

15 Cvek M Cleaton Jones P Austin P et al Pulp reactions toexposure after experimental crown fractures or grinding in adultmonkeys J Endod 8391-397August 1982

16 Cvek M Partial pulpotomy in crown-fractured incisors Results3 to 15years after treatment Acta Stomatol Croat 27167-1731993

Figure 1 Periapical radiograph of left central incisor with compli-cated crown fracture (pulpdentin exposure) in six-year-old boysixteen hours after trauma

the pulp wound with a sterile port-amalgam The cav-ity was sealed with ZOE (Figure 2) The other centralincisor tooth was restored with a composite resin Thepatient was told not to use his maxillary incisors to eatwith the exception of soft foods

Clinical and radiographical evaluations of the maxil-lary left central incisor were carried out at three monthssix months twelve months and yearly up to five yearsafter the Cvek pulpotomy The treatment was consid-ered clinically successful at follow-up if the treated toothshowed

bull No history of painbull No swelling or sinus tractbull No history of thermal sensitivitybull No tenderness to percussion

The pulpotomy was considered radiographically suc-cessful at follow-up if the radiographs showed

bull No loss of lamina durabull No loss of trabecular bonebull No internal resorptionbull Continued root developmentbull Dentin bridge formation

28 JANUARY-APRIL 2002

JOURNAL OF DENTISTRY FOR CHILDREN

Figure 2 Periapical radiograph of applied CaOH2 for maxillaryleft central incisor

Figure 3 Periapical radiograph at three months after Cvekpulpotomy Dentin bridge is clearly seen

Figure 4 Incisal view of left central incisor A hard tissue barrierwas observed clinically

Three months after treatment the tooth was clinicallysymptomless and radiographically a hard tissue barrierwas present (Figure 3)The temporary filling and CaOH2

were removed with a small spoon excavator and a hardtissue barrier was observed clinically (Figure 4) Thecavity was covered with a CaOH2 cement and the res-toration was completed with a glass ionomer cementand a composite resin material (Figure 5)

Three years post pulpal treatment it was seen thatthe apex of the tooth was closed (Figure 6 ) and by theend of five years the tooth remained clinically andradiographically symptomless (Figure 7)

DISCUSSION

Pulp capping and pulpotomy are the treatments ofchoice for injured teeth with vital exposed pulps andwith open apices These treatment techniques involvethe same procedure but differ at the level at which theprocedure is done4 Direct pulp capping has some dis-advantages when compared with pulpotomybull Direct pulp capping should not be done in the

presence of a blood clot5-8

bull Pulpotomy provides better retention of thedressing material and possible surgical control ofthe wound9

bull The time between the trauma and the treatmentmust be short in direct pulp capping24

In partial pulpotomy the exposure time is a second-ary factor because the well vascularized pulp tissue hasthe ability to produce a defense reaction to resist bacte-rial contaminationlObulln Also Cvek showed that anexposed pulp in a young tooth with an open apex can

29 SARI

CVEK PULPOTOMY

Figure 5 Intraoral view of completed composite restoration ofmaxillary left central incisor

Figure 6 Periapical radiograph at three years after pulpotomy apexof tooth was closed

remain viable for up to three weeks9 Cvek and Lundbergfound that in teeth with open apices that remainedexposed up to three weeks by removing 1-3 rnm of thesurface pulp viable tissue was present12 This allowed avital procedure to be done predictably Five years post-

Figure 7 Periapical radiograph at five years after Cvek pulpotomythere were no pathologic changes

pulp therapy the pulp tissue was extirpated and exam-ined histologically All the specimens had healthyuninfected non-inflamed pulp tissue This uniformresponse strongly indicated that this procedure couldbe done without resulting in calcification in the rootcanals In contrast for years the endodontic communityhad said that if a pulp capping or pulpotomy was donethe pulp was diseased and caused sclerosis that resultedin pulp degeneration and calcificmetamorphosis4 How-ever Camp asserted that the major reason for calcificmetamorphosis problems in pulpotomies was the levelat which they are done (at the cementoenamel junctionor deeper-cervical pulpotomy )4 These procedures needto done in the line of vision so that the practitioner cancontrol the procedure and visualize each step If CaOH2

gets into the pulp it is picked up by the circulation andspreads throughout the pulp Where a molecule of CHcontacts pulpal tissue calcification results Meticulouscontrol of the procedure restricts diffusion of the CaOH2

thus controlling calcification4The other advantages of Cvek pulpotomy versus

Cervical pulpotomy are in the preservation of cell-richcoronal pulp tissue (a necessary element for better heal-ing) forming a dentin bridge and in the physiologicapposition of dentin in the coronal area9bull1314 In contrastcervical pulpotomy removes all the coronal pulp leav-ing the crown without the physiologic apposition of

30 JANUARY-APRIL 2002

JOURNAL OF DENTISTRY FOR CHILDREN

dentin thereby increasing the risk of cervical fracture1516

In addition Cvek at al asserted that partial pulpotomyis conservative of tooth tissue thus facilitating subse-quent restoration of a fractured crown15

Camp concluded that if Cvek pulpotomy was carriedout correctly the canal would not be calcified or sclero-sed and would have a dentinal bridge root formationwould continue4 The same results were seen in thepresent case Camp also asserted that if pulpal pathol-ogy did occur root canal therapy was still an option

CONCLUSION

The present report demonstrates the clinical and radio-graphic success of the Cvek pulpotomy technique fiveyears following treatment

REFERENCES1 Andreasen JOChallenges in clinical dental traumatology Endod

Dent Traumatol 145-55February 19852 Blanco LP Treatment of crown fractures with pulp exposure

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82564-568November 1996

3 Camp HJ Pediatric endodontic treatment In Cohens BurnsRC editors Pathways of the pulp 6th ed St Louis cw MosbyCo 1994

4 Camp JH Management of trauma in child and adolescentPediatr Dent 17 379-383 September-November 1995

5 Tronstad 1 Mjar YACapping of the inflamed pulp Oral SurgOral Med Oral Oral Pathol 34477-485September 1972

6 Fuks AB Bielak S Chosak A A clinical and radiographicassessment of direct pulp capping and pulpotomy in young per-manent teeth Pediatr Dent 4240-244May-June 1982

7 Lirnm Kc Kirr EEJ Direct pulp capping A review EndodDent Traumatol 3213-219October 1987

8 Stanley HR Pulp capping Conserving the dental pulp OralSurg Oral Med Oral Pathol 68628-639November 1989

9 Cvek M A clinical report on partial pulpotomy and cappingwith calcium hydroxide in permanent incisors with complicatedcrown fracture J Endod 4232-237May 1978

10 Jontel M Bergenholtz G Scheynius A et al Immunocompe-tent cells in the normal dental pulp J Dent Res 661l49-1153Sep-tember 1987

11 Trowbridge HO Immunological aspects of chronic inflamationand repair J Endod 1654-61January 1990

12 Cvek M and Lundberg M Histological appearance of pulpsafter exposure by a crown fracture partial pulpotomy and clini-cal diagnosis of healing J Endod 98-11January 1983

13 Avery J Repair potential of the pulp J Endod 7205-212April1981

14 Fuks ABChosak A Klein H et al Partial pulpotomy as a treat-ment alternative for exposed pulps in crown-fractured perma-nent incisors Endod Dent Traumatol 3100-102April 1987

15 Cvek M Cleaton Jones P Austin P et al Pulp reactions toexposure after experimental crown fractures or grinding in adultmonkeys J Endod 8391-397August 1982

16 Cvek M Partial pulpotomy in crown-fractured incisors Results3 to 15years after treatment Acta Stomatol Croat 27167-1731993

Figure 4 Incisal view of left central incisor A hard tissue barrierwas observed clinically

Three months after treatment the tooth was clinicallysymptomless and radiographically a hard tissue barrierwas present (Figure 3)The temporary filling and CaOH2

were removed with a small spoon excavator and a hardtissue barrier was observed clinically (Figure 4) Thecavity was covered with a CaOH2 cement and the res-toration was completed with a glass ionomer cementand a composite resin material (Figure 5)

Three years post pulpal treatment it was seen thatthe apex of the tooth was closed (Figure 6 ) and by theend of five years the tooth remained clinically andradiographically symptomless (Figure 7)

DISCUSSION

Pulp capping and pulpotomy are the treatments ofchoice for injured teeth with vital exposed pulps andwith open apices These treatment techniques involvethe same procedure but differ at the level at which theprocedure is done4 Direct pulp capping has some dis-advantages when compared with pulpotomybull Direct pulp capping should not be done in the

presence of a blood clot5-8

bull Pulpotomy provides better retention of thedressing material and possible surgical control ofthe wound9

bull The time between the trauma and the treatmentmust be short in direct pulp capping24

In partial pulpotomy the exposure time is a second-ary factor because the well vascularized pulp tissue hasthe ability to produce a defense reaction to resist bacte-rial contaminationlObulln Also Cvek showed that anexposed pulp in a young tooth with an open apex can

29 SARI

CVEK PULPOTOMY

Figure 5 Intraoral view of completed composite restoration ofmaxillary left central incisor

Figure 6 Periapical radiograph at three years after pulpotomy apexof tooth was closed

remain viable for up to three weeks9 Cvek and Lundbergfound that in teeth with open apices that remainedexposed up to three weeks by removing 1-3 rnm of thesurface pulp viable tissue was present12 This allowed avital procedure to be done predictably Five years post-

Figure 7 Periapical radiograph at five years after Cvek pulpotomythere were no pathologic changes

pulp therapy the pulp tissue was extirpated and exam-ined histologically All the specimens had healthyuninfected non-inflamed pulp tissue This uniformresponse strongly indicated that this procedure couldbe done without resulting in calcification in the rootcanals In contrast for years the endodontic communityhad said that if a pulp capping or pulpotomy was donethe pulp was diseased and caused sclerosis that resultedin pulp degeneration and calcificmetamorphosis4 How-ever Camp asserted that the major reason for calcificmetamorphosis problems in pulpotomies was the levelat which they are done (at the cementoenamel junctionor deeper-cervical pulpotomy )4 These procedures needto done in the line of vision so that the practitioner cancontrol the procedure and visualize each step If CaOH2

gets into the pulp it is picked up by the circulation andspreads throughout the pulp Where a molecule of CHcontacts pulpal tissue calcification results Meticulouscontrol of the procedure restricts diffusion of the CaOH2

thus controlling calcification4The other advantages of Cvek pulpotomy versus

Cervical pulpotomy are in the preservation of cell-richcoronal pulp tissue (a necessary element for better heal-ing) forming a dentin bridge and in the physiologicapposition of dentin in the coronal area9bull1314 In contrastcervical pulpotomy removes all the coronal pulp leav-ing the crown without the physiologic apposition of

30 JANUARY-APRIL 2002

JOURNAL OF DENTISTRY FOR CHILDREN

dentin thereby increasing the risk of cervical fracture1516

In addition Cvek at al asserted that partial pulpotomyis conservative of tooth tissue thus facilitating subse-quent restoration of a fractured crown15

Camp concluded that if Cvek pulpotomy was carriedout correctly the canal would not be calcified or sclero-sed and would have a dentinal bridge root formationwould continue4 The same results were seen in thepresent case Camp also asserted that if pulpal pathol-ogy did occur root canal therapy was still an option

CONCLUSION

The present report demonstrates the clinical and radio-graphic success of the Cvek pulpotomy technique fiveyears following treatment

REFERENCES1 Andreasen JOChallenges in clinical dental traumatology Endod

Dent Traumatol 145-55February 19852 Blanco LP Treatment of crown fractures with pulp exposure

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82564-568November 1996

3 Camp HJ Pediatric endodontic treatment In Cohens BurnsRC editors Pathways of the pulp 6th ed St Louis cw MosbyCo 1994

4 Camp JH Management of trauma in child and adolescentPediatr Dent 17 379-383 September-November 1995

5 Tronstad 1 Mjar YACapping of the inflamed pulp Oral SurgOral Med Oral Oral Pathol 34477-485September 1972

6 Fuks AB Bielak S Chosak A A clinical and radiographicassessment of direct pulp capping and pulpotomy in young per-manent teeth Pediatr Dent 4240-244May-June 1982

7 Lirnm Kc Kirr EEJ Direct pulp capping A review EndodDent Traumatol 3213-219October 1987

8 Stanley HR Pulp capping Conserving the dental pulp OralSurg Oral Med Oral Pathol 68628-639November 1989

9 Cvek M A clinical report on partial pulpotomy and cappingwith calcium hydroxide in permanent incisors with complicatedcrown fracture J Endod 4232-237May 1978

10 Jontel M Bergenholtz G Scheynius A et al Immunocompe-tent cells in the normal dental pulp J Dent Res 661l49-1153Sep-tember 1987

11 Trowbridge HO Immunological aspects of chronic inflamationand repair J Endod 1654-61January 1990

12 Cvek M and Lundberg M Histological appearance of pulpsafter exposure by a crown fracture partial pulpotomy and clini-cal diagnosis of healing J Endod 98-11January 1983

13 Avery J Repair potential of the pulp J Endod 7205-212April1981

14 Fuks ABChosak A Klein H et al Partial pulpotomy as a treat-ment alternative for exposed pulps in crown-fractured perma-nent incisors Endod Dent Traumatol 3100-102April 1987

15 Cvek M Cleaton Jones P Austin P et al Pulp reactions toexposure after experimental crown fractures or grinding in adultmonkeys J Endod 8391-397August 1982

16 Cvek M Partial pulpotomy in crown-fractured incisors Results3 to 15years after treatment Acta Stomatol Croat 27167-1731993

Figure 7 Periapical radiograph at five years after Cvek pulpotomythere were no pathologic changes

pulp therapy the pulp tissue was extirpated and exam-ined histologically All the specimens had healthyuninfected non-inflamed pulp tissue This uniformresponse strongly indicated that this procedure couldbe done without resulting in calcification in the rootcanals In contrast for years the endodontic communityhad said that if a pulp capping or pulpotomy was donethe pulp was diseased and caused sclerosis that resultedin pulp degeneration and calcificmetamorphosis4 How-ever Camp asserted that the major reason for calcificmetamorphosis problems in pulpotomies was the levelat which they are done (at the cementoenamel junctionor deeper-cervical pulpotomy )4 These procedures needto done in the line of vision so that the practitioner cancontrol the procedure and visualize each step If CaOH2

gets into the pulp it is picked up by the circulation andspreads throughout the pulp Where a molecule of CHcontacts pulpal tissue calcification results Meticulouscontrol of the procedure restricts diffusion of the CaOH2

thus controlling calcification4The other advantages of Cvek pulpotomy versus

Cervical pulpotomy are in the preservation of cell-richcoronal pulp tissue (a necessary element for better heal-ing) forming a dentin bridge and in the physiologicapposition of dentin in the coronal area9bull1314 In contrastcervical pulpotomy removes all the coronal pulp leav-ing the crown without the physiologic apposition of

30 JANUARY-APRIL 2002

JOURNAL OF DENTISTRY FOR CHILDREN

dentin thereby increasing the risk of cervical fracture1516

In addition Cvek at al asserted that partial pulpotomyis conservative of tooth tissue thus facilitating subse-quent restoration of a fractured crown15

Camp concluded that if Cvek pulpotomy was carriedout correctly the canal would not be calcified or sclero-sed and would have a dentinal bridge root formationwould continue4 The same results were seen in thepresent case Camp also asserted that if pulpal pathol-ogy did occur root canal therapy was still an option

CONCLUSION

The present report demonstrates the clinical and radio-graphic success of the Cvek pulpotomy technique fiveyears following treatment

REFERENCES1 Andreasen JOChallenges in clinical dental traumatology Endod

Dent Traumatol 145-55February 19852 Blanco LP Treatment of crown fractures with pulp exposure

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82564-568November 1996

3 Camp HJ Pediatric endodontic treatment In Cohens BurnsRC editors Pathways of the pulp 6th ed St Louis cw MosbyCo 1994

4 Camp JH Management of trauma in child and adolescentPediatr Dent 17 379-383 September-November 1995

5 Tronstad 1 Mjar YACapping of the inflamed pulp Oral SurgOral Med Oral Oral Pathol 34477-485September 1972

6 Fuks AB Bielak S Chosak A A clinical and radiographicassessment of direct pulp capping and pulpotomy in young per-manent teeth Pediatr Dent 4240-244May-June 1982

7 Lirnm Kc Kirr EEJ Direct pulp capping A review EndodDent Traumatol 3213-219October 1987

8 Stanley HR Pulp capping Conserving the dental pulp OralSurg Oral Med Oral Pathol 68628-639November 1989

9 Cvek M A clinical report on partial pulpotomy and cappingwith calcium hydroxide in permanent incisors with complicatedcrown fracture J Endod 4232-237May 1978

10 Jontel M Bergenholtz G Scheynius A et al Immunocompe-tent cells in the normal dental pulp J Dent Res 661l49-1153Sep-tember 1987

11 Trowbridge HO Immunological aspects of chronic inflamationand repair J Endod 1654-61January 1990

12 Cvek M and Lundberg M Histological appearance of pulpsafter exposure by a crown fracture partial pulpotomy and clini-cal diagnosis of healing J Endod 98-11January 1983

13 Avery J Repair potential of the pulp J Endod 7205-212April1981

14 Fuks ABChosak A Klein H et al Partial pulpotomy as a treat-ment alternative for exposed pulps in crown-fractured perma-nent incisors Endod Dent Traumatol 3100-102April 1987

15 Cvek M Cleaton Jones P Austin P et al Pulp reactions toexposure after experimental crown fractures or grinding in adultmonkeys J Endod 8391-397August 1982

16 Cvek M Partial pulpotomy in crown-fractured incisors Results3 to 15years after treatment Acta Stomatol Croat 27167-1731993