This old amalgam on the upper left wisdom tooth was covering a large Cavit plug against a direct pulp cap with radiating hairline fractures. The patient had recently started to have sensitivity to cold (A-delta fibers) with the tooth and when exodontia was advised, asked whether it was possible at all to save the tooth. Access was extraordinarily difficult due to the proximity of the zygomatic arch during maximal opening. The buccal hairline fracture visualized needed to be left as there simply was no access for dissection of this due to limited opening.
The old restorative material was removed and the previous exposure begged the question of whether the pulp was hyperemic or not. The pulp was dissected a further 2mm with sharp, sterile burs. A pledget of NaOCl (aq) was applied to the pulp stump for 2 minutes and self-hemostasis was observed. A liner of Endosequence was applied (we did not have the putty on had) [BUSA Endosequence = pH12; bioceramic sealer] and sealed using Theracal LC before the preparation was micro air abraded using 27 micron aluminum oxide (Prep Start, Danville Engineering) before a total etch adhesive approach using Optibond Solo Plus. A layered base of Ever-X Flow was utilized to impart greater fracture toughness to the tooth before coronal layering using Simplishade Medium.
Fingers crossed for symptoms subsiding.
#KerrSimplishade #EndoSequence #BUSA #Pulpotomy
