Effect of iRoot BP Plus on Pulpotomy of Young Permanent Teeth

with Complicated Crown Fracture: A Case Report

JingE Song, Yan Nan and Bin Liu

School/Hospital of Stomatology, Lanzhou University, Lanzhou 730000, China

Keywords:

Root BP Plus, Pulpotomy, Complicated Crown Fracture.

Abstract: Complicated crown fracture in young children is usually caused by injury. The primary goal of treatment is

to maintain pulp vitality so that the root can develop normally. A newly developed bioactive ceramic called

iRoot BP Plus has been demonstrated to have the ability to maitain pulp vitality and induce hard-tissue

formation in pulpal tissue. In this case report, we preserved the pulp vitality of maxillary central incisor by

iRoot BP Plus pulpotomy in a 10-year-old boy with complicated crown fracture. The pulp showed signs of

vitality and there was no periapical radiolucency developed.

1 INTRODUCTION

There is a high incidence of dental trauma in children.

The complicated crown fracture of young permanent

teeth that characterized by enamel-dentin-pulp

fracture is a relatively common kind of dental trauma

(Rao, 2020). The root apical foramen of young

permanent teeth has not been fully developed. The

pulp is the main tissue to ensure the continuous

development of root (Love R M, 1997). When the

crown fractured and pulp exposed, it is particularly

important to take active and effective methods to

preserve the vitality of pulp. By preserving pulp

vitality, apical development can be accomplished

(Shabahang, 2020). The pulpotomy that the infected

pulp tissue was removed and the healthy pulp was left

is an effective treatment for the complicated crown

fracture (Cvek, 1978). Materials such as calcium

hydroxide (CH) and mineral trioxide aggregate

(MTA) have been proven effective for pulpotomy,

they are widely used in clinical (Parirokh, 2010;

David, 2006). However, they also have their own

shortcomings, such as low adhesion of calcium

hydroxide and the discoloration of MTA over time

(David, 2006).

IRoot BP Plus is a new type of bioceramic

material which is convenient and ready-to-use. It can

be used for pulpotomy because of its excellent

biological activity, antibacterial properties, sealing

ability as well as ability to promoting the formation

of dentin bridge (Ibrahim, 2014). This case reports

iRoot BP Plus was applied for pulpotomy in young

permanent teeth with complicated crown fracture.

2 CASE REPORT

A 10-year-old boy was referred to the Paediatric

Stomatology Department of our University for the

treatment of his traumatized maxillary anterior

incisors because an accident that his teeth hit a

swimming pool 16 hours earlier. The traumatized

teeth had no history of treatment. A clinical

examination found that the tooth 11 and 21

(Federation Dentaire Internationale, FDI) were

fractured and the pulp was exposed. The teeth were

active to the pulp electrical activity test.

Rradiographic examinationas showed that roots of

tooth 11 and 21 were under developed with open apex,

as is shown in Fig.1. The fractured teeth are treated

with pulpotomy. They were isolated with rubber dam

after local anesthesia. The infected pulp was removed

while the healthy pulp was left. The pulp wound was

rinsed with 5% sodium hypochlorite solution to

remove debris. Compressed with sterile cotton ball

for five minutes to stop bleeding. Subsequently, the

remained pulp was covered with iRoot BP Plus

(Innovative BioCeramixInc, Canada). Then, the

cavity was sealed with glass-ionomer cement (Ketac

Molar Easymix, 3M ESPE, USA) and light-cured

composite material (Filtek Z350 XT, 3M ESPE,

USA), as is shown in Fig. 2.

Song, J., Nan, Y. and Liu, B.

Effect of iRoot BP Plus on Pulpotomy of Young Permanent Teeth with Complicated Crown Fracture: A Case Report.

DOI: 10.5220/0012017900003633

In Proceedings of the 4th International Conference on Biotechnology and Biomedicine (ICBB 2022), pages 183-186

ISBN: 978-989-758-637-8

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

183

The tooth of 11 and 21 were reviewed clinically

and radiographically at 1 month,3month, 6 month and

12month during the first year. It means that an

effective treatment has been achieved when the

following conditions exist such as absence of clinical

symptoms like pain and swelling, absence of

radiographic pathology, presence of dentin bridges

and signs of continued development of the root.

The re-examination results showed that tooth 11

and 21 had no obvious discomfort. Radiographic

examination at 6 month showed that dentin bridge

under iRoot BP Plus existed without any sign of

pathology, as is shown in Fig.3a. In addition, the

reviewed radiographic examination at 12 month

showed that the roots walls thickened and the apical

foramen tended to converge, as is shown in Fig. 3b.

Figure 1: The preoperative periapical radiograph of tooth 11 and 21 with open apex.

Figure 2: The postoperative radiograph of tooth 11 and 21 with iRoot BP Plus pulpotomy.

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(a)The reviewed radiograph at 6 month.

(b) The reviewed radiograph at 12 month.

Figure 3: The reviewed periapical radiograph of the case.

3 DISCUSSION

After the tooth eruption, the continued development

of the root depends on the pulp. Immature permanent

teeth with open apex have a rich blood supply, so they

have strong anti-infection ability and repair ability

(Andreasen, 2015).

When the crown is fractured and the pulp is

exposed, the inflammatory reaction will spread to the

apex with time (Olsburgh, 2010). So it is very

important to choose suitable pulp capping agent to

preserve pulp vitality. Pulp capping agent with good

properties is indispensable to the success of

pulpotomy. The ideal pulp capping agent for

pulpotomy should have anti-infective ability, good

sealing properties as well as the ability to promote the

formation of dentin from the remained pulp (David,

2006; Schwendicke, 2016). IRoot BP Plus is a type

of newly developed premixed bioceramic material

(Yang, 2020; Mahgoub, 2019). As a newly developed

material, there are some studies on the properties of

iRoot BP Plus. IRoot BP Plus have similar bioactivity

and biocompatibility to MTA, which has been uesd

for pulpotomy for a long time (Sanz, 2020).

Moreover, iRoot BP Plus is insoluble in wate and

Effect of iRoot BP Plus on Pulpotomy of Young Permanent Teeth with Complicated Crown Fracture: A Case Report

185

easy to handle, it does not change color with time

(Elshamy, 2016).

IRoot BP Plus has good antibacterial properties.

Elshamy reported that the antimicrobial property of

iroot BP Plus comes from its high pH value (12.5).

During the process of solidification, hydroxyl ions

are released and penetrate into the dentin, raising the

pH value of the surrounding environment, and then

producing strong antibacterial activity against

common pathogenic bacteria in infected root canal

(Elshamy, 2016).

Besides, the reaction of iRoot BP Plus requires the

participation of water, so a humid or bloody

environment will not affect the curing of the material.

It can be tightly bonded with the wall of the

medullary cavity and will not be displaced by

external force because of its good adhesiveness

(Jitaru, 2016) .In addition, the research also found

that iRoot BP Plus can induce the proliferation of

dental pulp cells and promote the formation of dentin

bridge (Liu, 2015). In our case, the formation of the

dentin bridge can also be radiographically observed

under iRoot BP Plus. The thickened canal walls and

progressively converged apical foramen on the

periapical radiograph at 12 month indicated that the

pulp is active and the root is continuing to develop.

These properties possibly make iRoot BP Plus a ideal

pulp capping material for pulpotomy treatment.

4 CONCLUSION

IRoot BP Plus could be a candidate material in the

management of complicated crown fractures due to

its good biological activity, antibacterial and

adhesive properties. However, further research is

necessary to clarify this conclusion.

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