An immature permanent tooth is defined by the British Society of Paediatric Dentistry as [1]: … a tooth which is not fully formed, particularly the root apex. Therapeutic efforts are directed towards preserving the vitality of the pulpo-dentinal complex to facilitate normal root development and maturation (Figure 7.1). The open apex is associated with excellent pulpal vascularity and the potential for a favourable healing response. Keywords: Persistent symptoms occurring soon after placement of a restoration indicate pulpal pathology. In these cases, the underlying pathology is still present and must be resolved, despite the lack of obvious discomfort. This chapter is concerned with the cascade of therapeutic interventions used to promote an adaptive biological response in the pulpo-dentinal complex of the treated tooth, and optimize subsequent growth and development. Techniques of pulp therapy for primary and immature permanent teeth. In cases of congenital absence of teeth, the decision to extract or retain individual teeth will be influenced by the overall orthodontic strategy. (B) Ingress of oral streptococci into dentine tubules. The teeth without pulp exposure showed normal clinical and radiographic conditions during the 1-year follow-up, except for 3 primary teeth. A primary tooth that cannot be saved requires extraction despite potential future orthodontic complications. In the immature permanent tooth, raised response thresholds to electrical stimuli are observed. Generally, children with well-managed diabetes present no particular problem in relation to healing potential. Primary teeth adequately retain space for their successors and have been described as "the best space maintainers." The primary goal of pulp therapy is to maintain the integrity and health of the teeth and their supporting tissues while maintaining the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes. The aim of pulp therapy in primary and young permanent teeth is to maintain a functional tooth so that arch integrity is preserved in a growing child. Primary teeth adequately retain space for their successors and have been described as "the best space maintainers." (A) Caries may be much more extensive than clinically visible. (B) Undermined triangular ridge or cusp suggests carious pulpal involvement. It is a treatment objective to maintain the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes. Therefore, the decision to extract a primary tooth should take into consideration occlusal growth and development as well as the potential outcome of pulp therapy. (A) Much of the pain that children experience may be caused by food impacting into a cavity. Therapeutic efforts are directed towards the retention of carious or traumatized teeth, maintaining normal function, with the resolution of, or freedom from, clinical symptoms. • Fracture of the occlusal triangular ridges or carious undermining of the cusps in pit and fissure caries also suggests carious involvement (Figure 7.4B). Retention of a compromised immature permanent tooth with a poor long-term prognosis may still be beneficial for arch integrity and normal alveolar development during the period of dentofacial growth (see Chapter 14). Alveolar swelling, particularly involving the vestibular reflection, facial swelling, coronal discoloration, and the presence of a sinus, are indicators of pulp necrosis and abscess formation (see Figure 7.3B). Guideline on Pulp Therapy for Primary and Young Permanent Teeth. Direct pulp capping 3. ectodermal dysplasia, Figure 7.6A; see also Chapter 11). Where these outcomes cannot reasonably be achieved over the clinical life of the primary tooth, it is appropriate to extract the affected tooth and consider alternative strategies for occlusal guidance and maintenance of arch integrity (see Chapter 14). Facial cellulitis, including spread of infection into the tissue planes around the airway (Ludwig’s angina, see. Inappropriate tooth mobility, tenderness to palpation or a sensation of occlusal interference also suggests abscess formation. (A) Large multisurface glass ionomer restorations are inadequate to properly restore primary molars. These will dictate the decision on performing pulp therapy (for primary … Discover the world's research The current evidence base for pulp therapy in the primary dentition is poor with a demonstrated paucity of prospective randomized controlled trials. Obliteration suggests pulpal necrosis the primary objective of pulp therapy of immature permanent tooth be... 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