Endodontics in Pediatric Dentistry – Immature Permanent Dentition-Endodontics in Pediatric Dentistry

Video Transcription

Video Summary

The speaker updates pediatric dentists on managing endodontic problems in children and adolescents, emphasizing that most pediatric providers can handle much of this care—especially for fearful patients or those with special health care needs—while partnering with endodontists when needed. Success starts with an accurate pulpal/periapical diagnosis using structured pain assessment and proper sensibility testing (cold testing is most reliable; use a cotton pellet, not a swab). Pulp disease progresses along a continuum, so pain does not automatically mean root canal therapy; conservative treatment may be possible if the inflamed coronal tissue is removed and the remaining pulp can heal.<br /><br />For compromised permanent molars (caries, MIH, pre-eruptive intracoronal resorption), early intervention is stressed because waiting for full eruption can forfeit vital pulp therapy options. MIH alters bonding due to high protein/low mineral enamel; treatment may require alternatives such as SDF, glass ionomer, bands, or stainless steel crowns. Pre-eruptive lesions can mimic caries; even with periapical radiolucency, vital tissue may remain, allowing partial pulpotomy in selected cases.<br /><br />Recent evidence and AAPD guidelines support vital pulp therapy (direct pulp cap, partial/full pulpotomy) using calcium silicate materials (MTA, Biodentine, bioceramics) over calcium hydroxide, with strong coronal seal being critical. Hemostasis guidance (≈6 minutes) is discussed, though its predictive value is uncertain. If teeth are necrotic and immature, options include apexification, regenerative procedures, or strategic extraction timing for first molar substitution.<br /><br />The trauma section reviews modern injury classifications, unreliable early sensibility tests, healing patterns (including PCO), and complications like ankylosis. Management requires long-term monitoring, growth considerations, and interdisciplinary options such as decoronation or autotransplantation.

Keywords

pediatric endodontics

vital pulp therapy

pulpal diagnosis

periapical diagnosis

sensibility testing

cold test cotton pellet

partial pulpotomy

direct pulp cap

calcium silicate materials

MTA Biodentine bioceramics

molar incisor hypomineralization MIH

pre-eruptive intracoronal resorption

immature necrotic teeth apexification regeneration

dental trauma management ankylosis decoronation autotransplantation