20. Pediatr Dent 2001;23(3):217-222. Pereira MA, Santos-Junior RBD, Tavares JA, et al. Am J Dent. Fagundes TC, Barata TJ, Prakki A, et al. Blanco L, Cohen S. Treatment of crown fractures with exposed pulps. Thompson V, Craig RG, Curro FA, et al. 2010;118(3):290-297. found = true; $(this).after( ad_content ); Subclinical failures of direct pulp capping of human teeth by using a dentin bonding system. Direct pulp capping in permanent teeth in children – types of pulp exposure, therapeutic indications. Murray PE, About I, Franquin JC, Remusat M, Smith AJ. Although MTA was originally developed primarily for endodontic purposes, such as a root end sealant and for sealing inadvertent furcation and root canal perforations, its use as a potential direct pulp capping agent was quickly recognized.61 Indeed, there is a growing body of scientific evidence, including controlled clinical studies, that has found MTA typically has better clinical outcomes and histologic responses than calcium hydroxide when both are compared head to head in direct pulp capping studies.65-70 While studies indicate MTA is a viable, and perhaps better, option than calcium hydroxide for direct pulp capping procedures, traditional powder/liquid formulations of MTA have significant drawbacks and are not used in most dental offices.36 For example, they are not especially user friendly, require very precise mixing, can cause tooth discoloration, and manipulation and placement can be challenging. January 2015:52-56. target_offset = target_offset + 1000; Coll JA, Sadrian R. Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition. 1. Direct pulp capping in turn involves the placement of a dental material directly on a mechanically, traumatically [] or cariously exposed [3,15] vital pulp. Direct pulp capping is one of the treatments of an exposed vital pulp, and/or pulpotomy. var target_offset = 1000; 2008;34(6):666-670. 78. 2006;19(6):382-386. } Objectives: The tooth’s vitality should be maintained. Pediatr Dent 2001;23(3):331-6. Hilton TJ. 1999;25(3):197-205. Alex G. Adhesive considerations in the placement of direct composite restorations. 46. Camilleri, J. Hydration characteristics of Biodentine and Theracal used as pulp capping materials. 3. 2010;7(2): 18. In September 2015 the patient, a 40-year-old man, presented to the office with the chief complaint of cold sensitivity in the upper right quadrant. 60. This is a procedure in which an attempt is made to maintain the (Available at: "http://www.aapd.org/media/Policies_Recommendations/G_VitalPulpTherapies"). J Dent Res. Huth KC, Paschos E, Hajek-Al-Khatar N, et al. It can be used as a dentin substitute under composites for direct and indirect pulp capping, or as an endodontic repair material. The clinical guidance in that publication supersedes any conflicting recommendations which may be found in this document. 81. }); 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. In addition, due to the hydrophilic nature of polymerized TheraCal LC, it is postulated that water/fluids that are inherent in intertubular dentin, dentin tubules, and (in the case of direct pulp capping) the pulp itself diffuse into the polymer matrix over time, reacting with the MTA-releasing calcium and hydroxide ions in the process. Five-time winner of the Cellerant’s Technology Award, the EyeSpecial C-III camera from SHOFU enables staff to take impressive images for case documentation, diagnosis and treatment planning, and patient communication and education. The TheraCal LC was then light-polymerized for 20 seconds using a light-curing unit with a power density of approximately 1,000 mW/cm2 (Figure 10). Oper Dent 1984;9(2):57-68. pos = parent.attr('ccposition'); Apexogenesis is a histological term used to describe the continued physiologic development and formation of the root’s apex. A radiograph of a primary tooth pulpectomy should be obtained immediately following the procedure to document the quality of the fill and to help determine the tooth’s prognosis. Direct and indirect pulp capping, employing various materials and clinical protocols, has been used for many years to preserve the health and vitality of the pulp complex and induce pulp cells to form hard tissue (reparative/tertiary dentin). A clinical case will be presented in which a novel light-cured resin-modified mineral trioxide aggregate hybrid material was used to manage a mechanical vital pulp exposure that occurred during deep caries excavation. Int Endod J 1998;31(3):221-6. Direct Pulp capping is done mostly when there is accidental exposure of Pulp either by … If calcium hydroxide is used, a glass ionomer or reinforced zinc oxide/eugenol material should be placed over it to provide a seal against microleakage since calcium hydroxide has a high solubility, poor seal, and low compressive strength.28-31  The use of glass ionomer cements or reinforced zinc oxide/eugenol restorative materials has the additional advantage of inhibitory activity against cariogenic bacteria.32,33  The tooth then is restored with a material that seals the tooth from microleakage. 80. Duque C, Negrini Tde C, Hebling J, Spolidorio DM. if ( $(this).offset().top >= target_offset ) { 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.1  The caries surrounding the pulp is left in place to avoid pulp exposure and is covered with a biocompatible material.19  A radiopaque liner such as a dentin bonding agent,20 resin modified glass ionomer,21,22 calcium hydroxide,23,24 zinc oxide/eugenol,24 or glass ionomer cement7,9,25-27 is placed over the remaining carious dentin to stimulate healing and repair. Direct pulp capping is used when the pulp is visibly exposed (vital pulp exposure) due to caries, trauma, or iatrogenic insult such as accidental exposure during tooth preparation or caries removal. The treatment is carried out under aseptic conditions using a rubber dam. 31. } Lo EC, Holmgren CJ, Hu D, Van Palenstein Helderman W. Six-year follow up of atraumatic restorative treatment restorations placed in Chinese school children. Chibinski AC, Reis A, Kreich EM, et al. Author information: (1)Department of Morphology, Biological Sciences Institute, Federal University of … Wambier DS, dos Santos FA, Guedes-Pinto AC, Jaeger RG, Simionato MR. Ultrastructural and microbiological analysis of the dentin layers affected by carious lesions in primary molars treated by minimal intervention. Direct pulp capping . Instructions for use : After obtaining clean non-bleeding wound place Life over exposed pulp which is protected with Vitrebond Plus before restoration placement Aspdin had no way of knowing that roughly 170 years after his discovery this same product would form the backbone of a new class of calcium and alumina silicate based so-called "bioactive" dental materials, one of which was mineral trioxide aggregate (MTA). Direct pulp capping - indications - Asymptomatic - Small exposure (<0.5mm) - Haemorrhage easily controlled (within 10 min) - Exposure occurred is clean and uncontaminate - Atramatic exposure and little desiccation of tooth with no evidence of aspiration of blood into dentin. One technique that has worked well for the author when dealing with deep caries-affected dentin is to first disinfect the substrate with a 2% aqueous solution of chlorhexidine digluconate (eg, Cavity Cleanser™, BISCO, bisco.com; Concepsis®, Ultradent Products, ultradent.com) followed by the placement of a RMGI liner (eg, Vitrebond™, 3M, 3m.com; Fuji Lining™ LC, GC America, gcamerica.com) (Figure 3 through Figure 6). Pulpal bleeding after removal of inflamed pulpal tissue must be controlled. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Mineral trioxide aggregate pulpotomies: A series outcomes assessment. Indirect pulp treatment in a permanent molar: case report of a 4-year follow-up. St. Louis, Mo. J Am Dent Assoc 2006;137(9):610-8. J Clin Pediatr Dent 2006;31(2):68-71. Holan G, Fuks AB. }); J Dent Child 2006;73(2):91-7. Accessed February 1, 2018. Indirect pulp treatment. One researcher reported an impressive 20 out of 20 teeth with exposed pulps capped with TheraCal LC remained vital after 2 years.84 That same researcher reported 19 out of 20 of those same teeth remained vital after 4 years (according to a personal communication the author had with that researcher, Dr. Scotti Nicola, in January 2016). Direct pulp capping should be used only on a vital pulp that has been accidentally injured and shows no other symptoms. Shabbzendedar M, Mazhari F, Alami M, Talebi M. Sodium hypochlorite vs formocresol as pulpotomy in primary molars 1 year follow up. Strassler HE, Levin R. Biodentine tricalcium-silicate cement. // element is now visible in the viewport A clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth. The tooth’s vitality should be preserved. In some cases, the dentist may not need to expose the pulp, and will cap the soft layer of dentin that covers the pulp chamber. Primate pulpal healing after exposure and TheraCal application. Direct Pulp Capping. J Pedod 1978;2(2):99-105. 1991;70(1):75-78. Bjørndal L, Larsen T. Changes in the cultivable flora in deep carious lesions following a stepwise excavation procedure. Pediatr Dent. There should be no radiographic evidence of external root resorption, lateral root pathosis, root fracture, or breakdown of periradicular supporting tissues during or following therapy. Indirect Pulp Capping of Primary Teeth: A Systematic Review. Accessed February 1, 2018. Quintessence Int 2002;33(2):151-9. Indications: Direct pulp capping is indicated for a permanent tooth that has a small carious or mechanical exposure in a tooth with a normal pulp. found = true; 1996;21(1):4-11. Current status of direct pulp-capping materials for permanent teeth. Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF. Bioengineering (Basel). Dalplan DM, Casagrande L, Franzom R, et al. found = true; Am J Dent. Pediatr Dent 2004;26(3):214-20. Min KS, Park HJ, Lee SK, et al. When a pinpoint mechanical exposure of the pulp is encountered during cavity preparation or following a traumatic injury, a biocompatible radiopaque base such as MTA41-44 or calcium hydroxide45 may be placed in contact with the exposed pulp tissue. Koopaeei MM, Inglehart MR, McDonald N, Fontana M. General dentists', pediatric dentists', and endodontists' diagnostic assessment and treatment strategies for deep carious lesions: a comparative analysis. Clinical and microbiological effect of calcium hydroxide protection in indirect pulp capping in primary teeth. In vivo clinical studies support this general protocol.20,21, RMGI liners have several positive attributes, including good adhesive and sealing properties via micromechanical and chemical interaction with dentin.22 They are simple to mix and place, release high sustained levels of fluoride,23 have significant antimicrobial properties24,25 and low solubility,26,27 and exhibit a favorable modulus of elasticity and coefficient of thermal expansion and contraction (similar to that of dentin).28,29 In addition, RMGI liners have been shown in many studies to help reduce gap formation and microleakage.30-34 While there is scientific and anecdotal35,36 evidence supporting the use of RMGI liners in close proximity to (but not in direct contact with) pulp, their use as direct pulp capping agents is generally contraindicated in the literature.1,29,37,38 Clearly, the remaining dentin thickness, which is very difficult to access clinically, has an effect on the pulpal response to any indirect pulp capping material.38 The author has previously discussed in detail the use of RMGI liners as indirect pulp capping agents.39,40, Direct pulp capping is used when the pulp is visibly exposed (vital pulp exposure) due to caries, trauma, or iatrogenic insult such as accidental exposure during tooth preparation or caries removal. Pulp protection therapies aim to maintain the vitality of the tooth in which pulp tissue has been exposed due to trauma, carious lesions, or restorative procedures. J Esthet Dent. var target_offset = 2000; Menezes R, Bramante CM, Letra A, Carvalho VG, Garcia RB. Community Dent Oral Epidemiol 1998;26(2):122-8. Direct pulp capping This treatment is indicated when a pulp, without inflammation, has been exposed. Mehdipour O, Kleier DJ, Averbach RE. The coronal pulp is amputated, and the remaining vital radicular pulp tissue surface is treated with a long-term clinically-successful medicament such as Buckley’s Solution of formocresol or ferric sulfate.46-52  Several studies have utilized sodium hypochlorite with comparable results to formocresol and ferric sulfite.53-55 Calcium hydroxide has been used, but with less long term success.56  MTA is a more recent material used for pulpotomies with a high rate of success. McDonald RE, Avery DR, Dean JA, Jones JE. Dentin microhardness of primary teeth undergoing partial carious removal. Obturation as close as possible to the cementodentinal junction should be accomplished with gutta percha or other filling material acceptable as described in the AAE’s Guide to Clinical Endodontics.14, Apexification (root end closure). Caries control and other variables associated with success of primary molar vital pulp therapy. A thin layer of TheraCal LC was placed directly over the exposed pulp and onto the still-moist (with chlorhexidine) dentin surrounding the pulp. Indications: A pulpectomy is indicated in a primary tooth with irreversible pulpitis or necrosis or a tooth treatment planned for pulpotomy in which the radicular pulp exhibits clinical signs of irreversible pulpitis (e.g., excessive hemorrhage that is not controlled with a damp cotton pellet applied for several minutes) or pulp necrosis (e.g., suppuration, purulence). to preserve vitality of the radicular pulp tissue after removal of the coronal portion. $(".second_ready").click( function(){ Tam LE, Pulver E, McComb D, Smith DC. pos = parent.attr('ccposition'); 2003;19(8):739-746. Comparison of CaOH with MTA for direct pulp capping—a PBRN randomized clinical trial. Quintessence Int. Kasraei S, Azarsina M, Majidi S. In vitro comparison of microleakage of posterior resin composites with and without liner using two-step etch-and-rinse and self-etch dentin adhesive systems. Learn vocabulary, terms, and more with flashcards, games, and other study tools. A practice-based study on stepwise excavation of deep carious lesions in permanent teeth: A 1-year follow-up study. Direct pulp capping is defined as the treatment of an exposed pulp, which can be caused by caries, preparation measures or dental trauma. 15. Ibricevic H, Al-Jame Q. Ferric sulphate and formocresol in pulpotomy of primary molars: Long term follow-up study. If a pulp exposure was encountered, decide if pulp capping is feasible (minimal exposure 0.5 to 0.75 mm with slow oozing of red normal-looking blood). $(last_found).after( ad_content ); if ( found == false && typeof last_found !== 'undefined' ) { Mechanical properties of dental base materials. Young permanent teeth Vital pulp therapy for teeth diagnosed with a normal pulp or reversible pulpitis Protective liner. Eur Arch Paediatr Dent 2006;7(2):64-71. J Oral Implantol 2002;28(5):220-5. Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions. Bjørndal L, Thylstrup A. DIRECT PULP CAPPING: Placement of a medicament / non medicated material on a pulp that has been exposed in course of excavating the last portions of deep dentinal caries. Indications: Direct pulp capping is indicated for a permanent tooth that has a small carious or mechanical exposure in a tooth with a normal pulp. b) relief of pain in patients with acute pulpagia. Pereira JC, Manfio AP, Franco EB, Lopes ES. Pulpectomy is a root canal procedure for pulp tissue that is irreversibly infected or necrotic due to caries or trauma. Oen KT, Thompson VP, Vena D, et al. }); Effect of mineral trioxide aggregate on dentin bridge formation and expression of dentin sialoprotein and heme oxygenase-1 in human dental pulp. After discussion with the patient, the area was anesthetized with articaine, the tooth opened, and the decay visualized. Pediatr Dent 1994;16(5):346-9. 2000;66(4):195-198. 7. Evaluation of antibacterial effects of pulp capping agents with direct contact test method. Partial pulpotomy (aka Cvek pulpotomy) is the removal of a small portion of the vital coronal pulp as a means of preserving the vitality of the remaining coronal and radicular pulp tissues [ 9 ]. This article will provide a general discussion of direct and indirect pulp capping procedures and highlight a clinical case using a novel light-cured resin-modified mineral trioxide aggregate (MTA) hybrid material to manage a mechanical vital pulp exposure that occurred during deep caries excavation. Charland T, Hartwell GR, Hirschberg C, Patel R. An evaluation of setting time of mineral trioxide aggregate and EndoSequence Root Repair Material in the presence of human blood and minimal essential media. Root end closure is accomplished with an apical barrier such as MTA.107  In instances when complete closure cannot be accomplished by MTA, an absorbable collagen wound dressing (e.g., Colla-Cote®)108 can be placed at the root end to allow MTA to be packed within the confines of the canal space. Pediatr Dent 2004;26(4):302-9. http://multimedia.3m.com/mws/media/402237O/vitrebondtm-plus-light-cure-liner-base.pdf. There should be no adverse clinical signs or symptoms of sensitivity, pain, or swelling. Caries detecting solutions (typically propylene glycol mixed with various dyes) that in principle stain only the denatured collagen of the infected dentin (Figure 1 and Figure 2) may be useful adjuncts in this regard, but their accuracy is questionable and it is doubtful they indicate with certainty that all active caries has or has not been removed.16,17, The technique the author prefers is the judicious use of caries detecting solutions in conjunction with careful and thorough use of tactile and visual criteria to assess the caries status of the dentin during cavity excavation and preparation. Direct pulp capping with mineral trioxide aggregate: An observational study. Caries Res 2000;34(6):502-8.