Pulpotomy therapy in primary teeth: new modalities for old rationales

Area of Science:

• Dentistry
• Pediatric Dentistry
• Regenerative Medicine

Background:

• Pulpotomy techniques for primary teeth have evolved into three main categories: devitalization, preservation, and regeneration.
• Traditional methods like formocresol (devitalization) and glutaraldehyde/ferric sulfate (preservation) have limitations.
• Calcium hydroxide has been a long-standing agent for stimulating reparative dentin bridge formation (regeneration).

Purpose of the Study:

• To review the historical development and current trends in pulpotomy therapy for primary dentition.
• To highlight the emerging role of regenerative approaches in pediatric pulp therapy.
• To discuss the potential impact of bone morphogenetic proteins (BMPs) on future pulpotomy treatments.

Main Methods:

• Literature review of pulpotomy techniques and materials.
• Analysis of the principles behind devitalization, preservation, and regeneration methods.
• Exploration of recent advancements in regenerative endodontics, including BMPs.

Main Results:

• Devitalization (e.g., formocresol) aims to destroy vital tissue.
• Preservation (e.g., glutaraldehyde, ferric sulfate) retains vital tissue without inducing reparative dentin.
• Regeneration, historically linked to calcium hydroxide, is poised for significant advancement.
• Bone morphogenetic proteins (BMPs) offer new possibilities for dentinogenesis in pulpotomy.

Conclusions:

• Regenerative pulpotomy is expected to be the most rapidly advancing area in the coming years.
• Recombinant human BMPs with dentinogenic properties are becoming increasingly available.
• The future of pulpotomy therapy is shifting towards a healing-centered approach, leveraging regenerative principles.