What is the treatment for chronic hyperplastic pulpitis?

Treatment of Chronic Hyperplastic Pulpitis

Pulpotomy with calcium hydroxide is the recommended treatment for chronic hyperplastic pulpitis in young patients with restorable teeth, achieving 92% success rates and preserving tooth vitality. 1

Treatment Algorithm Based on Patient Age and Tooth Restorability

Young Patients (Age 10-30 years) with Restorable Teeth

• Perform vital pulpotomy as first-line treatment using an atraumatic surgical technique with calcium hydroxide placement directly on the remaining pulp tissue 1
• This approach successfully maintains pulp vitality in 22 of 24 cases (92% success rate) with follow-up ranging 12-48 months 1
• Success criteria include: absence of clinical symptoms, no periradicular pathology on radiographs, dentine bridge formation, and maintained pulp sensitivity to electrical stimulation 1

Alternative Vital Pulp Therapy Approach

• Consider calcium-enriched mixture (CEM) cement for partial pulpotomy when treating mature teeth with concurrent hyperplastic pulpitis and periradicular periodontitis 2
• Remove pulp tissue from only the coronal third of roots, place CEM cement to protect remaining pulp, and restore definitively 2
• This technique demonstrates periradicular healing at 6 months even in cases previously considered irreversible 2

When Pulpotomy is Contraindicated

• Proceed directly to complete root canal treatment if the tooth has mature apices and extensive coronal destruction that prevents adequate restoration 1, 3
• Extract the tooth only when coronal damage is so severe that restoration is impossible, as extraction of permanent molars leads to malocclusion, aesthetic, phonetic and functional problems 4

Critical Technical Considerations

Pulpotomy Technique Specifics

• Use atraumatic surgical technique to minimize additional trauma to remaining vital pulp tissue 1
• Remove all hyperplastic tissue and contaminated pulp from the pulp chamber 3
• For crown-fractured teeth with prolonged oral contamination (up to 6 months), partial pulpotomy can still succeed if proper technique is followed 3

Common Pitfalls to Avoid

• Do not automatically assume hyperplastic pulpitis requires extraction - this outdated approach unnecessarily sacrifices functional teeth in young patients 1, 4
• Do not perform root canal treatment as first-line therapy in young patients when pulpotomy can preserve pulp vitality and allow continued root development 1
• Do not dismiss vital pulp therapy in mature teeth - even teeth with concurrent internal resorption and periradicular periodontitis can heal with proper biocement placement 2

Follow-Up Protocol

• Monitor clinically for absence of symptoms, swelling, or sinus tract formation 1
• Obtain radiographs to confirm dentine bridge formation and absence of periradicular pathology 1
• Verify continued pulp vitality with electrical pulp testing 1
• Minimum follow-up should extend to 12 months, with optimal monitoring continuing to 48 months 1