Revitalizing Smiles: Endodontic Treatment with Vital Extirpation for Preservation of Function and Aesthetics

Endodontic treatment is a widely accepted procedure to manage irreversible pulpitis with vital pulp extirpation. Irreversible pulpitis is a condition in which the pulp tissue is inflamed and unable to recover spontaneously. The treatment involves removing the inflamed pulp tissue from the root canal system, cleaning, shaping, and filling the canal with an inert material. Vital pulp extirpation is a technique that removes the pulp tissue while maintaining the vitality of the periapical tissues. This approach can improve the success rate of endodontic treatment by reducing the risk of complications such as postoperative pain and apical periodontitis.

A 19-year-old female patient presented with a large cavity on her anterior teeth, which caused bad aesthetics and spontaneous pain. Clinical examination revealed large caries and a vitality test was positive. A percussion test was negative, and a periapical radiograph showed periodontal ligament widening. The diagnosis was pulpitis irreversible with asymptomatic apical periodontitis.

Firstly, caries removal was performed to remove the decayed part of the tooth under local anesthesia to expose the pulp chamber. Vital pulp extirpation was then carried out to remove any inflamed or infected pulp tissue using a barbed broach file to prevent the further spread of infection. Next, the crown was rebuilt using the canal projection technique, which involved shaping the remaining dentin to form a projection that would support the restoration. The working length of the canal was measured using an apex locator to ensure proper cleaning and shaping of the canal. Cleaning and shaping of the canal were then carried out using the crown-down technique, with irrigation done using different solutions such as NaoCl, EDTA, and Chlorhexidine to remove debris and disinfect the canal. An intracanal medicament of CaOH2 was placed for 2 weeks. The canal was then filled with gutta-percha, and a cold lateral condensation technique was carried out to ensure a tight seal. Lastly, the tooth was restored with a fiber-post and direct composite restoration to provide structural support and improve aesthetics.

The endodontic treatment resolved the aesthetic and functional problems, and the patient was satisfied with the result. The postoperative follow-up showed no pain, swelling, or other complications.

Endodontic treatment with vital pulp extirpation can be an effective approach to managing irreversible pulpitis with asymptomatic apical periodontitis. Proper diagnosis, treatment planning, and technique execution are crucial for the success of the treatment.

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