Reinforce the tubercle by applying flowable composite. Occlusion, restoration, pulp and periapex assessment should be done yearly. When there is adequate pulp recession, tubercle can be removed and tooth can be restored.For teeth with normal pulp and immature apex, reduce the opposing occluding tooth. Apply flowable composite to the tubercle. Occlusion, restoration, pulp and periapex assessment should be done every 3–4 months until the apex matures. When there are signs of adequate pulp recession, tubercle can be removed and tooth can be restored.For teeth with inflamed pulp and mature apex, conventional root canal treatment could be carried out and restored accordingly.For teeth with inflamed pulp and immature apex, shallow MTA pulpotomy could be performed and then restore with glass ionomer and composite.For teeth with necrotic pulp and mature apex, conventional root canal therapy could be done and restored.For teeth with necrotic pulp and immature apex, MTA root-end barrier could be carried out. Glass ionomer layer and composite could be used to restore the tooth.If there is occlusal interference, the opposing projection should be reduced. Make sure that the tubercle does not contact other teeth in all excursive movement. This is usually done over a few appointments, 6 to 8 weeks apart to allow the formation of reparative dentin to protect the pulp. Fluoride varnish should be applied onto the ground surface. Recall the patient for follow-up after 3, 6 and 12 months.In some cases, extraction could be considered (e.g. for orthodontic purposes, failed apexification)

References


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Topiramate has not been shown to work as a pain medicine in diabetic neuropathy, the only neuropathic condition in which it has been adequately tested. Other
One common off-label use for topiramate is in the treatment of bipolar disorder. A review published in 2010 suggested a benefit of topiramate in the treatment of symptoms of borderline personality disorder, however the authors noted that this was based only on one randomized controlled trial and requires replication.Topiramate has been used as a treatment for alcoholism. The Veterans Affairs and the Department of Defense 2015 guideline on substance use disorders lists topiramate as a "strong for" in its recommendations for alcohol use disorder.Other uses include treatment of obesity, binge eating disorder, and off-setting weight gain induced by taking antipsychotic medications. In 2012, the combination of phentermine/topiramate was approved in the United States for weight loss. It is being studied as a potential treatment for post traumatic stress disorder.There is some evidence for the use of topiramate in the management of cravings related to withdrawal from Dextromethorphan. Adverse effects
People taking topiramate should be aware of the following risks: 

Avoid activities requiring mental alertness and coordination until drug effects are realized. Topiramate may impair heat regulation, especially in children. Use caution with activities leading to an increased core temperature, such as strenuous exercise, exposure to extreme heat, or dehydration. Topiramate may cause visual field defects. Topiramate may decrease effectiveness of oestrogen-containing oral contraceptives. Taking topiramate in the first trimester of pregnancy may increase risk of cleft lip/cleft palate in infant.