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Inside Dentistry
January 2022
Volume 18, Issue 1
Peer-Reviewed

An Unusual Primary Molar Pulpotomy

Restoration with MTA, bioactive restorative, and stainless steel crown following traumatic injury

Theodore P. Croll, DDS | Kevin J. Donly, DDS, MS

Although zinc oxide and mineral trioxide aggregate (MTA) pulpotomies for primary molars have been documented in the literature, virtually all such pulpotomy/stainless steel crown procedures are performed to treat invasive caries lesions that have infected primary molars from their occlusal or occlusoaxial aspects. There is a dearth of evidence regarding primary molars requiring pulpotomy and restoration with a preformed stainless steel crown due to traumatic injury.

This case report documents the step-by-step repair of a fractured maxillary right primary first molar in a 6-year-old girl. She had been playing "cops and robbers" in her home when she fell on her face, striking and cutting her chin. After the chin laceration was sutured at a local hospital emergency room, the patient was brought to the dental office to have her teeth evaluated for injuries. The blow to her chin had crunched the posterior mandibular teeth against the opposing maxillary posterior teeth. As a result, the buccal aspect of her maxillary right primary first molar was sheared subgingivally, but still in place, and the pulp chamber was exposed. The mesiobuccal cusp of the adjacent primary second molar was also struck, and it demonstrated evidence of an internal craze fracture. Following pulpotomy and restoration of the fractured tooth with a stainless steel crown, the patient was followed for 3 years and 11 months, with no further treatment needed, until the tooth was extracted at the request of her orthodontist. The second molar with the craze-fractured cusp was closely monitored but required no treatment until it exfoliated.

Theodore P. Croll, DDS
Clinical Professor
Case Western Reserve University
School of Dental Medicine
Cleveland, Ohio
Adjunct Professor of Pediatric Dentistry
University of Texas Health
Science Center at San Antonio
School of Dentistry
San Antonio, Texas
Clinic Director
Cavity Busters Doylestown
Doylestown, Pennsylvania

Kevin J. Donly, DDS, MS
Diplomate
American Board of Pediatric Dentistry
Professor and Chair
Department of Developmental Dentistry
University of Texas Health
Science Center at San Antonio
School of Dentistry
San Antonio, Texas

Fractured buccal surface of maxillary right primary first molar at presentation.

Fig. 1

Examination revealed that the shear fracture extended subgingivally.

Fig. 2

Profound anesthesia was achieved with a local infiltration, and the fractured segment was removed.

Fig. 3

A sterile round carbide bur was used at slow speed to remove the pulp in the chamber.

Fig. 4

A cotton ball, which was soaked in ferric sulfate that was then squeezed out, was used to assist in achieving hemostasis.

Fig. 5

MTA material (NeoMTA®, NuSmile) was compressed into the pulp chamber.

Fig. 6

Mechanical undercut preparation completed with a high-speed cylindrical diamond bur.

Fig. 7

To restore the tooth’s form and accommodate crown preparation, a bioactive composite (ACTIVA™ BioACTIVE-RESTORATIVE™, Pulpdent) was injected into place.

Fig. 8

The dual-cure restorative material was photopolymerized per the manufacturer’s instructions.

Fig. 9

Buccal view of the primary first molar ready for preparation for the stainless steel crown. Note the craze fracture in the mesiobuccal cusp of the adjacent primary second molar.

Fig. 10

Primary first molar prepared for stainless steel crown coverage.

Fig. 11

A heatless stone was used to trim the margins of the stainless steel crown to proper length and then, spinning at about a 90-degree angle, to crimp the edge peripherally.

Fig. 12

A polishing wheel (Burlew, Pacific Abrasives Inc.) was then used to smooth and polish the crimped margins.

Fig. 13

Occlusal view of the restoration immediately after crown cementation.

Fig. 14

Follow-up occlusal, buccal, and radiographic views acquired 3 years, 11 months, postoperatively.

Fig. 15

Follow-up occlusal, buccal, and radiographic views acquired 3 years, 11 months, postoperatively.

Fig. 16

Follow-up occlusal, buccal, and radiographic views acquired 3 years, 11 months, postoperatively.

Fig. 17

Internal and side views of the extracted tooth demonstrating the crimped margins, which improved the fit.

Fig. 18

Internal and side views of the extracted tooth demonstrating the crimped margins, which improved the fit.

Fig. 19

Theodore P. Croll, DDS

Kevin J. Donly, DDS, MS

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