In the daily practice we face a questionable cases almost every day,diagnosis is the hardest part in such cases,a cases like(pt asking for treatment of carious tooth with no pain at all and tooth responsive for thermal test but on x-ray the caries reach the chamber,or a pt came suffering from pain for couple of days and he describe it as a severe pain that it cause headache but on x-ray the caries do not reach the pulp chamber) these two scenarios are repeatable making the diagnosis almost really hard and challenging.
pain is relative sometimes the patient do not feel that severe pain but he suffered for somedays and been annoyed and want to get rid from this pain describing it as a severe pain,specially the pt do not know exactly what you want to know from the word(pain).
so a multi disciplinary tests should be taken before judging the situation by pt mouth words,after asking for the history,x-ray should be taken to relate the caries situation with the pt symptoms , sensibility test should be done calculating the severity and duration of response,periapical area evaluation should be considered percussion and after caries removal if there was an exposure to the pulp chamber the bleeding time and severity should be considered since the healthy pulp do not bleed at least not for long time.
here in this case pt asked only for filling he do not feel any severe pain or sensitivity his chief compliant was food stagnation in the carious part of the tooth,after x-ray taken there was a lot of stones noticed in both molars and chamber recision noticed in the first molar revealing an inflammatory and immune response situation inorder to save the vitality of the pulp,thermal test was done by using cotton and endo ice the response of pt was at normal range no severe respond noticed also the stimulation gone as soon as the cotton was removed,you can also notice the canals mesially with a deep orifices.
after caries removal as I expected the two pulp horns mesialy exposed but they were solid and closed by sclerotic dentin and no any entry to the chamber detected,since there is no way to test the infectious situation of the pulp or the surrounding tissue can be done and there are no gold standards to deal with such situations ideally,I decided to do a (FOLLOW UP TREATMENT) by doing only ordinary filling with no capping materials hence there was already tertiary dentin closing the chamber so I decided to relay on my bond as a capping material and do the rest steps as a conventional filling.
now after almost one month the situation stable the tooth still respond normally to thermal test and the pt is symptoms free, a 3-6-9 months follow up appointments planned and pt monitoring on going.
am doing a lot of follow up dependant treatments these days with a very good results in lots of cases also vital pulp therapy is a first choice in such situations is very promising treatment making the clinical management easier and effective in preserving the pulp vitality,which should be the first goal in daily practice.
