I am writing regarding Dr. David Witherspoon and colleagues’ excellent May JADA article, "Mineral Trioxide Aggregate Pulpotomies: A Case Series Outcomes Assessment" (JADA 2006;137[5]:610–8). As a pediatric dentist who treats young traumatized permanent teeth, I read this article with great interest. Although I have not used mineral trioxide aggregate extensively, I am familiar with the literature on its use in these circumstances.
I do, however, need some clarification on the teeth that were treated for what the authors describe as irreversible pulpitis with a complicated enamel dentin fracture (IP/T/CDEDF) due to traumatic injury. My questions are as follows:
- – How was the diagnosis of irreversible pulpitis made?
- – I assume that the "complicated enamel dentin fractures" all involved pulpal exposure by definition. Is that in fact the case?
- – What were the time intervals between the traumatic pulpal exposures and treatment?
- – What was the maturity of the apexes of these teeth? Seven of the 23 cases were IP/T/CEDF, and all but one of the seven were 9 years old or younger, so I assume the apexes were not fully closed.
I think that this information should have been included in the "Materials and Methods" section to better aid the reader in understanding precisely in what circumstances this technique was successful. In fact, there also should have been a better description of the circumstances for the treatment of the IP/C (irreversible pulpitis with caries exposure) other than the fact that they were carious exposures.
