Instead, the dentist intentionally leaves the softened dentin/decay in place, and uses a layer of protective temporary material which promotes remineralization of the softened dentin over the pulp and the laying down of new layers of tertiary dentin in the pulp chamber. Figure 3: The final restoration, in this case resin-based composite, should be placed over the direct or indirect pulp cap in the normal manner as described in this article. [24] MTA also has for difficult handling properties and is a very expensive material, thus is less cost effective as compared to CaOH. The set cement has low compressive strength and cannot withstand or support condensation of a restoration. But success rates for pulpotomy decreases over time from 90% or more initially (6-12 months) to 70% or less after 3 years or more. Results of success, 6 and 12 months after indirect pulp therapy (in one or two sessions) of asymptomatic pulpitis in primary teeth. glass ionomer or resin-modified glass ionomer) over CaOH before packing the final restorative material. [13] This alkaline environment created around the cement has been suggested to give beneficial irritancy to pulpal tissues and stimulates dentine regeneration. 12. ... success rate of the ProRoot MTA material was higher than those of TheraCal LC and Dycal (the success rates were 94.4%, 87.8% and 84.6 % respectively). Table 1. At 6 months, the success rate was 89.6% with MTA, and remained steady at 73% with calcium hydroxide (P = 0.63). To prevent the pulp from deteriorating when a dental restoration gets near the pulp, the dentist will place a small amount of a sedative dressing, such as calcium hydroxide or MTA. Remaining dentin thickness(0.5-2mm) Choice of indirect pulp capping agent. When the use of RMGIC and calcium hydroxide has been studied as direct pulp capping agents, RMGIC has demonstrated increase in chronic inflammation in pulpal tissues and lack of reparative dentine bridge formation. This can lead to the pulp of the tooth either being exposed or nearly exposed which causes pulpitis (inflammation). 9. But more recently mineral trioxide aggregate (MTA) used as a primary molar medicament for pulpotomies reported a 97% success rate. RESULTS: The overall success rate was 100% in the absence of preoperative pain. [3] A direct pulp cap is a one-stage procedure, whereas a stepwise caries removal is a two-stage procedure over about six months. [ Links ] 8. Indirect pulp treatment is a procedure performed in a tooth with a deep carious lesion approximating the pulp but without signs or symptoms of pulp degeneration. Two different types of pulp cap are distinguished. Studies have demonstrated unfavourable results for ZOE when compared to calcium hydroxide as a direct pulp capping material as it causes pulpal necrosis. No statistical significant difference between the groups was observed (P = 0.62). Because of its many advantageous properties and long-standing success in clinical use, it has been used as a control material in multiple experiments with pulp capping agents over the years[17][18] and is considered the gold standard dental material for direct pulp capping to date. There have been several studies conducted on the success rates of direct and indirect pulp capping using a range of different materials. Selection was based on caries to or deeper than half the distance to the pulp. 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. Disadvantages have also been described for MTA. After 6 months, this result is put into perspective [68]. As a dentist, you find that the decay is extensive and very close to the pulp (nerve) of the tooth. ... ease of use and success rate. Grey MTA preparations can potentially cause tooth discolouration. J Endod. Van Hassel HJ. ×�Û�\Ìü@/‘rıÕ’×è²®÷KËé¬ôÚ­ëßÈh9é Vz�ĞcÅ:ŒIY5÷ÅRQ ãÁ2t~òİ�Ÿ�×ÑvÕ>>ÿ×õ¢×q³ãs¥`ƒßSú:èV�`_äÉ5'–#Ox¹fG…÷;” Jµ˜ó¸ÒKYGq‰åõXG«SUš²Ïø.K+õAoÃ>ç¹T«iÉÚÍ–lÍõ„�ÒK@¢pj`{KÖ5îh.ξ|hŸ,u6îìóœëËvƒÇ³á�Z?ˆ}©›¼Po@¤ÚÅ×Y7Tw”»5¯dØÁ. 1 The caries surrounding the pulp is left in place to avoid pulp exposure and is covered with a biocompatible material. Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex. However, calcium hydroxide and mineral trioxide aggregate (MTA) are the preferred material of choice in clinical practice due to their favourable outcome. (grossman) • without signs or symptoms of pulp degeneration. J Clin Pediatr Dent. One study further demonstrated that CaOH causes release of growth factors TGF-B1 and bioactive molecules from the dentine matrix which induces the formation of dentine bridges. 2002;24(3):241-8. In addition, the material triggers chronic inflammation even without the presence of bacteria makes it an unfavourable condition for pulp healing to take place. Defined as a 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 the pulp vitality. Oral Surg Oral Med Oral Pathol. 2006;31(2):68-71. Type of One Sided Exact This technique is used when most of the decay has been removed from a deep cavity, but some softened dentin and decay remains over the pulp chamber that if removed would expose the pulp and trigger irreversible pulpitis. Indirect pulp capping in the primary dentition: a four year follow-up study. Advertisement . Capping of the inflamed pulp. Alex G. Direct and indirect pulp capping: a brief history, material innovations, and clinical case report. 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. [9], Although MTA shows great promise which is possibly attributed to its adhesive properties and ability to act as a source of CaOH release,[9] the available literature and experimental studies of MTA is limited due to its recency. Retrospective studies have shown CH pulp capping to have a success rate of 30-85% over a period of 2-10 years (64) (65) (66) (67). [9] CaOH cement is not adhesive to tooth tissues and thus does not provide a coronal seal. The non-randomised study found a statistically significant difference in favour of indirect pulp capping for clinical and radiological success at 3 years but with high overall risk of bias. They had pulp dressing by indirect pulp capping technique.Results: MTA dressing (indirect pulp capping technique) is associated with 55% of the success meanwhile the use of calcium hydroxide is associated with 60% succes rate. 11. The success rate is presented in percentage to the number of teeth treated in the group. [9] MTA also takes a long time (up to 2 hours 45 minutes) to set completely[27] thus preventing immediate restoration placement without mechanical disruption of the underlying MTA. the criteria for successfully conducted indirect pulp capping were evaluated. It has been suggested that a pulp capped with MTA should be temporised to allow for the complete setting of MTA,[9] and the patient to present at a second visit for placement of the permanent restoration. This study concluded that indirect pulp capping had a success rate of 90.3% regardless of which material was used but stated that it is preferable to use non-resorbing materials where possible. 2009;35(8):1147-1151. When dental caries is removed from a tooth, all or most of the infected and softened enamel and dentin are removed. An Indirect pulp cap is where, in a permanent tooth, most of the decay is removed. [1] The ultimate goal of pulp capping or stepwise caries removal is to protect a healthy dental pulp and avoid the need for root canal therapy. [9], Materials that fall under this category include 4-META-MMA-TBB adhesives and hybridizing dentine bonding agents. Another study reported that the success rate of DPC with BD is 90.9% in patients younger than 40 and 73.8% in patients 40 or older [ 109 ]. A systematic review attempted to compare success rates of direct pulp capping and indirect pulp capping and found that indirect pulp capping had a higher level of success but found a low quality of evidence in studies on direct pulp capping. [24] There is also less coronal microleakage of MTA in one experiment comparing it to amalgam[25] thus suggesting some tooth adhesion properties. CaOH has a high antimicrobial activity which has been shown to be outstanding. This is due to Eugenol, being cytotoxic to the pulp are present in large quantity in this formulation. Dentin formation usually starts within 30 days of the pulp capping (there can be a delay in onset of dentin formation if the odontoblasts of the pulp are injured during cavity removal) and is largely completed by 130 days.[2]:491–494. [23] MTA has also demonstrated reliable and favourable healing outcomes on human teeth when used as a pulp cap on teeth diagnosed as nothing more severe than reversible pulpitis. [33] This study was conducted on 6-18 year old patients, while a comparable study conducted on mature permanent teeth found success rates of 84.6% using MTA and 92.3% using Biodentine. This is a step wise procedure and a long procedure which takes about 6 months or more to complete. Aim Indirect pulp capping (IPC) is a treatment that preserves pulp vitality. Bogen et al 7 reported a high survival rate of 97.96% for pulp capping with mineral trioxide aggregate (MTA) in carious exposures. Results: After 48 months, Group-1 showed a success rate of 88.8% and Group-2 of 93%. [36] More research will be needed to provide a comprehensive answer. The tooth is then washed and dried, and the protective material placed, followed finally by a dental restoration which gives a bacteria-tight seal to prevent infection. These materials, protect the pulp from noxious agents (heat, cold, bacteria) and stimulate the cell-rich zone of the pulp to lay down a bridge of reparative dentin. Studies on indirect pulp capping had clinical success ranging from 73 to 97% after a follow-up period of 2 weeks to 11 years . A direct pulp cap is done on permanent teeth when the removal of deep decay results in exposing the pulp. [30] These results show no significant difference, nor do the results from an indirect pulp capping experiment comparing calcium silicate cement (Biodentine) and glass ionomer cement, which had clinical success rates of 83.3%. Tronstad L, Mjör IA. Pulp Capping Treatent. [9] The material comprises a blend of tricalcium silicate, dicalcium silicate and tricalcium aluminate; bismuth oxide is added to give the cement radiopaque properties to aid radiological investigation. The color of the carious lesion changes from light brown to dark brown, the consistency goes from soft and wet to hard and dry so that Streptococcus Mutans and Lactobacilli have been significantly reduced to a limited number or even zero viable organisms and the radiographs show no change or even a decrease in the radiolucent zone. Compend Contin Educ Dent. 2018; 39(3):182-189. (1991), bacteria-inoculated root canals of extracted human teeth were treated with CaOH for 1 hour against a control group with no treatment and the results yielded 64-100% reductions in all viable bacteria. [20] MTA has been shown to produce CaOH as a hydration product[21] and maintains an extended duration of high pH in lab conditions. Marchi JJ, de Araujo FB, Froner AM, et al. In fact, it may be likely that if you did remove all of the decay, the pulp would be exposed by the infected decay thus resulting in the need for a root canal. The mean initial residual dentine thickness was 0.23 mm, and increased by 0.121 mm with MTA and by 0.136 mm with calcium hydroxide at 3 months. 16. "[3][7] [5] Pulpitis, in turn, can become irreversible, leading to pain and pulp necrosis, and necessitating either root canal treatment or extraction. However, when the preoperative pain was present, the … Indirect Pulp Capping: In this process, a thin layer of the soft dentin is left over the pulp, and a protective dressing is placed over the soft dentin. [3], Contraindication for Direct Pulp Capping:[4], In 1938, Bodecker introduced the Stepwise Caries Excavation (SWE) Technique for treatment of teeth with deep caries for preservation of Pulp vitality. MTA also comes in white and grey preparations[26] which may aid visual identification clinically. 2006;31(2):68-71. FACTORS DETERMINING SUCCESS OF IPC. Since pulp capping is not always successful in maintaining the vitality of the pulp, the dentist will usually keep the status of the tooth under review for about 1 year after the procedure. The use of ZOE as a pulp capping material remains controversial. [22] Similar to CaOH, this alkalinity potentially provides beneficial irritancy and stimulates dentine repair and regeneration. The following materials have been studied as potential materials for direct pulp capping. If the pulp appears infected or symptomatic, the dentist may decide a root canal is the best treatment option. 10. Clinically and radiographically, teeth treated with indirect pulp capping using MTA show higher success rates after 3 months compared to using a setting calcium salicylate cement (Dycal, Dentsply Sirona, Konstanz, Germany). One study of indirect pulp capping recorded success rates of 98.3% and 95% using bioactive tricalcium silicate [Ca3SiO5]-based dentin substitute and light-activated calcium hydroxide [CA(OH)2]-based liner respectively. This method is also called "stepwise caries removal. [3] Once the exposure is made, the tooth is isolated from saliva to prevent contamination by use of a dental dam, if it was not already in place. Physiology of the human dental pulp. "Vital Pulp Capping: A Worthwhile Procedure (review)", "Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology", "Keys to Clinical Success with Pulp Capping: A Review of the Literature", "Restorative dentistry: Management of the deep carious lesion and the vital pulp dentine complex", "Keys to clinical success with pulp capping: a review of the literature", "Calcium hydroxide liners: a literature review", "Mineral trioxide aggregate: a review of the constituents and biological properties of the material", "Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial", https://en.wikipedia.org/w/index.php?title=Pulp_capping&oldid=997975367, Creative Commons Attribution-ShareAlike License, Immature/mature permanent teeth with simple restoration needs, Recent trauma less than 24hours exposure of pulp / mechanical trauma exposure (during restorative procedure), This page was last edited on 3 January 2021, at 04:13. In the reported literature, the prognosis of direct pulp capping is unpredictable, with the lowest success rate in carious pulp exposures in the adult dentition. One study of indirect pulp capping recorded success rates of 98.3% and 95% using bioactive tricalcium silicate [Ca3SiO5]-based dentin substitute and light-activated calcium hydroxide [CA(OH)2]-based liner respectively. Only age had a significant effect on the pulpal survival rate: the success rate was 90.9% in patients younger than 40 years and 73.8% in patients 40 years or older (P = .0480). These results show no significant difference, nor do the results from an indirect pulp capping experiment comparing calcium silicate cement (Biodentine) and gl… Increases micro-leakage vital pulp capping ( IPC ) is a treatment that preserves pulp vitality may. To tooth tissues and thus does not provide a comprehensive answer adhesives and hybridizing bonding... 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