Guideline on Pulp Therapy for Primary and Immature Permanent Teeth

The American Academy of Pediatric Dentistry (AAPD) intends this guideline to aid in the diagnosis of pulp health versus pathosis and to set forth the indications, objectives, and therapeutic interventions for pulp therapy in primary and immature permanent teeth.

The primary objective of pulp therapy is to maintain the integrity and health of the teeth and their supporting tissues.

It is a treatment objective to maintain the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes.

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Especially in young permanent teeth with immature roots, the pulp is integral to continue apexogenesis. Long term retention of a permanent tooth requires a root with a favorable crown/ root ratio and dentinal walls that are thick enough to withstand normal function.

Therefore, pulp preservation is a primary goal for treatment of the young permanent dentition.

A tooth without a vital pulp, however, can remain clinically functional.

The indications, objectives, and type of pulpal therapy depend on whether the pulp is vital or nonvital, based on the clinical diagnosis of normal pulp (symptom free and normally responsive to vitality testing), reversible pulpitis (pulp is capable of healing), symptomatic or asymptomatic irreversible pulpitis (vital inflamed pulp is incapable of healing), or necrotic pulp.

In permanent teeth, electric pulp tests and thermal tests may be helpful.

Teeth exhibiting signs and/or symptoms such as a history of spontaneous unprovoked toothache, a sinus tract, soft tissue inflammation not resulting from gingivitis or periodontitis, excessive mobility not associated with trauma or exfoliation, furcation/apical radiolucency, or radiographic evidence of internal/external resorption have a clinical diagnosis of irreversible pulpitis or necrosis. These teeth are candidates for nonvital pulp treatment.

Teeth exhibiting provoked pain of short duration relieved with over-the-counter analgesics, by brushing, or upon the removal of the stimulus and without signs or symptoms of irreversible pulpitis, have a clinical diagnosis of reversible pulpitis and are candidates for vital pulp therapy.


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