Pulp Therapy for Primary and Immature Permanent Teeth: Indications and Objectives

Abstract

This best practice supports clinicians in the diagnosis of pulp health or pathosis and provides evidence for various therapeutic interventions for pulp therapy in both primary and immature permanent teeth. The health status of pulp tissue determines which form of pulp therapy is indicated. Vital pulp therapies for primary teeth with normal pulp or reversible pulpitis include protective liner, indirect pulp treatment, direct pulp cap, and pulpotomy. Nonvital pulp treatment for primary teeth with irreversible pulpitis or necrotic pulp includes pulpectomy and lesion stabilization/tissue repair. Vital pulp therapy for immature permanent teeth with a normal pulp or reversible pulpitis includes protective liners, indirect pulp treatment, direct pulp cap, partial pulpotomy, and complete pulpotomy. Nonvital pulp treatment for permanent teeth includes conventional root canal treatment, apexification, and regenerative endodontics. A complete pulpotomy may be considered in select primary and permanent teeth exhibiting signs of irreversible pulpitis in absence of clinical and radiographic signs of infection. Clinicians should familiarize themselves with these pulp therapies and consider the value of each tooth in question, restorability of the tooth, and potential alternative treatment.

This document was developed through a collaborative effort of the American Academy of Pediatric Dentistry Councils on Clinical Affairs and Scientific Affairs to offer updated information and guidance on pulp therapy for primary and immature permanent teeth.

^{KEYWORDS:  DENTAL PULP, ROOT CANAL THERAPY; ROOT CANAL PREPARATION; PULP CAPPING; APEXIFICATION}