You are presented with a 2 year old MN Lab who fractured his tooth the day prior. You examine the patient and find the right maxillary canine tooth has the following appearance:
You confirm that the pulp is exposed. The typical treatment options for a tooth with a complicated fracture (pulp exposed) are root canal or extraction. This patient is in a unique position because he has a third treatment option that is less costly than a root canal and but can save the tooth. What is that procedure called? How would you explain the pros and cons of this procedure to your client? What is the optimal window of opportunity to perform this procedure?
A vital pulpotomy is a procedure I describe to clients as a “mini root canal”. The optimal patient is young (under 5 years) with a complicated fracture present less than 72hours. During a vital pulpotomy the occlusal (nearest to the tip of the tooth) 5-7mm is removed in a sterile manner and filled most often with MTA or calcium hydroxide. The fractured tip is then restored using a composite resin.
This is the appearance of a tooth with a vital pulpotomy and composite restoration.
The benefits of this procedure versus a root canal are shorter anesthetic time and cost and retaining the viability of the tooth. As a tooth matures, dentin continues to thicken and the pulp becomes more narrow. This is a particularly attractive option for a very young animal with thin dentin whose tooth can be strengthened by a vital pulpotomy procedure allowing the tooth to mature. A root canal, on the other hand, would stall maturation of the tooth and the dentin would never thicken. A tooth treated with a vital pulpotomy is at a slightly greater risk of failure than a root canal for several reasons. A vital pulpotomy, by definition, retains the vitality of the tooth and infection is more likely. This risk increases the longer the tooth has been fractured prior to the procedure.
The post procedure dental rad shows the radiopaque filling material at the occlusal margin:
The same patient rechecked after 9 months shows a radiolucent dentinal bridge (see arrows) forming a barrier between the fractured tip with the filling material and the remaining pulp canal.
The main points to remember are:
• Young dog or cat (optimally under 5 years) with a complicated fracture
• Procedure within 72 hours
For our referring veterinarians: If you have a patient who is a candidate for vital pulpotomy please let us know that when you make the referral. We will do everything possible to see your patient for a vital pulpotomy with that 72 hour window.