MTA has demonstrated significantly greater frequency of dentin bridge formation, thicker and less porous dentin, and less pulp inflammation compared with calcium hydroxide. The continued deposition of dentin occurs throughout the length of the root, providing greater strength and resistance to fracture. Participants were followed up for 1 year. The term, maturogenesis , was recently introduced by Weisleder and Benitez and defined as physiologic root development not restricted to the apical segment. Methods: Types: Indirect pulp cap. Some studies have reported that the pulp has some physiologic feedback mechanisms to counteract inflammation and increased tissue pressure, which in turn explains why inflammation of the pulp could be long standing and could heal if appropriate measures are taken in a timely manner. Vital pulp therapy can be used in immature and fully formed permanent teeth. The radicular pulp chamber may be filled with a resorbable paste of either zinc oxide–eugenol or, preferably, calcium hydroxide with iodoform within the paste. The cause of apical periodontitis is toxic metabolites and byproducts released from microorganisms within the canal and diffused into periapical tissues, eliciting inflammatory responses and bone resorption. Cvek and colleagues investigated the depth of inflammatory reactions of adult monkey pulps exposed by fracture or cavity prep at different time intervals and found that inflammation extended 1.5 mm to 2 mm into the pulp at the 48-hour mark and only 0.8 mm to 2.2 mm after 1 week. It has a higher number of fibroblasts with more in the central region of the pulp. Determining whether it’s best to perform vital pulp therapy or orthograde root canal therapy for an individual tooth is a judgment call. Copyright © 2017 American Association of Endodontists. Indirect pulp capping has been defined as a procedure in which a small amount of carious dentin is retained in deep areas of cavity preparation to avoid an exposure of the pulp. Studies have reported this material to have similar cytotoxicity levels as MTA De-Deus and colleagues found that BA was as biocompatible as MTA and another study reported that BA up-regulated the gene expression of collagen 1, osteocalcin, and osteopontin in osteoblasts and differentiation of human periodontal ligament fibroblasts compared with MTA. Apply pressure with a moist sterile cotton pellet on the pulp stump to control hemorrhage. Vital pulp therapy has a high success rate if the following conditions are met: (1) the pulp is not inflamed, (2) hemorrhage is properly controlled, (3) a nontoxic capping material is applied, and (4) the capping material and restoration seal out bacteria. Indirect pulp capping is achieved by applying a protective agent on the thin layer of dentin remaining over a nearly exposed pulp, in order to allow the underlying dental pulp … Other studies have reported that calcium hydroxide caused a layer of necrosis of the pulp tissue when used in pulp capping procedures. Pulpotomy and pulp capping are indicated for teeth that have had a pulp exposure after trauma or injury, which may include the process of caries excavation in developing or mature teeth. Control the hemorrhage with a sterile cotton pellet moistened with sterile saline.  |  Endodontics is defined as the branch of dentistry concerned with the morphology, physiology, and pathology of the human dental pulp and periradicular tissues. The success of different pulp capping materials has been measured by thickness of the dentinal bridge, morphology of the dentinal bridge, intensity of pulpal inflammation, presence of odontoblasts cells, and biocompatibility. Carious or traumatically exposed primary and permanent teeth, Vital pulp, which responds to sensitivity tests, Limited to moderate restorative treatment. Indirect Pulp Therapy NLM The first part of this article provides insight into the basic biology of the dental pulp, the mechanisms involved in inflammation, and the reactions of the pulp to various dental materials at the cellular and molecular level whereas the second part deals with the clinical aspects of treatment of the primary and permanent dentition. The most important factors in success of VPT are the early diagnosis of pulp and periradicular status, preservation of the pulp vitality and p … From a clinical perspective, the control of the hemorrhage is critical to determine the level of pulp inflammation. BA has also been shown have antifungal and antibacterial activity. If you continue browsing the site, you agree to the use of cookies on this website. Dental caries is a progressive infection of the dentin, which may lead to inflammation and ultimately necrosis of the pulp. The structure of the dental pulp is similar to the other connective tissues in the body. Ultimately, the goal of treating the exposed pulp with an appropriate pulp capping material is to promote the dentinogenic potential of the pulpal cells. It is recommended that practitioners gather additional information in each of the referenced areas before engaging in pulp therapy for children. 2013 Jan;23(1):56-63. doi: 10.1111/j.1365-263X.2012.01224.x. Disinfect the cavity using 2.5% sodium hypochlorite for at least 1 minute. For cases of open apexes, maintaining the pulp vital is essential for the development of the root and maturation of the whole tooth. However, pulpotomy and pulpectomy are the most popular procedures. J Int Soc Prev Community Dent. When considering the capping material, current evidence in the literature has consistently demonstrated a better outcome when using MTA. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. Epub 2020 Nov 5. Thus, protection of the pulp by applying capping agents directly or indirectly on pulp tissue is called vital pulp therapies (VPTs) (Da Rosa et al. If there is the ability to retain the tooth in the mouth via pulpectomy and careful monitoring of the tooth to reduce or eliminate local infection, while waiting for a permanent molar to erupt (in the case of second primary molar infection), this treatment option may be performed with careful monitoring as a transitional treatment. Vital pulp therapy can be used in immature and fully formed permanent teeth. If there are signs of early external root resorption, radiolucency beyond the confines of the pulp chamber related to the tooth or other signs of disease, or inadequate tooth structure to support a restoration, the tooth may need to be extracted. It is likely that recommendations going forward will require sealing the orifices as the main objective. Vital pulp therapy has a high success rate if the following conditions are met: (1) the pulp is not inflamed, (2) hemorrhage is properly controlled, (3) a nontoxic capping material is applied, and (4) the capping material and restoration seal out bacteria. Studies have previously shown that HEMA induces apoptosis in different cell types and also in dental pulp stem cells and in odontoblast-like cells. Cases of permanent tooth mean long-term preservation of the tooth in a healthy state in the mouth. Direct pulp capping is defined as the placement of a medicament on a pulp that has been exposed in the course of excavating the last portions of deep dental caries. One of the main causes of inflammation of the pulp is dental caries. IL-1β has been shown to induce the synthesis of collagen, resulting in a more organized response of the pulp and assisting in the healing process. The groups were homogenous in terms of age, sex, marital status, education, and practitioner; pre- and intraoperative conditions were similar in all arms and did not affect the long-term success. A medicament is then placed over the carious dentin to stimulate and encourage pulp recovery. A material that further seals, such as glass ionomer or resin-modified glass ionomer, should then be used to fill the coronal pulp chamber. Vital pulp therapy is a different kind of endodontic procedure, performed instead on teeth that have had recent pulp exposure. HHS Vital pulp therapy--a review J Ir Dent Assoc. eCollection 2018. Odontoblastic layers appeared earlier; less hyperemia, inflammation, and necrosis were noted; and dentinal bridges were more pronounced in the MTA-treated teeth.