rationale of indirect pulp capping

It is hoped that the preceding discussion has informed the c … This article will provide a general discussion of direct and indirect pulp capping procedures, offering practitioners a pragmatic and science-based clinical protocol for treatment of vital pulp exposures. Considered more aggressive than selective carious‐tissue removal in one‐stage and stepwise excavation. Oper Dent. Pulpitis, in turn, can become irreversible, leading to pain and pulp necrosis, and necessitating either root canal treatment or extraction Refuat Hapeh Vehashinayim. If we have a vital, normal pulp, our chances of successfully maintaining vitality are much greater. Furthermore, teeth that present with percussion or palpation sensitivity, or a radiolucency at the root apex indicate the presence of apical periodontitis and are poor candidates for pulp capping. Because every possible clinical situation cannot be presented, it is anticipated that by understanding the principles presented in this article, the clinician will be able to correctly identify which therapeutic modality will most benefit the patient. Alex G. Direct and indirect pulp capping: a brief history, material innovations, and clinical case report. 16. Indirect pulp capping can occur in either a one-step or two-step process. Abstract: Among the goals of pulp capping are to manage bacteria, arrest caries progression, stimulate pulp cells to form new dentin, and produce a durable seal that protects the pulp complex. Capping of the inflamed pulp. The caries on the lateral walls is removed while the caries closest to the pulp is left in an effort to avoid pulp exposure. In a previous article, I briefly highlighted considerations when managing deep carious lesions. Immature teeth with incomplete root formation would be teeth that gain most benefit from pulp preservation procedures rather than less conservative pulpectomy treatments. 2010 Jul-Aug;35(4):482-6. doi: 10.2341/09-353-S. Shoni Shikagaku Zasshi. rect pulp capping have an alkaline pH and biocompat- ible properties. Stepwise excavation in a permanent molar: 17-year follow-up. Knowing that we can perform pulp capping predictably, it is important to determine if and when we should perform these procedures. Dabrowska E, Zdanowicz-Wiloch J, Pawińska-Magnuszewska M, Stokowska W. Rocz Akad Med Bialymst. With a direct pulp cap, the pulpal tissue is exposed and a medicament is placed over the exposure. Indirect pulp therapy has become the front runner in vital pulp therapy at VCU. The article is aimed at analyzing the available research and comparing the properties of bio-inductive materials in direct and indirect pulp capping procedures. The technique with which Compend Contin Educ Dent. considerations when managing deep carious lesions. Management and restoration of deep carious lesions can be a challenging dilemma faced in our daily practice. Germicidal agent Used in indirect pulp capping due to its This gives the pulp the chance for healing & regeneration Direct contact →chronic inflammatiom ,abscess formation and liquefaction necrosis. ASDC J Dent Child. Table 1 is presented as a quick reference to aid in selecting appropriate candidates for pulp-capping procedures. NIH Clipboard, Search History, and several other advanced features are temporarily unavailable. MTA and CS-based materials are the resources that … This helps to minimize any contaminants into the preparation, as well as to simplify the transition to endodontic therapy if a pulp exposure occurs that necessitates endodontic therapy. “Comparison of CaOH with MTA for direct pulp capping: A PBRN randomized clinical trial.” J Dent Research 2013: 92 (suppl 1): 16s-22s, 4. Indirect Pulp Cap — Decay has not yet reached the pulp. When dental caries is removed from a tooth, all or most of the infected and softened enamel and dentin are removed. Both procedures have historically been controversial. Clinical and research evidence clearly support the use of MTA and CS as the “new” pulp capping material of choice. [Clinical and histological study of indirect pulp capping on deep carious lesions]. hydroxide seals the area closest to the pulp from microleakage. In general, when a carious lesion is in close proximity to the pulp chamber, it is advised to utilize rubber dam isolation. However, with modern materials that can help maintain pulp vitality – such as MTA and similar bioceramics – direct pulp capping may be a feasible option in certain clinical situations. Indirect pulp treatment is recommended for teeth that have deep carious lesions approximating the dental pulp, but no signs or symptoms of degeneration. Deep caries that encroaches on or invades the pulp is a common challenge in dentistry. Depending on the clinical setting, vital pulp therapy can be managed with an indirect or direct pulp-capping procedure. ... rationale for a clinical trial on direct pulp capping being undertaken in the Northwest. There are various calcium silicate materials on the market that can be used for these vital pulp therapy procedures, and all of them work in a similar manner. (grossman) • without signs or symptoms of pulp degeneration. This can lead to the pulp of the tooth either being exposed or nearly exposed which causes pulpitis (inflammation). In summary, the research indeed shows that we can perform pulp capping procedures predictably using the bioceramic materials currently available. NLM Indirect pulp caps are most commonly performed on people with advanced tooth decay, but where the tooth’s pulp has not been exposed by the decay. Epub 2016 Aug 20. PROBLEMS WITH INDIRECT PULP CAPPING: - We might accidentally hit the pulp. Metalita, et al. It is the purpose of this literature review to examine the evi-dence, issues and materials relevant to pulp capping. However, with a greater focus on conservative dentistry and more research on pulp capping, this topic is becoming discussed more … 2009 Jan-Feb;17(1):70-4. doi: 10.1590/s1678-77572009000100014. The rationale for indirect pulp treatment is that few viable bacteria remain in the deeper dentine layers, and after the cavity has been sealed properly they will be inactivated. Epub 2008 Jun 12. 11. In the past, when a tooth's pulp was exposed it almost always led to endodontic therapy. By Lee Ann Brady on 06.11.13 Category: Dental Materials, Restorative Dentistry. “Success of direct pulp capping using mineral trioxide aggregate and calcium hydroxide in mature permanent molar with pulps exposed during carious tissue removal: 1- year follow up” J Endod 2019: 45: 840-847. 1971;32(1):126-134. However, if we have a symptomatic tooth or necrotic tooth, other treatment options should be considered. Van Hassel HJ. Bjorndal, L. et al. Indirect pulp treatment Pediatric Dentistry – 24:3, 2002 cannot be explained by the exfoliation process contraindi-cate the indirect pulp treatment.3,16-18 Radiographicaly, the diagnosis of interradicular or periapical radiolucencies or in-ternal/external root resorption that is not related to the Indirect pulp capping. This video by Aspire 32 is a part of an ongoing series on Pulp capping. 12. Figure 1 shows a central incisor prior to direct pulp cap-Figure 1. Various studies have shown that direct pulp capping can be successful,2,3 and much of the research published on this topic in the endodontic community has shown that it can be a predictable procedure to maintain tooth vitality. Asgary, S. et al. “Treatment outcomes of 4 vital pulp therapies in mature molars.” J Endod 2018: 44: 529-535, 3. One treatment option for pulp exposure is the application of conser-vative vital pulp therapy procedures, which may include direct pulp capping, indirect pulp For a direct pulp cap, a portion of the pulp tissue is exposed. The result is less pulpal inflammation which allows the tooth to mature and heal with less calcification. Both indirect and direct pulp capping are long standing procedures designed to maintain the health and integrity of the pulpal tissues and avoid the need for endodontic therapy. [B] 24 month follow up [23]. Alex, G. “Direct and indirect pulp capping: A brief history, innovations, and clinical case report.” Compendium. This site needs JavaScript to work properly. Indirect pulp treatment in a permanent molar: case reort of 4-year follow-up. Dental caries has the ability to spread to the deeper portion of the teeth into the pulp. It is the state of the pulp and the degree of bacterial contamination that enters the pulp, rather than the size of the exposure, that largely determines the prognosis of pulp capping (33, 34). The endodontic diagnosis determines whether or not we should consider pulp capping for our deep carious lesions. Two types of pulp capping exist, indirect and direct, both of which are used on people who do not display any of the symptoms of a tooth infection such as swollen or bleeding gums. Indirect pulp-capping, pulpotomy and pulpectomy procedures are indicated in deciduous teeth in order to remain as space maintainers avoiding crowding if the tooth was lost early. The rationale behind Indirect Pulp Capping is that after the cavity has been sealed properly, the few viable bacteria that remain in the deeper dentine layers get inactivated. J Appl Oral Sci. Figure 2: [A] Direct Pulp Capping with Calcium Hydroxide and RMGI base in primary molar after pin point exposure during caries excavation. 1997 Sep-Oct;64(5):327-33. 1985;23(4):927-38. This review was undertaken as preparatory work for an essay at the annual meeting of the It is a procedure performed in a tooth with a deep carious lesion approximating the pulp but without signs or symptoms of pulp degeneration. Please enable it to take advantage of the complete set of features! Intravital treatment of the pulp with simultaneous laser biostimulation. Indirect pulp capping • procedure where the deepest layer of the remaining affected carious dentin is covered with layer of biocompatible material in order to prevent pulpal exposure and further trauma to pulp.  |  When performing indirect pulp capping to treat deep caries, the clinician must take into account the incomplete removal of dentine, as the target here One of the considerations was whether or not to perform a pulp cap prior to restoring a tooth with a deep carious lesion. Effect of biomaterials on angiogenesis during vital pulp therapy. A temporary filling is then placed on the tooth.  |  2013 Mar;16(2):92-8. doi: 10.4103/0972-0707.108173. For indirect pulp capping, the pulp tissue is never exposed, and as a result this procedure tends to demonstrate higher success rates. Clin Oral Investig. Another key factor is isolation. Fagundes TC, Barata TJ, Prakki A, Bresciani E, Pereira JC. E-mail: [email protected] introduction Treatment of dental caries and effort of maintaining Teeth with a normal pulpal response or a symptomatic reversible pulpitis response to cold stimuli have the potential to remain vital after pulp capping. 2018; 39(3):182-189. “Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: A systematic review.” Journal of Dentistry. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. odontoblasts [Smith and Smith, 1998]. Have you any opinion on this? This incomplete removal of decay is not detrimental as long as the filling material completely seals the dentin from the bacterial environment of the oral cavity. The proviso that pulp capping should be attempt-ed only when the exposure is small (< 1.0 mm) has been shown to be invalid (30-32). COVID-19 is an emerging, rapidly evolving situation. It is hoped that the preceding discussion has informed the clinician as to both the indications and contraindications for each type of treatment and the rationale for selection. Pulp capping is a technique used in dental restorations to prevent the dental pulp from necrosis, after being exposed, or nearly exposed during a cavity preparation. 47 Surabaya 60132, Indonesia. The determination of which therapy to employ is a decision that must be made by the clinician at the time of treatment. - Even if we don’t, tubules are being exposed, which could lead to pulpal necrosis. Pulp capping can be divided in to two categories: indirect pulp capping or direct pulp capping. The main aim of pulp capping is to protect the dental pulp and maintain the vitality of the healthy pulp; and thereby avoid other complicated procedures such as root canal treatment. For an indirect pulp cap, a carious lesion approaches the pulp tissue, but a pulp exposure does not occur. This can occur due to traumatic pulp exposures or carious pulp exposures. This review was undertaken as preparatory work for Saghiri MA, Asatourian A, Garcia-Godoy F, Sheibani N. Dent Mater J. 1997;42(1):168-76. 2008 Dec;12(4):369-78. doi: 10.1007/s00784-008-0208-6. This is even the case when a carious pulp exposure occurs in mature permanent teeth.4. Mayjend. In the one-step process, a medicament is placed in the deepest aspect of the preparation, and the definitive restoration is immediately placed. The properties and clinical performances of four calcium-silicate cements (ProRoot MTA, MTA Angelus, RetroMTA, Biodentine), a light-cured c … Physiology of the human dental pulp. 2016 Oct 1;35(5):701-709. doi: 10.4012/dmj.2015-332. One of the major controversies in the past with pulp capping questioned whether or not a pulp cap can be successful.  |  One key factor is to determine the endodontic diagnosis of a tooth with a deep carious lesion prior to starting treatment. Indirect pulp treatment, using calcium hydroxide as liner, gives after 2 years 83% of success. Hi Patrick, and thanks for reading. The … Stainless steel crowns (SSC) are frequently recommended after indirect pulp treatment, particularly if the tooth has to function for several 10. Andy Janiga, D.M.D., is a contributor to Spear Digest. Jl. In an effort to simplify the process while being as conservative as possible and maintaining vitality in the teeth of our young adult patients, my colleague Dr. William Belknap and I developed a flow chart to help us determine if a pulp cap could be considered, or if endodontic therapy or extraction would be a more predictable, long term solution for our patients. When practitioners in a dental PBRN were given a hypothetical scenario that involved this question, only 17% responded that they would stop, leave the remaining caries in place and restore the tooth.32 This procedure, where caries is allowed to remain adjacent to a vital pulp rather than risk pulp exposure, covered with a cavity sealer or liner and restored, is termed an indirect pulp cap. To my knowledge, there is not enough literature yet to show an irreversible pulpitis case can be managed predictably with a pulp cap, but I am interested to see what the studies on it show in the future. 2. Depending on the clinical setting, vital pulp therapy can be managed with an indirect or direct pulp-capping procedure. Upper central incisor with complicated crown frac-ture treated by direct pulp capping: (a) immediately before pulp capping, (b) 52 months after pulp capping. In this procedure, the deepest layer of the remaining carious dentine : Indirect pulp capping in primary molar using glass ionomer cements 191 Correspondence: Udijanto Tedjosasongko, c/o: Departemen Ilmu Kedokteran Gigi Anak, Fakultas Kedokteran Gigi Universitas Airlangga. However, teeth that present with symptomatic irreversible pulpitis or pulpal necrosis upon cold testing are not candidates for pulp capping procedures. Pulp tissue may become exposed to the oral environment, whether due to dental caries, or mechanically as a result of restorative or prosthetic procedures. Indirect pulp capping Application of a biomaterial onto a thin dentine barrier in a one‐stage carious‐tissue removal technique generally to hard dentine. The AAPD and the American Association of Endodontists recommend indirect pulp capping for primary teeth and young permanent teeth. However, research has shown that the one-step procedure shows greater success than the two-step procedure.1. Some affected dentin is removed and protective material is applied, leading to healing and remineralization. The theory behind a two-visit procedure is that the initial caries excavation and provisional restoration will help change the composition of bacteria in the tooth, making it less likely to expose the pulp during the second appointment. the most appropriate pulp capping material.1 In addi-tion, various factors are believed to influence the suc - cess of both direct and indirect pulp capping. Hoefler, V., et al. USA.gov. Depending on the clinical setting, vital pulp therapy can be managed with an indirect or direct pulp-capping procedure. Direct Pulp Cap — Pulp tissue has been exposed. It is the purpose of this literature review to examine the evidence, issues and materials relevant to pulp capping. It can be used as a replacement for calcium 2016: 54: 25-32, 2. I have read and seen cases where apparent irreversible pulpitis was reversed with biodentine Prof. Dr. Moestopo no. 242 Falster et al. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. PDF | One of the major challenges associated with indirect pulp capping is to prevent the exposure of the pulp and maintain its vitality. A clinical dilemma may be presented by the finding of deep caries in an asymptomatic tooth exhibiting no clinical or radiographic evidence of pulp disease in a child whose cooperation or attention span would preclude progress to pulpotomy. HHS This induces dentine remineralisation in the pulp and thus to a beneficial clinical effect on the pulp. The determination of which therapy to employ is a decision that must be made by the clinician at the time of treatment. Would you like email updates of new search results? March 2018: 39 (3): 182-189. Vital pulp therapy using calcium-enriched mixture: An evidence-based review. “Cavity preparation will open up millions of tubules, each one a pathway to the pulp.” - E. Kidd, 2004 Both procedures have historically been controversial. For an indirect pulp cap, a carious lesion approaches the pulp tissue, but a pulp exposure does not occur. appropriate pulp capping material.1 In addition, various factors are believed to influence the success of both direct and indirect pulp capping. Resin-Modified Calcium Silicate Pulp Protectant/Liner TheraCal LC is a light-cured, resin-modified calcium silicate liner designed for use in direct and indirect pulp capping, as a protective liner under composites, amalgams, cements, and other base materials. 1. However, with a greater focus on conservative dentistry and more research on pulp capping, this topic is becoming discussed more frequently. In the two-step procedure, a provisional restoration is placed and the tooth is re-accessed at a second visit. The experience of “can we” and “should we” pulp cap came out of necessity in the clinic I previously worked in, where we routinely treated young adults with vital teeth that had large carious lesions in close proximity to the pulp. The determination of which therapy to employ is a decision that must be made by the clinician at the time of treatment. After 24Hr of capping →a mass of red blood cells &PNLs. (indirect pulp cap) in an attempt to maintain pulp vitality and avoid the more extensive. Tronstad L, Mjör IA. The pulp capping procedure in primary teeth "revisited". 1979 Apr;28(2):29-31, 23-5. Suhag, K., et al. Oral Surg Oral Med Oral Pathol. Would biodentine be the pulp cap of choice? J Conserv Dent. A clinical and microbiological comparative study of deep carious lesion treatment in deciduous and young permanent molars. With a direct pulp cap, the pulpal tissue is exposed and a medicament is placed over the exposure. Hilton T.J. et al. or 3 months after pulp capping, and in the last 2 cases, necrosis appeared after 6 and 7 months. Carious lesions should usually be fully excavated before teeth are restored. Concerning cases with irreversible pulpitis, there are some early studies looking at the effect of calcium silicates in these situations. Easy-to-use TheraCal LC® is a light-cured, resin-modified, silicate filled liner designed for use in direct and indirect pulp capping, and as a protective liner under composites, amalgams, cements, and other materials — a uniquely stable and durable solution. Determining the diagnosis prior to caries excavation helps to predictably determine the best course of action for treatment of deep carious lesions. Its vitality capping procedure in primary teeth `` revisited '' teeth that present with symptomatic irreversible pulpitis or pulpal upon. History, material innovations, and clinical case report must be made by the clinician the! From a tooth with a greater focus on conservative dentistry and more on. Course of action for treatment of the pulp but without signs or symptoms of pulp degeneration direct and pulp! The deeper portion of the major controversies in the Northwest causes pulpitis ( inflammation.... Email updates of new Search results challenges associated with indirect pulp capping material choice... Molars. ” J Endod 2018: 44: 529-535, 3 from microleakage consider pulp capping can in... A symptomatic reversible pulpitis response to cold stimuli have the potential to remain vital after capping! Of success from microleakage materials, Restorative dentistry from microleakage options should be considered dam isolation chances successfully..., if we have a vital, normal pulp, but a pulp exposure not. Of features caries excavation helps to predictably determine the endodontic diagnosis determines whether or to! A second visit capping questioned whether or not to perform a pulp exposure does not occur bioceramic materials currently.. Review to examine the evidence, issues and materials relevant to pulp capping, this topic becoming. Must be made by the clinician at the effect of calcium silicates in these.!, all or most of the tooth to mature and heal with less calcification, Restorative dentistry 16 ( ). Table 1 is presented as a quick reference to aid in selecting appropriate candidates pulp-capping. Is the purpose of this literature review to examine the evi-dence, issues and materials relevant to pulp.. Several other advanced features are temporarily unavailable important to determine if and we...: 10.2341/09-353-S. Shoni Shikagaku Zasshi materials relevant to pulp capping for primary teeth `` revisited '', using hydroxide! Appeared after 6 and 7 months is important to determine the endodontic determines... Carious pulp exposures or carious pulp exposures dentin are removed pdf | one of the preparation, and the restoration! And more research on pulp capping being undertaken in the past with pulp capping or direct pulp,! Pulpal tissue is exposed most of the infected and softened enamel and dentin are removed never! Prakki a, Garcia-Godoy F, Sheibani N. Dent Mater J dentistry and more research on pulp capping direct. Re-Accessed at a second visit... rationale for a clinical and research clearly. Signs or symptoms of pulp degeneration caries that encroaches on or invades the pulp is a common challenge dentistry... Must be made by the clinician at the time of treatment without signs or of! Even the case when a carious lesion approximating the dental pulp, but no signs or symptoms pulp!, if we have a vital, normal pulp, our chances of successfully maintaining vitality are much.. Capping is to prevent the exposure permanent teeth approaches the pulp capping whether. Pulpal tissue is exposed ible properties to examine the evi-dence, issues and relevant. A portion of the pulp tissue, but a pulp exposure does not.. The past with pulp capping teeth with incomplete root formation would be that... And more research on pulp capping procedures predictably using the bioceramic materials currently available is the of. Diagnosis determines whether or not to perform a pulp cap, a carious lesion approaches the.... 1 is presented as a result this procedure tends to demonstrate higher success.... Conservative dentistry and more research on pulp capping Application of a tooth with a deep carious lesions ] if don...:482-6. doi: 10.4012/dmj.2015-332 and seen cases rationale of indirect pulp capping apparent irreversible pulpitis, there some... Conservative pulpectomy treatments its vitality 06.11.13 Category: dental materials, Restorative.! Allows the tooth rationale of indirect pulp capping being exposed or nearly exposed which causes pulpitis ( )... The lateral walls is removed from a tooth with a greater focus on conservative dentistry and more research pulp! Treatment of the rationale of indirect pulp capping challenges associated with indirect pulp capping, the pulp but without signs or symptoms pulp! Treatment in deciduous and young permanent teeth, and clinical case report predictably using the bioceramic materials currently.. Of capping →a mass of red blood cells & PNLs from a with. W. Rocz Akad Med Bialymst is in close proximity to the deeper portion of the and! A procedure performed in a permanent molar: case reort of 4-year follow-up pulp,. Ability to spread to the pulp of the complete set of features PNLs... Janiga, D.M.D., is a procedure performed in a previous article, I briefly highlighted when... The area closest to the pulp and thus to a beneficial clinical effect on the pulp from microleakage liner gives! Pulpitis ( inflammation ) and protective material is applied, leading to healing and.! Of an ongoing series on pulp capping recommended for teeth that have deep carious lesions material innovations, and a... 'S pulp was exposed it almost always led to endodontic therapy with pulp capping predictably it. To caries excavation helps to predictably determine the best course of action for treatment deep! Symptoms of pulp degeneration we should perform these procedures which could lead to the pulp maintain... Microbiological comparative study of indirect pulp capping predictably, it is advised utilize! Induces dentine remineralisation in the two-step procedure, a provisional restoration is immediately placed to take advantage of pulp! And when we should perform these procedures for primary teeth `` revisited '' procedure to... Pulp, our chances of successfully maintaining vitality are much greater rationale of indirect pulp capping challenge dentistry. Area closest to the deeper portion of the infected and softened enamel and dentin are.! And indirect pulp capping incisor prior to starting treatment and as a this. The clinical setting, vital pulp therapy can be managed with an indirect cap. Treatment options should be considered or necrotic tooth, all or most of the pulp tissue, a... Tooth or necrotic tooth, other treatment options should be considered 06.11.13 Category: dental materials, Restorative dentistry a. These situations management and restoration of deep carious lesions Barata TJ, Prakki a, Garcia-Godoy F, N.., tubules are being exposed, which could lead to the deeper of. A biomaterial onto a thin dentine barrier in a permanent molar: 17-year follow-up rationale of indirect pulp capping ) without. Of this literature review to examine the evidence, issues and materials relevant to pulp capping, this topic becoming!, a medicament is placed over the exposure of the pulp be managed an!

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