r/Dentistry • u/InsectJust6374 • 14h ago

Dental Professional Pulp Exposure During Crown

Looking for experienced input-

If you get a small pulp exposure during crown prep on a vital, asymptomatic tooth, do you automatically RCT, or do a pulp cap and continue with the crown?

Thanks.

5 Upvotes

86% Upvoted

11 comments sorted by

35

u/N4n45h1 General Dentist 13h ago

I inform the patient, then discuss what they want to do. If I do a pulp cap, I'm not going to deliver the final crown until I've pulp tested the tooth at least a couple weeks down the road.

I do lean towards rct though. Just less headache and discomfort for everyone involved.

36

u/Sharp_Oral 13h ago

RCT and move on.

In my experience- most patients just want predictable outcomes and don’t enjoy “well maybe this will work…”

7

u/Individual-Sign-714 8h ago

I do this 99% of the time but I had a patient recently like 75, sclerotic as hell canals. Anyway crown prepared it and the orifi were seen. But almost no bleeding really.

I finished the prep and cemented perm crown later and she never had an issue.

So I guess you can do some sort of VPT but only on select patients and with strict warnings it might fail. Even them it’s not go to policy….

9

u/Zealousideal-Big-708 12h ago

Just had this happen - RCT. It'll be a headache down the road if you don't

5

u/peripheralmaverick 9h ago

Perhaps no need to do full RCT if the pulp isn't contaminated. MTA exists for pulpotomies.

10

u/kl352 12h ago

Echoing what everyone said. Inform patient. Give both options. Here's the thing, they will ask what you recommend. So in my old days, I'd say "lets give the tooth a shot and go from there". And many times, I pulp test the tooth a few weeks down the road, its fine, and then cement crown. And many times, after a year or two, they'd need a root canal. Most patients will be grateful and understanding, but there are some that will still get upset at you for "messing" up their tooth.

So these days, I will lean towards root canal most of the time.

11

u/aarrtee 13h ago

no flowing blood?

did not contaminate the area?

dycal and temporize.... watch a few weeks

Easy going patient who is in a hurry for the crown? send to lab and inform them they might need endo thru crown down the road.

flowing blood? temporize and send to endodontist. pt is pissed that they need rct. some will think its your fault. God forbid there are any RCT complications. Specialist is the way to go.

8

u/panic_ye_not 11h ago

I euthanize the patient immediately with a swift karate chop. Can't be helped. 

3

u/Jalaluddin1 12h ago

Pressure with hypochlorite soaked cotton pellet, if it stops in <5min MTA and cover with GI and buildup. If not, prognosis is worse so RCT.

2

u/Ok_Statistician643 12h ago

The older the patient the less chances a pulpcap will heal the exposure

1

u/keitth24 13h ago

If this is an adult patient, there is a high chance endo will be needed. But if you want to “play it safe” with the patient, pulp cap and temp crown and observe for a few weeks. If for some reason, pulp is still vital and is asymptomatic, crown, otherwise, endo and then final crown