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Indirect Pulp Treatment in First Primary Molar & Restoration With Zirconia Crown

Categories: Restorative Dentistry

Author(s): William H. Lieberman, DDS, MBA, Danielle M. Lombardi, DDS

Date: 03-23-2020 12:09:31 pm

The American Academy of Pediatric Dentistry (AAPD) supports the preservation of primary teeth until natural exfoliation to maintain appropriate oral function and facial growth. There-fore, the maintenance of sound tooth structure and its supporting tissues remains a leading objective of pulp therapy in teeth that have been affected by caries or other injuries.
Currently, pulpotomy followed by a full-coverage stainless steel crown is the most frequently used treatment for carious lesions approximating a vital pulp in primary teeth. However, existing research has shown that an alternative technique, indirect pulp treatment, is a suitable option and results in similar or greater success rates than pulpotomy. A study conducted by Rosenberg and colleagues at New York University College of Dentistry demonstrates the efficacy of indirect pulp treatment in primary molars when using 2% chlorhexidine gluconate disinfecting solution and resin-modified glass ionomer liner. Additionally, the use of pediatric zirconia crowns provides an obvious esthetic advantage over stainless steel crowns.
Indirect pulp treatment is indicated for treating large carious lesions that approximate the pulp and do not demonstrate signs or symptoms of irreversible pulpitis. Indirect pulp treatment involves removing the first layer of the infected dentin of a carious lesion, while leaving behind a thin layer of affected dentin to prevent pulp exposure. Next, a biocompatible liner is applied over the remaining affected dentin to stimulate healing at the dentin-pulp interface. Finally, the tooth is restored to form an adequate seal and prevent microleakage.
Zirconia is a biocompatible material used widely for crown and bridge, implant, and endodontic procedures in adult dental patients. However, the use of zirconia for pediatric crowns was not available until recently. Zirconia crowns provide superior esthetics over preveneered and stainless steel crown options and they do not stain or chip.
One important disadvantage to consider when using zirconia crowns, however, is that saliva and blood contamination can weaken the bond strength between the tooth and the crown. Some manufacturers have overcome this problem by developing try-in crowns to verify proper fit before the final crown is cemented. Furthermore, zirconia crowns may not be suitable in cases with significant crowding or space loss, as their size, shape, and fit cannot be altered.
The following case presents a 6-year-old healthy patient with a large carious lesion on the lower left first primary molar. Indirect pulp treatment was completed after caries removal, and the tooth was restored with a zirconia crown.

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