PULP CAPPING IN PEDODONTICS

1. PULP CAPPING
ABIRAMI VETRISELVAN

2. INTRODUCTION
 The treatment of pulpally involved teeth in primary dentition poses an unique
challenge
 Young dental pulp in primary teeth , has a high potential for repair
 High degree of cellularity and vascularity is seen in these tissues in stages prior to
advanced physiological resorption of roots
 The young pulp lends itself more readily to procedures concerned with preservation
of pulp vitality

3. PULP is defined as soft tissue forming
inner structure of tooth and
containing nerve and blood vessel , also
called as tooth pulp.
The dental pulp occupies the center of each
tooth and shapes itself to a maturation of
the tooth .

4. VITAL PULP
THERAPY
Indirect pulp
capping
Direct pulp
capping
NON-VITAL
PULP
THERAPY
Pulpotomy
Pulpectomy

5. PULP TREATMENT
CONSERVATIVE
 Indirect pulp therapy
 Direct pulp therapy
 Pulpotomy
RADICAL
 Pulpectomy
Treatment modalities

6. INDIRECT PULP CAPPING

7.  Defined as a procedure where a small amount of carious dentin is retained
in deep areas of cavity to avoid exposure of pulp, followed by placement
of a suitable medicament and restorative material that seals off the carious
dentin and encourages pulp recovery – Ingle
 A procedure in which only the gross caries is removed from the lesion and
the cavity is sealed for a time with a biocompatible material – McDonald
DEFINITION

8. OBJECTIVES:
 Arresting the carious process
 Promoting dentin sclerosis
 Stimulating formation of tertiary dentin
 Remineralization of carious dentin

9. INDICATIONS:
CLINICAL EXAMINATION:
 Large carious lesion
 Absence of lymphadenopathy
 Normal appearance of adjacent
gingiva
 Normal colour of tooth
RADIOGRAPHIC
EXAMINATION
 Large carious lesion in close
proximity to the pulp
 Normal lamina dura
 Normal periodontal ligament
space
 No interradicular or periapical
radiolucency
When pulp inflammation is judged to be minimal and complete removal of caries would cause pulp exposure
HISTORY:
o Mild discomfort from chemical and thermal stimuli
o Absence of spontaneous pain

10. CONTRAINDICATIONS
CLINICAL EXAMINATION:
 Excessive tooth mobility
 Soft leathery dentin covering a
large area of the cavity, in a non-
restorable tooth
 Parulis approximating the affected
tooth
 Tooth discoloration
 Non-responsiveness to pulp testing
RADIOGRAPHIC
EXAMINATION:
 Pulp exposure
 Interrupted or broken lamina
dura
 Widened PDL space
 Radiolucencies in the root apices
or furcation areas
Any signs of pulpal or periapical pathology & Soft leathery dentin covering a very large area of the cavity
HISTORY:
o Sharp, penetrating pain persisting after withdrawal of stimulus
o Prolonged spontaneous pain(nocturnal)

11. Treatment procedure
Administer LA and isolate with rubber dam
Prepare outline cavity and remove the infected
dentin(caries detector dye may be used)
Stop excavation after firm resistance of sound
dentin is felt
Cavity flushed with saline and dried with
cotton pellet
Site covered with Ca(OH)2 and remainder with
ZOE
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12. 6-8 WEEKS LATER
Final restoration is then placed
Cover the floor with Ca(OH)2 and base is built with reinforced ZOE or GIC
Cavity is washed out and dried gently
The area around the potential exposure will appear whitish, may be soft, which is predentin, don’t
disturb this area
Previous remaining carious dentin will have become dried out, flaky and easily removed
But if caries remain on re-entry, remove the caries
If a reparative dentin is formed, permanent restn followed by full coverage restoration is chosen
Between the appointment, history must be negative and temp restn should be intact
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13. Factors affecting success of IPC
 RDT – 0.5-2mm
 Choice of IPC agent

14. OUTCOME
 3 new types of dentin are formed
 Cellular fibrillar dentin – first 2 months
 Globular dentin – 3 months
 Tubular dentin – (uniform mineralized dentin)
 1/5th of reparative dentin formation occurs in less than 30 days
 After 3 months, 0.1mm is formed

15. DIRECT PULP CAPPING

16. DEFINITION:
 It is the placement of the calcium hydroxide preparation on a small
(pinpoint) pulpal exposure – Mathewson
 It consists merely of placing a protective material over the site of the
exposed pulp prior to restoring the tooth - Finn

17. OBJECTIVES
 Preservation of vitality of the radicular pulp.
 Relief of pain in patients with acute pulpagia.
 Ensuring the continuity of normal apexogenesis in immature
permanent teeth

18. INDICATIONS:
 Accidental pin point exposure of pulp when excavating deep caries,
less than 1 sq. mm. surrounded by clean dentin for (<24hours)
 Traumatic fracture of tooth(<24 hours) with pin point exposure
 Iatrogenic exposure during cavity preparation & crown preparation
 Bleed if touched but not excessively and controlled easily with cotton
pellet
 Normal vitality tests without tender to percussion
 No radiographic evidence of periradicular pathology
 Young patient

19. CONTRAINDICATIONS
 History of severe spontaneous tooth aches at night
 Excessive tooth mobility
 Periodontal ligament thickening
 Intraradicular radiolucency
 Excessive bleeding at exposure site
 Purulent , serous exudate from exposure
 External or internal resorption
 Swelling and fistula with associated tooth

20. Treatment procedure
Final restoration is done under determining the success by determination of dentin bridge,
maintenance of pulp vitality, lack of pain and minimal inflammatory response
Place temporary restoration
Place the pulp capping material on exposed pulp with application of minimal pressure so as to avoid
forcing the material into pulp chamber
Hemorrhage is arrested with light pressure from sterile cotton pellet
Cavity irrigated with saline / chloramine T / distilled water
Once exposure is encountered, further manipulation of pulp is avoided

21. DPC CONTRAINDICATED IN PRIMARY TEETH
 Localization of infection & inflammation in primary teeth is poorer than in permanent teeth. [Mc
Donalds,1956]
 Incidence of reparative dentin formation in primary teeth is more extensive than permanent Teeth.
[Sayegh , 1968]
 Primary pulp contain high cellular content which might be responsible for failures. Primary pulp
responds more rapidly to the effects of dentinal caries then the perm. Teeth. [Rayner & Southam,
1979]
 Undifferentiated mesenchymal cells may differentiate into osteoclasts in response to caries or pulp
capping material which could lead to internal resorption. [Kennedy,1985]

22. THANK YOU