A Two-Visit Pulpotomy Approach for the Management of Uncontrolled Bleeding in a Crown-Root Fractured Immature Incisor: A Case Report.

Background/

Objective

The present case demonstrates the successful preservation of a severely inflamed dental pulp despite uncontrolled bleeding occurring during pulpotomy. This novel therapeutic approach was developed when a 7-year-old boy presented for endodontic treatment one week after sustaining a crown-root fracture in an immature incisor. The tooth exhibited slight hypersensitivity to cold testing, with no tenderness to percussion or palpation. An exposed pulp was present; however, when he could avoid contact with the exposed pulp tissue, the patient reported no symptoms.

Methods

The critical determinant of success when uncontrolled pulpal bleeding occurred following pulpotomy was the stepwise treatment in two visits and the bacteria-tight seal of the access cavity. The seal was achieved through the incremental application of the temporary filling material. A calcium hydroxide preparation was applied as interappointment topical pulp dressing. Four weeks after the initial visit the pulpotomy could be accomplished.

Results

During 3.5 years of follow-up, the patient remained without symptoms and the tooth showed ongoing root growth in length and width combined with positive reaction to electric pulp testing.

Conclusions

In summary, this case demonstrates that, despite persistent bleeding following pulpotomy, pulpal vitality can be preserved, thereby promoting continued root development.