"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. Marchi JJ, de Araujo FB, Fröner AM, Straffon LH, Nör JE. Marchi JJ, de Araujo FB, Froner AM, et al. The idea of using adhesive materials for direct pulp capping has been explored two decades ago. [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 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. 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]. 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. Success expectations for indirect and direct pulp caps. The following materials have been studied as potential materials for direct pulp capping. Factors affecting the outcomes of direct pulp capping using Biodentine. 16. 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. Capping of the inflamed pulp. Results: After 48 months, Group-1 showed a success rate of 88.8% and Group-2 of 93%. This is due to Eugenol, being cytotoxic to the pulp are present in large quantity in this formulation. 2006;31(2):68-71. Several materials have been used for this procedure. Grey MTA preparations can potentially cause tooth discolouration. [ Links ] 8. Studies on indirect pulp capping had clinical success ranging from 73 to 97% after a follow-up period of 2 weeks to 11 years . Results of success, 6 and 12 months after indirect pulp therapy (in one or two sessions) of asymptomatic pulpitis in primary teeth. 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. CaOH has a high antimicrobial activity which has been shown to be outstanding. FACTORS DETERMINING SUCCESS OF IPC. 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 ]. The success rate is presented in percentage to the number of teeth treated in the group. S�†zÊ‚>e˜w @¯’¿£0`mc}£0tOaaïQmĞPËšUv1¶c¡ :œ…¶Ñ‰¯@„Z§Ğ±Úk©Ë¢GŞS¶f©_Æ«BmQèÏ:­öœÆúsÙ¶Óî¸RğdkSZltLIإ蘒­vL54:S? 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). 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. Compend Contin Educ Dent. For vital pulp capping to be successful, the tooth should be asymptomatic or have minimal symptoms and the bleeding must be controlled. 10. [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%. Studies have demonstrated unfavourable results for ZOE when compared to calcium hydroxide as a direct pulp capping material as it causes pulpal necrosis. 2018; 39(3):182-189. This method is also called "stepwise caries removal. 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]. As a dentist, you find that the decay is extensive and very close to the pulp (nerve) of the tooth. Physiology of the human dental pulp. irreversible pulpitis) and a bacteria-tight seal can be applied. Indirect Pulp Treatment (IPT) was a success in 95%. ... 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. Direct pulp capping Indirect pulp capping 15. 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. and practice of indirect pulp capping in primary teeth. When dental caries is removed from a tooth, all or most of the infected and softened enamel and dentin are removed. Zinc Oxide Eugenol (ZOE) is a commonly used material in dentistry. 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. 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. The overall success rate was 82.6%. 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. [20] MTA has been shown to produce CaOH as a hydration product[21] and maintains an extended duration of high pH in lab conditions. 2006;31(2):68-71. Van Hassel HJ. But more recently mineral trioxide aggregate (MTA) used as a primary molar medicament for pulpotomies reported a 97% success rate. 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). This report included 22 operators and a total of 299 teeth. 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. 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. Remaining dentin thickness(0.5-2mm) Choice of indirect pulp capping agent. 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. "[3][7] 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. 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. 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. A direct pulp cap is done on permanent teeth when the removal of deep decay results in exposing the pulp. the criteria for successfully conducted indirect pulp capping were evaluated. 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). 10. 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. The set cement has low compressive strength and cannot withstand or support condensation of a restoration. [11] CaOH also has a high pH and high solubility, thus it readily leaches into the surrounding tissues. 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). 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]. If the indirect pulp capping procedure has been accomplished properly, there is an amazingly high success rate. This is due to its superior properties of good biocompatibility and adhesive nature, providing coronal seal to prevent bacteria infiltration. Aim Indirect pulp capping (IPC) is a treatment that preserves pulp vitality. 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. [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. If the pulp appears infected or symptomatic, the dentist may decide a root canal is the best treatment option. Alex G. Direct and indirect pulp capping: a brief history, material innovations, and clinical case report. [24] There is also less coronal microleakage of MTA in one experiment comparing it to amalgam[25] thus suggesting some tooth adhesion properties. Tronstad L, Mjör IA. These results show no significant difference, nor do the results from an indirect pulp capping experiment comparing calcium silicate cement (Biodentine) and gl… [24] MTA also has for difficult handling properties and is a very expensive material, thus is less cost effective as compared to CaOH. J Clin Pediatr Dent. Aim Indirect pulp capping (IPC) is a treatment that preserves pulp vitality. 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. However, they are not a material of choice for direct pulp capping. [13][15] It is thus good practice to place a stronger separate lining material (e.g. 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 prognosis of pulp capping (both direct and indirect) varies with success rates ranging from 13 percent to 100 percent. 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%. This can lead to the pulp of the tooth either being exposed or nearly exposed which causes pulpitis (inflammation). [ 9 ], CaOH does however have significant disadvantages primary teeth a bacteria-tight seal can be applied clinical... Non infected dentin and there is an amazingly high success rate to tooth tissues and stimulates repair. 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