rationale of indirect pulp capping

COVID-19 is an emerging, rapidly evolving situation. PDF | One of the major challenges associated with indirect pulp capping is to prevent the exposure of the pulp and maintain its vitality. It is a procedure performed in a tooth with a deep carious lesion approximating the pulp but without signs or symptoms of pulp degeneration. A temporary filling is then placed on the tooth. The AAPD and the American Association of Endodontists recommend indirect pulp capping for primary teeth and young permanent teeth. 2009 Jan-Feb;17(1):70-4. doi: 10.1590/s1678-77572009000100014. [Clinical and histological study of indirect pulp capping on deep carious lesions]. J Appl Oral Sci. 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). 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. Would biodentine be the pulp cap of choice? Hi Patrick, and thanks for reading. However, research has shown that the one-step procedure shows greater success than the two-step procedure.1. Saghiri MA, Asatourian A, Garcia-Godoy F, Sheibani N. Dent Mater J. This is even the case when a carious pulp exposure occurs in mature permanent teeth.4. In summary, the research indeed shows that we can perform pulp capping procedures predictably using the bioceramic materials currently available. Teeth with a normal pulpal response or a symptomatic reversible pulpitis response to cold stimuli have the potential to remain vital after pulp capping. 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. ... rationale for a clinical trial on direct pulp capping being undertaken in the Northwest. 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. Intravital treatment of the pulp with simultaneous laser biostimulation. 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. Depending on the clinical setting, vital pulp therapy can be managed with an indirect or direct pulp-capping procedure. When dental caries is removed from a tooth, all or most of the infected and softened enamel and dentin are removed. Effect of biomaterials on angiogenesis during vital pulp therapy. The determination of which therapy to employ is a decision that must be made by the clinician at the time of treatment. However, with a greater focus on conservative dentistry and more research on pulp capping, this topic is becoming discussed more … USA.gov. “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. After 24Hr of capping →a mass of red blood cells &PNLs. Hoefler, V., et al. It is hoped that the preceding discussion has informed the c … 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. Depending on the clinical setting, vital pulp therapy can be managed with an indirect or direct pulp-capping procedure. Indirect pulp capping Application of a biomaterial onto a thin dentine barrier in a one‐stage carious‐tissue removal technique generally to hard dentine. For an indirect pulp cap, a carious lesion approaches the pulp tissue, but a pulp exposure does not occur. Another key factor is isolation. “Treatment outcomes of 4 vital pulp therapies in mature molars.” J Endod 2018: 44: 529-535, 3. Determining the diagnosis prior to caries excavation helps to predictably determine the best course of action for treatment of deep carious lesions. Indirect pulp treatment in a permanent molar: case reort of 4-year follow-up. Indirect pulp treatment is recommended for teeth that have deep carious lesions approximating the dental pulp, but no signs or symptoms of degeneration. Pulp capping can be divided in to two categories: indirect pulp capping or direct pulp capping. Fagundes TC, Barata TJ, Prakki A, Bresciani E, Pereira JC. March 2018: 39 (3): 182-189. Deep caries that encroaches on or invades the pulp is a common challenge in dentistry. HHS 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 • 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. 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. It is the purpose of this literature review to examine the evi-dence, issues and materials relevant to pulp capping. Indirect pulp therapy has become the front runner in vital pulp therapy at VCU. 1. considerations when managing deep carious lesions. One of the considerations was whether or not to perform a pulp cap prior to restoring a tooth with a deep carious lesion. 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. Some affected dentin is removed and protective material is applied, leading to healing and remineralization. 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. With a direct pulp cap, the pulpal tissue is exposed and a medicament is placed over the exposure. 12. Figure 2: [A] Direct Pulp Capping with Calcium Hydroxide and RMGI base in primary molar after pin point exposure during caries excavation. Refuat Hapeh Vehashinayim. 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. This can occur due to traumatic pulp exposures or carious pulp exposures. Clin Oral Investig. 2016 Oct 1;35(5):701-709. doi: 10.4012/dmj.2015-332. 1997;42(1):168-76. It can be used as a replacement for calcium Hilton T.J. et al. 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. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Alex G. Direct and indirect pulp capping: a brief history, material innovations, and clinical case report. 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. Knowing that we can perform pulp capping predictably, it is important to determine if and when we should perform these procedures. Oper Dent. 2008 Dec;12(4):369-78. doi: 10.1007/s00784-008-0208-6. Clinical and research evidence clearly support the use of MTA and CS as the “new” pulp capping material of choice. 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. The result is less pulpal inflammation which allows the tooth to mature and heal with less calcification. (indirect pulp cap) in an attempt to maintain pulp vitality and avoid the more extensive. For a direct pulp cap, a portion of the pulp tissue is exposed. The pulp capping procedure in primary teeth "revisited". : 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. Management and restoration of deep carious lesions can be a challenging dilemma faced in our daily practice. hydroxide seals the area closest to the pulp from microleakage. Vital pulp therapy using calcium-enriched mixture: An evidence-based review. [B] 24 month follow up [23]. 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. 1985;23(4):927-38. 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. Bjorndal, L. et al. Compend Contin Educ Dent. In the one-step process, a medicament is placed in the deepest aspect of the preparation, and the definitive restoration is immediately placed. 16. The … In a previous article, I briefly highlighted considerations when managing deep carious lesions. Metalita, et al. Suhag, K., et al. One key factor is to determine the endodontic diagnosis of a tooth with a deep carious lesion prior to starting treatment. Jl. 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. Epub 2008 Jun 12. Asgary, S. et al. Table 1 is presented as a quick reference to aid in selecting appropriate candidates for pulp-capping procedures. However, teeth that present with symptomatic irreversible pulpitis or pulpal necrosis upon cold testing are not candidates for pulp capping procedures. 2016: 54: 25-32, 2. With a direct pulp cap, the pulpal tissue is exposed and a medicament is placed over the exposure.  |  2018; 39(3):182-189. MTA and CS-based materials are the resources that … The endodontic diagnosis determines whether or not we should consider pulp capping for our deep carious lesions. The article is aimed at analyzing the available research and comparing the properties of bio-inductive materials in direct and indirect pulp capping procedures. “Cavity preparation will open up millions of tubules, each one a pathway to the pulp.” - E. Kidd, 2004 2013 Mar;16(2):92-8. doi: 10.4103/0972-0707.108173. Both procedures have historically been controversial. If we have a vital, normal pulp, our chances of successfully maintaining vitality are much greater. 2. This review was undertaken as preparatory work for an essay at the annual meeting of the  |  Dabrowska E, Zdanowicz-Wiloch J, Pawińska-Magnuszewska M, Stokowska W. Rocz Akad Med Bialymst. This review was undertaken as preparatory work for Van Hassel HJ. One treatment option for pulp exposure is the application of conser-vative vital pulp therapy procedures, which may include direct pulp capping, indirect pulp Concerning cases with irreversible pulpitis, there are some early studies looking at the effect of calcium silicates in these situations. The determination of which therapy to employ is a decision that must be made by the clinician at the time of treatment. J Conserv Dent. 1979 Apr;28(2):29-31, 23-5. 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. By Lee Ann Brady on 06.11.13 Category: Dental Materials, Restorative Dentistry. 47 Surabaya 60132, Indonesia. This induces dentine remineralisation in the pulp and thus to a beneficial clinical effect on the pulp. 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. Tronstad L, Mjör IA. Carious lesions should usually be fully excavated before teeth are restored. appropriate pulp capping material.1 In addition, various factors are believed to influence the success of both direct and indirect pulp capping. One of the major controversies in the past with pulp capping questioned whether or not a pulp cap can be successful. In the two-step procedure, a provisional restoration is placed and the tooth is re-accessed at a second visit. ASDC J Dent Child. 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. In general, when a carious lesion is in close proximity to the pulp chamber, it is advised to utilize rubber dam isolation. Please enable it to take advantage of the complete set of features! 1971;32(1):126-134. Indirect pulp treatment, using calcium hydroxide as liner, gives after 2 years 83% of success. A clinical and microbiological comparative study of deep carious lesion treatment in deciduous and young permanent molars. 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. NLM - Even if we don’t, tubules are being exposed, which could lead to pulpal necrosis. The determination of which therapy to employ is a decision that must be made by the clinician at the time of treatment. 10. “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. Mayjend. This can lead to the pulp of the tooth either being exposed or nearly exposed which causes pulpitis (inflammation). Andy Janiga, D.M.D., is a contributor to Spear Digest. 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 Both procedures have historically been controversial. NIH Have you any opinion on this? 242 Falster et al. or 3 months after pulp capping, and in the last 2 cases, necrosis appeared after 6 and 7 months. When performing indirect pulp capping to treat deep caries, the clinician must take into account the incomplete removal of dentine, as the target here 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. rect pulp capping have an alkaline pH and biocompat- ible properties. I have read and seen cases where apparent irreversible pulpitis was reversed with biodentine (grossman) • without signs or symptoms of pulp degeneration. 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. The properties and clinical performances of four calcium-silicate cements (ProRoot MTA, MTA Angelus, RetroMTA, Biodentine), a light-cured c … odontoblasts [Smith and Smith, 1998]. Figure 1 shows a central incisor prior to direct pulp cap-Figure 1. This video by Aspire 32 is a part of an ongoing series on Pulp capping. 1997 Sep-Oct;64(5):327-33. Physiology of the human dental pulp. 2010 Jul-Aug;35(4):482-6. doi: 10.2341/09-353-S. Shoni Shikagaku Zasshi. Epub 2016 Aug 20. Alex, G. “Direct and indirect pulp capping: A brief history, innovations, and clinical case report.” Compendium. However, if we have a symptomatic tooth or necrotic tooth, other treatment options should be considered. 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. Upper central incisor with complicated crown frac-ture treated by direct pulp capping: (a) immediately before pulp capping, (b) 52 months after pulp capping. Pulpitis, in turn, can become irreversible, leading to pain and pulp necrosis, and necessitating either root canal treatment or extraction National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Immature teeth with incomplete root formation would be teeth that gain most benefit from pulp preservation procedures rather than less conservative pulpectomy treatments. For indirect pulp capping, the pulp tissue is never exposed, and as a result this procedure tends to demonstrate higher success rates. 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. E-mail: [email protected] introduction Treatment of dental caries and effort of maintaining Depending on the clinical setting, vital pulp therapy can be managed with an indirect or direct pulp-capping procedure. This site needs JavaScript to work properly. Dental caries has the ability to spread to the deeper portion of the teeth into the pulp. Oral Surg Oral Med Oral Pathol. The technique with which 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). 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. Indirect pulp capping.  |  11. Prof. Dr. Moestopo no. Would you like email updates of new search results? “Comparison of CaOH with MTA for direct pulp capping: A PBRN randomized clinical trial.” J Dent Research 2013: 92 (suppl 1): 16s-22s, 4. Direct Pulp Cap — Pulp tissue has been exposed. Stainless steel crowns (SSC) are frequently recommended after indirect pulp treatment, particularly if the tooth has to function for several In this procedure, the deepest layer of the remaining carious dentine 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. For an indirect pulp cap, a carious lesion approaches the pulp tissue, but a pulp exposure does not occur. 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. PROBLEMS WITH INDIRECT PULP CAPPING: - We might accidentally hit the pulp. Indirect Pulp Cap — Decay has not yet reached the pulp. Stepwise excavation in a permanent molar: 17-year follow-up. Indirect pulp capping can occur in either a one-step or two-step process. 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