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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
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.
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