References

Duncan HF, Galler KM European Society of Endodontology position statement: management of deep caries and the exposed pulp. Int Endod J. 2019; 52:923-934 https://doi.org/10.1111/iej.13080
Mathur VP, Dhillon JK, Logani A, Kalra G Evaluation of indirect pulp capping using three different materials: a randomized control trial using cone-beam computed tomography. Indian J Dent Res. 2016; 27:623-629 https://doi.org/10.4103/0970-9290.199588
Lipski M, Nowicka A, Kot K Factors affecting the outcomes of direct pulp capping using Biodentine. Clin Oral Investig. 2018; 22:2021-2029 https://doi.org/10.1007/s00784-017-2296-7
Sabeti M, Huang Y, Chung YJ, Azarpazhooh A Prognosis of vital pulp therapy on permanent dentition: a systematic review and meta-analysis of randomized controlled trials. J Endod. 2021; 47:1683-1695 https://doi.org/10.1016/j.joen.2021.08.008
Weisleder R, Yamauchi S, Caplan DJ The validity of pulp testing: a clinical study. J Am Dent Assoc. 2009; 140:1013-1017 https://doi.org/10.14219/jada.archive.2009.0312
Careddu R, Duncan HF A prospective clinical study investigating the effectiveness of partial pulpotomy after relating pre-operative symptoms to a new and established classification of pulpitis. Int Endod J. 2021; 54:2156-2172 https://doi.org/10.1111/iej.13629
Taha NA, Abuzaid AM, Khader YS A randomized controlled clinical trial of pulpotomy versus root canal therapy in mature teeth with irreversible pulpitis: outcome, quality of life, and patients' satisfaction. J Endod. 2023; 49:624-631.e2 https://doi.org/10.1016/j.joen.2023.04.001
Consensus Conference on Diagnostic Terminology. J Endod. 2009; 35:(12)
Bjørndal L, Simon S, Tomson PL, Duncan HF Management of deep caries and the exposed pulp. Int Endod J. 2019; 52:949-973 https://doi.org/10.1111/iej.13128
Shahi P, Sood PB, Sharma A Comparative study of pulp vitality in primary and young permanent molars in human children with pulse oximeter and electric pulp tester. Int J Clin Pediatr Dent. 2015; 8:94-98 https://doi.org/10.5005/jp-journals-10005-1291
Ghouth N, Duggal MS, Kang J, Nazzal H A diagnostic accuracy study of laser doppler flowmetry for the assessment of pulpal status in children's permanent incisor teeth. J Endod. 2019; 45:543-548 https://doi.org/10.1016/j.joen.2019.01.017
Patro S, Meto A, Mohanty A Diagnostic accuracy of pulp vitality tests and pulp sensibility tests for assessing pulpal health in permanent teeth: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022; 19 https://doi.org/10.3390/ijerph19159599
Dummer PM, Hicks R, Huws D Clinical signs and symptoms in pulp disease. Int Endod J. 1980; 13:27-35 https://doi.org/10.1111/j.1365-2591.1980.tb00834.x
Ricucci D, Siqueira JF, Li Y, Tay FR Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure. J Dent. 2019; 86:41-52 https://doi.org/10.1016/j.jdent.2019.05.022
Chua SKX, Sim YF, Wang WC One-year outcome of selective caries removal versus pulpotomy treatment of deep caries: a pilot randomized controlled trial. Int Endod J. 2023; 56:1459-1474 https://doi.org/10.1111/iej.13978
Maltz M, Garcia R, Jardim JJ Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. J Dent Res. 2012; 91:1026-1031 https://doi.org/10.1177/0022034512460403
Davaie S, Hooshmand T, Ansarifard S Different types of bioceramics as dental pulp capping materials: a systematic review. Ceramics International. 2021; 47:20781-20792 https://doi.org/10.1016/J.CERAMINT.2021.04.193
Hashem DF, Foxton R, Manoharan A The physical characteristics of resin composite-calcium silicate interface as part of a layered/laminate adhesive restoration. Dent Mater. 2014; 30:343-349 https://doi.org/10.1016/j.dental.2013.12.010
Falacho RI, Melo EA, Marques JA Clinical in-situ evaluation of the effect of rubber dam isolation on bond strength to enamel. J Esthet Restor Dent. 2023; 35:48-55 https://doi.org/10.1111/jerd.12979

Predictable outcomes with vital pulp therapy in deep caries management of mature teeth

From Volume 52, Issue 3, March 2025 | Pages 199-204

Authors

Anoushka Yadav

BDS, MDS, Consultant Endodontist, Panchkula, India

Articles by Anoushka Yadav

Email Anoushka Yadav

Ashwini Kamat

BDS, Postgraduate Student

Articles by Ashwini Kamat

Janina Loren D'Souza

BDS, MDS, Senior Lecturer

MDS, Senior Lecturer; Department of Conservative Dentistry and Endodontics Manipal College of Dental Sciences Mangalore, Affiliated to Manipal Academy of Higher Education, Karnataka, Manipal, India

Articles by Janina Loren D'Souza

Email Janina Loren D'Souza

Abstract

Preserving pulp vitality is paramount in endodontics, necessitating a conservative and systematic approach. In the first case, a 48-year-old woman complained of pain on cold stimuli and food lodgement in the upper left posterior tooth region. Following thorough clinical and radiographic examination, the UL7 was diagnosed with reversible pulpitis and normal peri-apical tissues. Upon caries removal, pulp exposure occurred and was treated with direct pulp capping with Biodentine. A successful outcome was observed at 12-month follow-up. In the second case, a 26-year-old woman complained of food lodgement in a upper left posterior tooth region for 2 months. Subsequent clinical and radiographic examination confirmed deep caries in the UL4 with normal peri-apical tissues. Indirect pulp capping was performed, followed by 12-month follow-up.

CPD/Clinical Relevance: This case report underscores the management of deep caries, emphasizing the importance of following correct protocols, including isolation, use of bioceramic materials and adhering to proper bonding protocols to ensure maximum success.

Article

Vital pulp therapies have been gaining momentum since bioceramic materials were introduced, especially in the past decade. The main aim of carrying out vital pulp therapy is to ensure the pulp is healthy and reduce complications, such as tooth fractures resulting from root canal treatment.

Vital pulp therapy (VPT) procedures include indirect and direct pulp capping (DPC), as well as partial and full pulpotomy. DPC entails applying a biomaterial directly onto the exposed pulp, whereas indirect pulp capping (IPC) involves applying a biomaterial onto a thin dentine barrier in a one-stage carious tissue removal technique, typically onto hard dentine.1 The success rate of IPC stands at 96.6%, while that for DPC is at around 82.6%.2,3 A recent systematic review by Sabeti et al found that the overall success rate of VPT, using modern capping materials, such as mineral trioxide aggregate or calcium silicate-based materials, was 93.2%.4 Although the success of these treatment modalities depends on various factors, such as the pulp capping material, the operator's experience and technique, as well as the intensity and location of the insult, one of the major factors determining success is the true state of the pulp.

Register now to continue reading

Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Up to 2 free articles per month
  • New content available