Barrieshi-Nusair and Qudeimat18 reported that all 7 immature permanent cases treated with MTA pulpotomy were successful after 2 years. According to these clinical reports, MTA pulpotomy has a superior success rate in developing teeth with open apices. In the present case report, 2 MTA pulpotomy cases were unsuccessful. The primary Crizotinib clinical cause of pulp inflammation after vital pulp treatment is known as bacterial infection.21 Early contamination associated with treatment delay and later contamination with microleakage are the ways for bacteria to cause inflammation and necrosis in complicated crown fractures. There is no time limit for the pulpotomy of fractured immature cases when healthy pulp is clinically present.22 For unsuccessful Cases 3 and 6, the level of pulpotomy may not have been deep enough to reach healthy tissue for recovery.

Materials used during pulpotomy, such as NaOCl and MTA, may have put additional pressure on pulp tissue in these cases. Pulpal hemorrhage may cause increased solubility in MTA before setting. The distribution of MTA particles during hemorrhage may also exceed the clean-up capacity of pulp tissue. In all six cases, gray MTA caused severe discoloration in the tooth crowns. Such a complication following pulpotomy specifically in the anterior teeth should be accounted as a clinical failure of treatment. Discoloration effect of gray MTA as a pulpotomy agent in the crowns was shown and white MTA was developed because of this clinical complication. However, significant tooth discoloration was also reported after the use of white MTA.

23 Belobrov and Parashos23 observed that most of the discoloration was inside white MTA and did not penetrate into dentin. They questioned and did not encourage the use of white MTA for vital therapy in the esthetic zone. Lenherr et al24 asserted that the infiltration of blood components into the porosities within MTA may be the prime cause of discoloration. The other possible reasons for tooth discoloration may be bismuth oxide, magnesium oxide and ferric oxide ingredients in MTA powder.25,26 Composite fillings also showed poor marginal adaptation, which may indicate the presence of coronal leakage around the fillings during service. Restorations should be replaced when a possible microleakage is diagnosed clinically, in order to maintain the vitality of pulpotomized cases. CONCLUSION MTA may be used as an alternative pulpotomy agent in immature teeth with pulp exposure to stimulate pulp healing with dentin bridge formation and complete root formation. Carfilzomib But, discoloration following MTA pulpotomy appears as a major clinical complication. Figure 7 2011 follow-up radiograph of Case 2. Note complete root formation and evident dentin bridge formation beneath MTA (arrow).