This document provides information on various vital pulp therapy procedures including indirect pulp capping, direct pulp capping, and pulpotomy. It defines each procedure and discusses their objectives, indications, contraindications and treatment considerations. Indirect pulp capping involves sealing off carious dentin near the pulp to encourage recovery, while direct pulp capping places a protective material directly over an exposed pulp. Pulpotomy involves removing the coronal pulp and placing a medicament to preserve the vitality of the remaining radicular pulp. The document outlines the factors that influence the success of each procedure such as the size of any pulp exposure and presence of preoperative pain or radiographic abnormalities.
4. Vital Pulp Therapy
Definition:
Vital pulp therapy is the treatment
initiated on an exposed pulp to repair
and maintain the pulp vitality.
- Grossman
7. Pulp Capping
Pulp capping is a
technique used in
dental restorations
to prevent the
dental pulp from
dying, after being
exposed,or nearly
exposed during a
cavity preparation.
FIG: Exposed or nearly
exposed pulp
1) Crown
2) Root
3) Restoration
4) PULP CAPPING
5) Pulp chamber
14. • “A procedure where the deepest layer of the remaining
affected carious dentin is covered with a layer of
biocompatible material in order to prevent pulpal
exposure and further trauma to pulp”.
Grossman
• A procedure where in 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 gross caries is removed
from the lesion and cavity is sealed for a time with a
biocompatible material.”
McDonald
Definitions:
15. Arresting the carious process
Promoting dentin sclerosis
Stimulating formation of tertiary dentin
Remineralization of carious dentin
Objectives:
Given by Eidelman in 1965:
16. Rationale
Disinfection of the
residual affected
dentin.
Patients comfort is
immediate.
Pulp vitality is
maintained.
allow the pulp to
regenerate reparative
dentin.
17. Layers of carious
dentin
Infected dentin
Affected dentin
Infected dentin Affected dentin
Superficial layer Deeper layer
Highly demineralized Intermediately demineralized
Unremineralizable Remineralizable
Lacking sensation Sensitive
Stained by 0.5% fuschin or i.e. 1.0% acid
red solution Does not stain
Should be excavated Should be left remineralize.
18. Indication
Mild pain associated
with eating
Negative history of
spontaneous, extreme
pain
History
19. Deep carious lesion, which are
close to, but not involving the
pulp in vital primary or young
permanent teeth
No mobility
When pulp inflammation is
seen as nominal and there is a
definite layer of affected
dentin after removal of
infected dentin.
Clinical Examination
20. Normal lamina dura
and PDL space
No radiolucency in
the bone around
the apices of the
roots or in the
furcation.
Radiographic
examination
22. Excessive
tooth
mobility
Soft leathery dentin covering a
very large area of the cavity, in a
non restorable tooth
Swelling/ Fistula
Tooth
discoloration
Non responsiveness to pulp
testing techniques
Clinical examination
23. Radiographic examination
Large carious
lesion with
apparent pulp
exposure
Interrupted or broken
lamina dura
Widened periodontal
ligament space
Radiolucency at the root
apices or furcation areas
25. Use local anesthesia
Isolate with rubber dam
Cavity outline established using high
speed air turbine
Remove all caries with caries
detector dye
Single appointment procedure
26. Stop the excavation as soon as the
firm resistance of sound dentin is
felt.
Periapical carious dentin is removed
with a sharp spoon excavator.
Cavity flushed with saline and dried
with cotton pellet.
Site is covered with calcium
hydroxide.
Remaining cavity is filled with
reinforced ZOE cement.
27. 2nd appointment procedure
( 6-8 weeks later)
Between the appointment history must be negative and
temporary restoration should be intact.
Take a bitewing radiograph and observe for sclerotic
dentin.
Carefully remove all temporary filling material.
Previous remaining carious dentin will have become dried
out, flaky and easily removed.
28. The area around the potential exposure will appear
whitish and may be soft; which is predentin. Do not
disturb this area.
The cavity preparation is washed out and dried gently.
Cover the entire floor with calcium hydroxide.
Base is built up with reinforced ZOE cement or GIC.
Final restoration is then placed
29.
30.
31. Advantages of
two appointment
technique
Dentist get chance
to assess reaction
of tooth and caries
activity
Final excavation of
caries is safer in
second sitting.
Avoid
unintentional pulp
exposure
Helps to remove
slowly
progressing
lesion
35. • Procedure in which the exposed vital pulp is covered with a
protective dressing or base placed directly over the site of
exposure in an attempt to preserve pulpal vitality.
Grossman
• Placement of medicament or non medicated material
on a pulp that has been exposed in course of
excavating the last portions of deep dentinal caries or
as a result of trauma.
Kopel
(1992)
• It is the protection of a pulp exposed by traumatic fracture
or in the course of excavating deep dentinal caries.
Protection is provided by placing a medicated or non
medicated material in direct contact with the pulp tissues to
promote a reparative reaction.
Ingel
Definitions:
37. Healing/ Repair of the pulp
Pulp’s vitality and function.
Formation of secondary dentine.
Normal responsiveness to electrical and thermal
pulp tests.
Objectives:
38. Asymptomatic
• No spontaneous pain
• Normal response to thermal testing
• Vital pulp
True pin point exposure
• Less than 0.5mm in diameter
39. Hemorrhage from exposure site
should be easily controlled
• Within 10 minutes
The exposure occurred is clean
and uncontaminated
• Rubber dam isolation
46. Treatment of DPC
Rubber dam provides only means of working
in a sterile environment, so it has to be used.
Once an exposure is encountered, further
manipulation of pulp is avoided.
Cavity should be irrigated with saline or
distilled water.
Hemorrhage is arrested with light pressure
from sterile cotton pellets.
47. Final restoration is done after determining
the success pulp of capping
Place the pulp capping material, on the
exposed pulp with application of minimal
pressure so as to avoid forcing the material
into pulp chamber
Place temporary restoration.
51. Pulp exposure
Size of exposure
Stepwise excavation
to avoid exposure
Preparation deep
Yes No Likely
Large
Excessive
Bleeding
Apply pulp
protection
and restore
Small
No Excessive
Bleeding
Indirec
t pulp
cappin
g
Pain preoperatively
Vital
responses
No
radiographic
evidences
RCT
Direct pulp
capping
No
Yes
No
Yes
No
Yes
52.
53.
54. • complete removal of the coronal portion of the
dental pulp, followed by placement of a suitable
dressing or medicament that will promote healing
and preserve vitality of the tooth.
Finn
(1995)
• A Procedure in which a portion of the exposed
coronal vital pulp is surgically removed as a means of
preserving the vitality and function of the remaining
radicular portion.
Grossman
• Amputation of the affected or infected coronal
portion of the dental pulp, preserving the vitality &
function of all or part of the remaining radicular pulp
AAPD
(1998)
Definitions:
55. Objectives
Preservation of
vitality of radicular
pulp
Relief of the pain in
patient with acute
pulpalgia
There should be no
postoperative radiographic
evidence of pathologic
external root resorption.
There should be no
harm to the
succedeous tooth.
56. Indications
1)Mechanical or carious pulp exposure
2) History of only spontaneous pain.
3) Hemorrhage from exposure be controlled.
4) No abscess or fistula.
5)No interradicular bone loss.
57. 4) No interradicular
radiolucency.
5) At least 2/3rd of root
length still present to
ensure reasonable
functional life.
6) In young permanent tooth
with vital exposed pulp and
incompletely formed apices
58. Contraindication
History of spontaneous pain
Tenderness to percussion
Pathological mobility
External/internal root resorption
Periapical or interradicular radiolucency
Pulp calcifications
Swelling or Fistula
Root resorption more than 1/3rd of root length
Large carious lesion with non-restorable crown
59.
60. It is defined as the treatment
of the vital pulp by capping
or pulpotomy in order to
permit continued growth of
the root and closure of the
root apex.
Definition
If it is determined to be vital or reversibly inflamed, the vital pulp therapy techniques are indicated.
The restorative material should seal completely the involved dentin from` oral environment
Evidence by radiographic evaluation ( 1.5 microns per day after 30 days of pulp capping)
Removing of the outer carious dentin and sealing the lesion to allow the pulp to regenerate reparative dentin.
Care must be taken to remove all caries at DEJ. If there is communication of caries with the oral cavity , the carious process will continuoue, resulting in failure of treatment.
Sedative dressing – calcium hydroxide, ZOE
The rate of reparative dentin deposition has been shown to average 1.4 micron per day following cavity preperation in the dentin of human teeth.
The rate of reparative dentin formation decreases markedly after 48 days.
RDT is a key determinant of pulp survival after cavity preparation & avoiding pulp exposure has been considered advantageous
Undifferentiated mesenchymal cells may differentiate into osteoclasts in response to caries or pulp capping material which could lead to internal resorption.
Wide apical foramina in pri. teeth leads to abundant blood supply which results in more typical and faster inflammation response to irritation than in permanent teeth
American academy of pediatric dentistry
Through the surgical excision of the coronal pulp, the infected and inflamed areaa is removed, lraving vital uninfected pulpal tissur in the root canal
Removal of the inflamed portion of the pulp afford temoprary rapid relief of pulpalgia
