| Resumo: |
Conservative treatments of pulp are standard approaches of dentistry, both in primary teeth, as the permanent. Among the therapeutic, pulpotomy is reported in the literature as a quick option, easy to perform, affordable and with high potential for success, when correctly indicated. However, the lack of reliable diagnostic methods for pulp indications and clinical and radiographic parameters harsh for your proservation, to make before these uncertainties, a technique rarely used and implemented as definitive treatment in endodontics. Making a historical reflection, we can see great scientific advances in materials developed to conservative treatments. However, the factors that act directly on the success or failure and longevity of pulpotomy, are still unclear to our knowledge. Thus, the aim of this study was to try to clarify and understand this, from a retrospective study. Initially, the first article of this thesis was selected for a case of dens invaginatus type 3 with still open apex. Conservative treatment in one of the teeth and a classical approach to endodontic pulp necrosis was adopted in other. The invaginatus dens is an anomaly stage of tooth formation, which promotes many structural changes in the dental organ, offering great difficulties when conventional endodontic treatment is required. As a result, was executed endodontic treatment with calcium hydroxide exchanges in the main tooth and the tooth pulpotomy in invaginated, inducing its apicogênese. After 21 years of clinical and radiographic follow-up, we observed the injury has healed and the complete root formation. The preservation of pulp vitality, followed by the formation of dentin bridge in pulpotomizado tooth, proved to be a viable alternative and definitive treatment. In the second article of the thesis, we seek a retorspectiva analysis of outcome. Reevaluated 273 pulpotomies in permanent teeth performed by a single professional, specialist in endodontics, and verify the influence of clinical, radiographic and systemic in proservation and determination of success or failure in pulpotomy. Data were analyzed using Cox regression test and Fisher's Exact Test (p = 0.05) for a period ranging from 1 to 29 years of follow up. We can conclude that pulpotomy can be performed at any age, without statistical correlation with the systemic problems. The absence of clinical symptoms and radiographic changes of peri-implant tissues, followed by the presence of dentin bridge and hermetic coronal sealing, are indicative reliable in proservation. |
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