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. [ Links ] 8. [13] This alkaline environment created around the cement has been suggested to give beneficial irritancy to pulpal tissues and stimulates dentine regeneration. A three-year study of 44 carious exposed pulps capped with calcium hydroxide resulted in an 80% success rate.46 Thirty-four traumatically exposed teeth that experienced an approximately four-hour delay before calcium hydroxide pulp capping demonstrated 97% success when followed for periods of up to 17 years.90 To better elucidate the relative benefits of MTA versus calcium hydroxide for pulp … 2006;31(2):68-71. In studies where dentists where were described the scenario of deep caries and given the option of removing all the affected dentin and exposing the pulp and doing a direct pulp cap, versus leaving some of the affected dentin and placing an indirect pulp cap, only 17% responded that they would stop and leave carious dentin behind. This report included 22 operators and a total of 299 teeth. Marchi JJ, de Araujo FB, Fröner AM, Straffon LH, Nör JE. Also due to its nature of non-adhesive, it leads to poor coronal seal hence increases micro-leakage. This can lead to the pulp of the tooth either being exposed or nearly exposed which causes pulpitis (inflammation). [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. 2002;24(3):241-8. [28][29], There have been several studies conducted on the success rates of direct and indirect pulp capping using a range of different materials. 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). For vital pulp capping to be successful, the tooth should be asymptomatic or have minimal symptoms and the bleeding must be controlled. (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. [9], Both Glass Ionomer (GI) and Resin Modified Glass Ionomer (RMGIC) has been widely used as a lining or base material for deep cavities where pulp is in close proximity. This is a step wise procedure and a long procedure which takes about 6 months or more to complete. In addition, the material triggers chronic inflammation even without the presence of bacteria makes it an unfavourable condition for pulp healing to take place. Pediatr Dent. 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. 12. 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. The success rate is presented in percentage to the number of teeth treated in the group. 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. Oral Surg Oral Med Oral Pathol. Calcium hydroxide liners increased the success rate of IPT. 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 ]. This is due to Eugenol, being cytotoxic to the pulp are present in large quantity in this formulation. 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. [5] Logistic regression was performed to identify significant clinical and demographical factors associated with the success of the indirect pulp capping. 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). [13][15] It is thus good practice to place a stronger separate lining material (e.g. [9] CaOH cement is not adhesive to tooth tissues and thus does not provide a coronal seal. Pulpitis, in turn, can become irreversible, leading to pain and pulp necrosis, and necessitating either root canal treatment or extraction. Indirect pulp capping in the primary dentition: a 4 year follow-up study. Remaining dentin thickness(0.5-2mm) Choice of indirect pulp capping agent. Factors affecting the outcomes of direct pulp capping using Biodentine. [32], Similar studies have been conducted of direct pulp capping, with one study comparing ProRoot Mineral Trioxide Aggregate (MTA) and Biodentine which found success rates of 92.6% and 96.4% respectively. MTA also comes in white and grey preparations[26] which may aid visual identification clinically. But more recently mineral trioxide aggregate (MTA) used as a primary molar medicament for pulpotomies reported a 97% success rate. Advertisement . Indirect Pulp Treatment (IPT) was a success in 95%. ... ease of use and success rate. Grey MTA preparations can potentially cause tooth discolouration. After 6 months, this result is put into perspective [68]. [36] More research will be needed to provide a comprehensive answer. DIRECT PULP CAPPING. A recent systematic review of vital pulp therapy in vital permanent teeth with cariously exposed pulps reviewed success rates of direct pulp capping.3 In this review the success rate of direct pulp capping was reported as >6 months-1 year, 87.5%; >1-2 … Direct pulp capping Indirect pulp capping 15. Direct pulp capping (DPC) and calcium hydroxide has been widely used with high success rates in young permanent teeth, but the results in primary teeth are less satisfactory [3,4]. Disadvantages have also been described for MTA. [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%. 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. Van Hassel HJ. J Endod. Capping of the inflamed pulp. 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. [34] Calcium hydroxide has also been tested on its use in indirect pulp capping and was found to have a success rate of 77.6%, compared to a success rate of 85.9% for MTA in another study.[35]. The prognosis of pulp capping (both direct and indirect) varies with success rates ranging from 13 percent to 100 percent. [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. and practice of indirect pulp capping in primary teeth. 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. J Clin Pediatr Dent. 2009;35(8):1147-1151. CaOH has a high antimicrobial activity which has been shown to be outstanding. ×�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. "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. Other studies also support claims of Biodentine’s and MTA’s superiority over calcium hydroxide in terms of success rate in pulp capping procedures [107,108]. [14], CaOH does however have significant disadvantages. [3] A direct pulp cap is a one-stage procedure, whereas a stepwise caries removal is a two-stage procedure over about six months. Type of One Sided Exact 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. Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex. 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. [13][16] It is suggested that an adhesive coronal restoration be used above the CaOH lining to provide adequate coronal seal. The overall success rate was 82.6%. 11. [9], Materials that fall under this category include 4-META-MMA-TBB adhesives and hybridizing dentine bonding agents. Studies have demonstrated that it encourages bleeding due to its vasodilating properties hence impairing polymerisation of the material, affecting its ability to provide a coronal seal when used as a pulp capping agent. 2006;31(2):68-71. Physiology of the human dental pulp. 16. [24] MTA also has for difficult handling properties and is a very expensive material, thus is less cost effective as compared to CaOH. However, they are not a material of choice for direct pulp capping. Indirect pulp capping in the primary dentition: a four year follow-up study. In this study, the success rate for Biodentine™ after 24 months became 77.8% due to the lower recall rate and for Fuji IX™ was 66.7%. FACTORS DETERMINING SUCCESS OF IPC. Selection was based on caries to or deeper than half the distance to the pulp. At 6 months, the success rate was 89.6% with MTA, and remained steady at 73% with calcium hydroxide (P = 0.63). [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. If the pulp appears infected or symptomatic, the dentist may decide a root canal is the best treatment option. 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. 9. 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. Conclusions Despite the success rate of indirect pulp Tronstad L, Mjör IA. 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. 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. 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. J Clin Pediatr Dent. 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 method is also called "stepwise caries removal. An Indirect pulp cap is where, in a permanent tooth, most of the decay is removed. Several materials have been used for this procedure. Aim Indirect pulp capping (IPC) is a treatment that preserves pulp vitality. [22] Similar to CaOH, this alkalinity potentially provides beneficial irritancy and stimulates dentine repair and regeneration. Aim Indirect pulp capping (IPC) is a treatment that preserves pulp vitality. The following materials have been studied as potential materials for direct pulp capping. [31] A further study testing medical Portland cement, Mineral Trioxide Aggregate (MTA) and calcium hydroxide in indirect pulp treatment found varying success rates of 73%-93%. No statistical significant difference between the groups was observed (P = 0.62). This is due to its superior properties of good biocompatibility and adhesive nature, providing coronal seal to prevent bacteria infiltration. Bogen et al 7 reported a high survival rate of 97.96% for pulp capping with mineral trioxide aggregate (MTA) in carious exposures. Success expectations for indirect and direct pulp caps. the criteria for successfully conducted indirect pulp capping were evaluated. [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. 1 The caries surrounding the pulp is left in place to avoid pulp exposure and is covered with a biocompatible material. 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: The overall success rate was 100% in the absence of preoperative pain. Results: The success rate of direct capping was 80.1% after 1 … 1971;32(1):126-134. 10. If the indirect pulp capping procedure has been accomplished properly, there is an amazingly high success rate. Results of success, 6 and 12 months after indirect pulp therapy (in one or two sessions) of asymptomatic pulpitis in primary teeth. 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