Compend Contin Educ Dent. J Endod. MTA also comes in white and grey preparations[26] which may aid visual identification clinically. Studies on indirect pulp capping had clinical success ranging from 73 to 97% after a follow-up period of 2 weeks to 11 years . [ Links ] 8. When dental caries is removed from a tooth, all or most of the infected and softened enamel and dentin are removed. Bogen et al 7 reported a high survival rate of 97.96% for pulp capping with mineral trioxide aggregate (MTA) in carious exposures. Advertisement . [9] CaOH cement is not adhesive to tooth tissues and thus does not provide a coronal seal. 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. 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. [22] Similar to CaOH, this alkalinity potentially provides beneficial irritancy and stimulates dentine repair and regeneration. Direct pulp capping Indirect pulp capping 15. S�†zÊ‚>e˜w @¯’¿£0`mc}£0tOaaïQmĞPËšUv1¶c¡ :œ…¶Ñ‰¯@„Z§Ğ±Úk©Ë¢GŞS¶f©_Æ«BmQèÏ:­öœÆúsÙ¶Óî¸RğdkSZltLIإ蘒­vL54:S? It is only feasible if the exposure is made through non infected dentin and there is no recent history of spontaneous pain (i.e. 16. This can lead to the pulp of the tooth either being exposed or nearly exposed which causes pulpitis (inflammation). Zinc Oxide Eugenol (ZOE) is a commonly used material in dentistry. [6] A temporary filling is used to keep the material in place, and about 6 months later, the cavity is re-opened and hopefully there is now enough sound dentin over the pulp (a "dentin bridge") that any residual softened dentin can be removed and a permanent filling can be placed. Success expectations for indirect and direct pulp caps. glass ionomer or resin-modified glass ionomer) over CaOH before packing the final restorative material. [9], Calcium hydroxide (CaOH) is an organo-metallic cement that was introduced into dentistry in the early twentieth century[10] and there have since been many advantages to this material described in much of the available literature. [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. The idea of using adhesive materials for direct pulp capping has been explored two decades ago. No statistical significant difference between the groups was observed (P = 0.62). 10. 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. 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. [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. However, they are not a material of choice for direct pulp capping. Selection was based on caries to or deeper than half the distance to the pulp. (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. There have been several studies conducted on the success rates of direct and indirect pulp capping using a range of different materials. 9. 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. 12. 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. Tronstad L, Mjör IA. In addition, the material triggers chronic inflammation even without the presence of bacteria makes it an unfavourable condition for pulp healing to take place. The set cement has low compressive strength and cannot withstand or support condensation of a restoration. irreversible pulpitis) and a bacteria-tight seal can be applied. 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. J Clin Pediatr Dent. [19], Mineral trioxide aggregate (MTA) is a recent development of the 1990s[20] initially as a root canal sealer but has seen increased interest in its use as a direct pulp capping material. Pediatr Dent. Indirect pulp capping in the primary dentition: a 4 year follow-up study. (grossman) • without signs or symptoms of pulp degeneration. 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. CaOH has a high antimicrobial activity which has been shown to be outstanding. At 6 months, the success rate was 89.6% with MTA, and remained steady at 73% with calcium hydroxide (P = 0.63). Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex. [36] More research will be needed to provide a comprehensive answer. Pulp capping material should provide a suitable condition to encourage regeneration of the dentin-pulp complex; be able to induce differentiation of odontoblastlike cells; and be antibacterial, biocompatible, and nontoxic 8 . These results show no significant difference, nor do the results from an indirect pulp capping experiment comparing calcium silicate cement (Biodentine) and gl… 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. 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. Physiology of the human dental pulp. 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. [20] MTA has been shown to produce CaOH as a hydration product[21] and maintains an extended duration of high pH in lab conditions. The difficulty with this technique is estimating how rapid the carious process has been, how much tertiary dentine has been formed and knowing exactly when to stop excavating to avoid pulp exposure.[8]. Pulpitis, in turn, can become irreversible, leading to pain and pulp necrosis, and necessitating either root canal treatment or extraction. RESULTS: The overall success rate was 100% in the absence of preoperative pain. 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 … [3] A direct pulp cap is a one-stage procedure, whereas a stepwise caries removal is a two-stage procedure over about six months. [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. 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. 2018; 39(3):182-189. Logistic regression was performed to identify significant clinical and demographical factors associated with the success of the indirect pulp capping. Studies that compare pulp capping abilities of MTA to CaOH in human teeth yielded generally equal and similarly successful healing outcomes at a histological level from both materials. 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. Objective: A retrospective study of the success rate of direct pulp capping (DPC) and indirect pulp capping (IPC) was carried out in children between 6–14 years-old, con-sidering separately primary caries or caries affecting teeth with molar incisor hypo-mineralization (MIH). 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). [11] CaOH also has a high pH and high solubility, thus it readily leaches into the surrounding tissues. [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%. 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. 1971;32(1):126-134. Several materials have been used for this procedure. 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). 10. 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. 16. After 6 months, this result is put into perspective [68]. 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. Type of One Sided Exact 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. 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. But more recently mineral trioxide aggregate (MTA) used as a primary molar medicament for pulpotomies reported a 97% success rate. [28][29], There have been several studies conducted on the success rates of direct and indirect pulp capping using a range of different materials. 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. Oral Surg Oral Med Oral Pathol. 2002;24(3):241-8. Marchi JJ, de Araujo FB, Fröner AM, Straffon LH, Nör JE. ... 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). 11. Van Hassel HJ. [9], Materials that fall under this category include 4-META-MMA-TBB adhesives and hybridizing dentine bonding agents. Calcium hydroxide liners increased the success rate of IPT. Marchi JJ, de Araujo FB, Froner AM, et al. The prognosis of pulp capping (both direct and indirect) varies with success rates ranging from 13 percent to 100 percent. This method is also called "stepwise caries removal. 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. Alex G. Direct and indirect pulp capping: a brief history, material innovations, and clinical case report. As a dentist, you find that the decay is extensive and very close to the pulp (nerve) of the tooth. Conclusions Despite the success rate of indirect pulp [13][15] It is thus good practice to place a stronger separate lining material (e.g. [24] MTA also has for difficult handling properties and is a very expensive material, thus is less cost effective as compared to CaOH. Pulp Capping Treatent. This report included 22 operators and a total of 299 teeth. Also due to its nature of non-adhesive, it leads to poor coronal seal hence increases micro-leakage. The success rate is presented in percentage to the number of teeth treated in the group. 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. Two different types of pulp cap are distinguished. This is a step wise procedure and a long procedure which takes about 6 months or more to complete. Indirect Pulp Treatment (IPT) was a success in 95%. 2006;31(2):68-71. [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. Capping of the inflamed pulp. The overall success rate was 82.6%. [9] In pulp perfusion studies, CaOH has shown to insufficiently seal all dentinal tubules, and presence of tunnel defects (patent communications within reparative dentine connecting pulp and exposure sites) indicate a potential for microleakage when CaOH is used. 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 … However, when the preoperative pain was present, the … J Clin Pediatr Dent. [24] There is also less coronal microleakage of MTA in one experiment comparing it to amalgam[25] thus suggesting some tooth adhesion properties. However, calcium hydroxide and mineral trioxide aggregate (MTA) are the preferred material of choice in clinical practice due to their favourable outcome. Results: The success rate of direct capping was 80.1% after 1 … 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 direct pulp cap is done on permanent teeth when the removal of deep decay results in exposing the pulp. [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. Direct Pulp Caps. In direct pulp capping, the protective dressing is placed directly over an exposed pulp; and in indirect pulp capping, a thin layer of softened dentin, that if removed would expose the pulp, is left in place and the protective dressing is placed on top. 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. 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. ... ease of use and success rate. An Indirect pulp cap is where, in a permanent tooth, most of the decay is removed. If the indirect pulp capping procedure has been accomplished properly, there is an amazingly high success rate. the criteria for successfully conducted indirect pulp capping were evaluated. [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. For vital pulp capping to be successful, the tooth should be asymptomatic or have minimal symptoms and the bleeding must be controlled. 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. "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. [13][16] It is suggested that an adhesive coronal restoration be used above the CaOH lining to provide adequate coronal seal. Disadvantages have also been described for MTA. 2006;31(2):68-71. [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%. A very recent multi-centre RCT of moderate quality observed better success rate for indirect pulp capping than stepwise excavation after an observation period of 3 years, 91% versus 69%. 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 is due to Eugenol, being cytotoxic to the pulp are present in large quantity in this formulation. [14], CaOH does however have significant disadvantages. [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. [13] This alkaline environment created around the cement has been suggested to give beneficial irritancy to pulpal tissues and stimulates dentine regeneration. Aim Indirect pulp capping (IPC) is a treatment that preserves pulp vitality. 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). The following materials have been studied as potential materials for direct pulp capping. 11. [5] "[3][7] 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]. ×�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. [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. Factors affecting the outcomes of direct pulp capping using Biodentine. Aim Indirect pulp capping (IPC) is a treatment that preserves pulp vitality. Results of success, 6 and 12 months after indirect pulp therapy (in one or two sessions) of asymptomatic pulpitis in primary teeth. 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]. Table 1. 2009;35(8):1147-1151. 1 The caries surrounding the pulp is left in place to avoid pulp exposure and is covered with a biocompatible material. and practice of indirect pulp capping in primary teeth. 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. 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. The teeth were observed up to 9 years with a first visit after 3 months followed by an annual routine visit. 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 use of ZOE as a pulp capping material remains controversial. 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. 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. 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. [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. If the pulp appears infected or symptomatic, the dentist may decide a root canal is the best treatment option. Grey MTA preparations can potentially cause tooth discolouration. Results: After 48 months, Group-1 showed a success rate of 88.8% and Group-2 of 93%. [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]. [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. Remaining dentin thickness(0.5-2mm) Choice of indirect pulp capping agent. Indirect pulp capping in the primary dentition: a four year follow-up study. Evidenced-based review of clinical studies on indirect pulp capping. Most importantly, its toxicity to human pulp cells once again makes it an unacceptable material of choice. This technique is used when a pulpal exposure occurs, either due to caries extending to the pulp chamber, or accidentally, during caries removal. 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