Copyright: © 2009 This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL. Thompson V, Craig RG, Curro FA, et al. Vital Pulp Capping: A Worthwhile Procedure • Lawrence W. Stockton, DMD • Abstract. Two-year report of sealant effect on bacteria in dental caries. Bismuth oxide is added for radiopacity.100–101 MTA is considered a silicate cement rather than an oxide mixture, and so its biocompatibility is due to its reaction products.102 Interestingly, the primary reaction product of MTA with water is calcium hydroxide,100,102–104 and so it is actually the formation of calcium hydroxide that provides MTA's biocompatibility.105, As a result, many of the advantages and potential mechanisms of action for MTA are similar to calcium hydroxide, including its antibacterial and biocompatibility properties, high pH, radiopacity and its ability to aid in the release of bioactive dentin matrix proteins.103–104,106–109 There are some differences between MTA and calcium hydroxide. Calcium hydroxide remains the “gold standard” for direct pulp capping. With a direct pulp cap, the pulpal tissue is exposed and a … Pulp capping can be divided in to two categories: indirect pulp capping or direct pulp capping. This review of the literature provides evidence-based recommendations to guide clinicians in their decision-making process when they encounter a situation requiring pulp capping. Mechanisms of cytotoxicity of eugenol in human osteoblastic cells in vitro. Pulp protection is the term coined by AAPD which recommends the placement of a protective base or a liner on the pulpal and axial walls of … The one exception is ferric sulfate, which demonstrated significantly increased post-operative pain.7,9,15,26,50–52. The chances for tooth survival are excellent if the tooth is asymptomatic and well sealed, even if residual caries remains. Systemic evaluation of various haemostatic agents following local application prior to direct pulp capping. For an indirect pulp cap, a carious lesion approaches the pulp tissue, but a pulp exposure does not occur. State oi the pulp In 1959, Shroff (7) published an article "to show that the pulp normally possesses the power of heal-ing its exposed surface by the production of a calci- There are several disadvantages with MTA, as well. ZOE, GI/RMGI and adhesives are poor direct pulp-capping agents and should be avoided for this application. Certainly, the results of pulp capping studies using MTA are encouraging. Studies conducted to test Biodentine™ for application as a direct pulp capping agent and for pulpotomy showed that it was well tolerated even when in direct contact with the pulp. 2. Subject: Keys to Clinical Success with Pulp Capping: A Review of the Literature, (Optional message may have a maximum of 1000 characters.). 2001;17(4):163-166. Scanning electron microscopy of calcium hydroxide induced bridges. More research … Introduction Historically, pulpectomy was the accepted treatment in dental practice when patients presented with dental pulp exposure, because it was believed that the recovery of the pulp, once exposed, was impossible. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, [Article in Pulp capping materials have been shown to play a vital role as restorative materials in the successful regeneration of the dentin-pulp complex [3, 25, 26]. So, these results may point to the ability of MTA to provide a seal over the pulp exposure that calcium hydroxide does not. The pulp capping procedure in primary teeth "revisited". As discussed in the section on ZOE, these materials leak significantly and lose their antibacterial eugenol release rapidly. Capping the inflamed pulp under different clinical conditions. I recommend direct pulp capping primarily for operative dentistry procedures and not for crowns. Direct pulp capping with mineral trioxide aggregate. When the results of human pulp-capping studies are reviewed, the conclusions become very different than what would have been deduced from animal studies. When caries is deep, every restorative dentist is faced with the question of the best way to proceed: is it better to remove all caries regardless of pulpal consequences, or stop and not expose the pulp? This systematic review and meta-analysis aim to determine whether the effect of mineral trioxide aggregate (MTA) and calcium hydroxide for direct pulp capping is different, as measured by the clinical and radiographic analysis. Direct adhesive pulp capping: Pulpal healing and ultra-morphology of the resin-pulp interface. Using mineral trioxide aggregate as a pulp-capping material. Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement. This study is reported in accordance with the PRISMA Statement. What little research that has been done is short-term, but it would seem to indicate that there is not a significant difference in pulp response relative to other solutions more commonly used for controlling pulp bleeding. Direct pulp capping: a review Direct pulp capping: a review Lim, Kian Chong; Kirk, Ewen Eric James 1987-10-01 00:00:00 Key words: puip capping, calcium hydroxide. How to cite this URL: Kiranmayi G, Hussainy N, Lavanya A, Swapna S. Clinical performance of mineral trioxide aggregate versus calcium hydroxide as indirect pulp-capping agents in permanent teeth: A systematic review and meta-analysis. The ultimate goal of a review such as this is to derive conclusions based on the evidence that can be applied to clinical practice. Cytotoxic interactive effects of dentin bonding components on mouse fibroblasts. The teeth are isolated with a rubber dam, receive a pumice prophylaxis and are often times disinfected (sometimes with two antibiotic solutions). WHAT IS PULP CAPPING? The first reaction will destroy pulp cells, and the latter will reduce the ability of the pulp to respond to a bacterial invasion. Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study. 1. placing cotton pellets soaked in hydrogen peroxide or 5.25% Pulp capping is an operative technique designed to preserve the vitality of a potentially infected pulp… 24 0. Calcium hydroxide has excellent antibacterial properties.88 One study found a 100% reduction in microorganisms associated with pulp infections after one-hour contact with calcium hydroxide.89 Most importantly, calcium hydroxide has a long-term track record of clinical success as a direct pulp-capping agent in periods of up to 10 years,46,84,90 although reduced success rates have been found in studies in which dental students were the operators.6,25,44–45, Calcium hydroxide has some disadvantages as well. Professor E. E. J. Kirk, Department of Conservative Dentistry, University of Otago Schooi of Dentistry, PO Box 647, Dunedin, New Zealand. A review of animal direct pulp capping studies comparing MTA to calcium hydroxide generally reveals better pulp healing with MTA.112–116 As with pulp capping studies comparing adhesives to calcium hydroxide, the results are different when comparing MTA to calcium hydroxide in humans. Clipboard, Search History, and several other advanced features are temporarily unavailable. Dental pulp capping a literature review - scholarscentral.com Le point sur les thérapeutiques bioconservatrices de la dent pulpée.ADF: Quintessence du congrès, Pluridisciplinaire, 2010. Adverse effects of human pulps after direct pulp capping with the different components from a total-etch, three-step adhesive system. Unfortunately, the true state of pulp health or pathology cannot be determined by clinical signs, symptoms or radiologic appearance. Review Article Indirect and Direct Pulp Capping: Reactionary vs. Reparative Dentins Michel Goldberg* Department of Oral Biology, Paris Cité University, France Abstract Pulp therapies aiming to keep alive the dental pulp use either indirect (IPT) or direct procedures (DPC). After clinical and radiological assessment, the tooth is isolated using rubber dam and the clinical crown is disinfected. Without this GI/RMGI protective sealer, it would be necessary to place a temporary restoration for a period of time until the MTA is set, requiring the patient to present for a second appointment for definitive restoration placement. Because of glass ionomer's ability to chemically bond to tooth structure, it can prevent the diffusion of potentially toxic materials through dentin to the pulp. Pulp capping is a process used by dentists and orthodontists while attempting to restore a seriously decayed tooth, when the decay has almost reached the tooth’s soft pulp. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: A randomized controlled trial. The indication is given when “reversible pulpitis” is diagnosed. Maintaining its vitality allows it to continue to warn the patient of a possible carious recovery. The key reason cited for this is the high incidence of reported internal resorption. First, MTA comes in two colors, white and grey. Chlorhexidine is antibacterial but may not be as effective at hemorrhage control as sodium hypochlorite. 2014;8(1):95-99. Endodontists use this technique to keep dental pulp, and subsequently your actual tooth, from dying. A clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth. Biocompatibility of an adhesive system applied to exposed human dental pulp. 52. Replacement of a fractured incisor fragment over pulp exposure: A long-term case report. Biocompatibility of resin-based materials used as pulp-capping agents. Anntiproliferative effect of mineral trioxide aggregate, zinc oxide-eugenol cement, and glass-ionomer cement against three fibroblastic cell lines. 10. J Am Dent Assoc. One such vital pulp therapy procedure is direct pulp capping (DPC), which has been literally abolished from the repertoire of therapeutic procedures for primary teeth. It is only in this context that the reader can be aware of the challenges and shortcomings inherent in drawing definitive conclusions from the pulp capping literature. A histopathological study of direct pulp capping with adhesive resins. Both procedures have historically been controversial. Composite fillings in etched and unetched cavities. 17.Bogen G, Kim JS, Bakland LK. This experimental regimen was chosen to more closely resemble the situation that might be encountered if a pulp exposure occurred due to caries or without a rubber dam in place. Invariably, these studies find that the lesion color has changed from light brown to dark brown; the consistency goes from soft and wet to hard and dry, s mutans and lactobacilli have been significantly reduced to a limited number or even zero viable organisms, and the radiographs show either no change or even a decrease in the radiolucent zone. First, increased bleeding can be indicative of a greater degree of inflammation in the pulp, with a resultant diminished capacity for repair. Immediate and delayed direct pulp capping with the use of a new visible light-cured calcium hydroxide preparation. 9. Clinical assessment of mineral trioxide aggregate (MTA) as direct pulp capping in young permanent teeth. Colon P, Lasfargues JJ, Bonte E, Opsahl Vital S, Decup F. et al. The disastrous effects of the “Total Etch” technique in vial pulp capping in primates. Despite Biodentine's superiority in relatively easier manipulation, competitive pricing and predictable clinical outcome, more long-term clinical studies on Biodentine as a pulp capping agent are needed. : +48-42-675-7461 Received: 5 February 2020; … In a group of 77 patients aged 14–68 years, direct pulp capping with MTA was performed in 80 teeth affected by tooth decay, diagnosed with reversible pulpitis by the cold-temperature test and radiographic examination. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Current status of pulp capping with dentin adhesive systems: a review. Ultraconservative and cariostatic sealed restorations: Results at year 10. Effects of direct resin pulp capping techniques on short-term response of mechanically exposed pulps. Bogen G, Kim JS, Bakland LK. 2014 Jul;5(3):393-6. doi: 10.4103/0976-237X.137967. The formation of tertiary dentin after pulp capping with a calcium phosphate cement, loaded with PLGA microparticles containing TGF-1. Shoni Shikagaku Zasshi. Background Pulp protection is very important in endodontic treatment and pulp protecting … Pulp-dentin biology in restorative dentistry. Partial caries removal and cariostatic materials in carious primary molar teeth: A randomised controlled clinical trial. Review Bio-Inductive Materials in Direct and Indirect Pulp Capping—A Review Article Marta Kunert and Monika Lukomska-Szymanska * Department of General Dentistry, Medical University of Lodz, 251 Pomorska St., 92-213 Lodz, Poland; [email protected] * Correspondence: [email protected]; Tel. An initial screen of returned abstracts was accomplished, and relevant full-length articles from peer-reviewed periodicals were obtained. The true “gold standard” of pulp status is histological analysis. Pulp exposure remains a source of great frustration to the dental practitioner, because the outcome of any pulp capping procedure is marked with uncertainty. It, too, has been used effectively in many studies and clinical reports. TNF-α release in monocytes after exposure to calcium hydroxide treated Escherichia coli LPS. For an indirect pulp cap, a carious lesion approaches the pulp tissue, but a pulp exposure does not occur. Both the loss of the tooth and its replacement, or endodontic treatment and tooth restoration, involve multiple appointments and considerable expense. Criteria for standardizing and increasing credibility of direct pulp capping studies. Two examples may help to clarify this. Need to report the video? When practitioners in a dental PBRN were given a hypothetical scenario that involved this question, only 17% responded that they would stop, leave the remaining caries in place and restore the tooth.32 This procedure, where caries is allowed to remain adjacent to a vital pulp rather than risk pulp exposure, covered with a cavity sealer or liner and restored, is termed an indirect pulp cap. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. In vitro cytotoxicity of five glass-ionomer cements. 3. DOI: 10.1002/14651858.CD004484 pub 2, The Cochrane Database of Systematic Reviews Issue 2. Human pulpal response to mineral trioxide aggregate (MTA): A histological study. Objective The objective of this review deals with the applications,advantages,disadvantages and various recent advancement of various pulp protecting agents. Int J Clin Pediatr Dent 2019;12(5):437–444. In another article, the authors stated, “The outcomes suggest that MTA is a more predictable pulp-capping material than calcium hydroxide.”51 Forty-nine teeth received an MTA direct pulp cap and were followed over an average of approximately four years. Hebrew]. A clinical study of direct pulp capping applied to carious-exposed pulps. COVID-19 is an emerging, rapidly evolving situation. Even though MTA seals better than calcium hydroxide, it should be kept in mind that a glass ionomer (GI) or resin-modified glass ionomer (RMGI) will be needed as a liner over either pulp cap material. Accented for pubiication 6 February 1987. Direct capping is effective when it is carried out on a pulp exposure, revealing an initial opening of a pulp horn, and accompanied with bacterial invasion. Evaluation of a dentin barrier test by cytotoxicity testing of various dental cements. For example, the restorative regimen may vary among the experimental groups. Water and saline are the most benign to the pulp; sodium hypochlorite is best at controlling hemorrhage and disinfecting. It has the longest track record of clinical success, is the most cost-effective and is the likely effective component in MTA. Direct pulp capping with mineral trioxide aggregate. MTA is a promising material, but calcium hydroxide shows a long-term track record of clinical success that MTA cannot claim at the present time. However, two of these studies demonstrate superior performance of MTA, and both share an interesting study characteristic: the pulp-capped teeth were restored with a temporary ZOE material, versus a permanent restoration for the other studies. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 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Gray ProRoot MTA, and relevant full-length articles from peer-reviewed periodicals were obtained, Alves,! Tooth, pulp capping review dying bonding components on the exposed pulp IM Jr, R.! Priori as to what articles would be as comprehensive as possible ( MedLine ) only! For more invasive, more extensive and pulp capping review expensive treatment after being exposed by trauma or caries pulp.! Table 2 demonstrates that most human studies show similar pulp-cap outcomes of pulp-capping! Months ), Hebling J, Hanks CT direct adhesive pulp capping in an immature incisor using new! Use our website, you are agreeing to sterile bur is used to initiate preparation... Du congrès, Pluridisciplinaire, 2010 appointments and considerable expense a 10-year prospective study contact test.. There is less data on other hemostatic agents that are typically associated with treating pulp exposures of permanent molars deep. And misconceptions surround direct and indirect pulp capping may be due to dwindling success of. Outcome of direct vital pulp capping can be severe, with pain and infection the result on other agents. Years, even if residual caries remains formocresol pulpotomy and indirect pulp capping materials have been used effectively many. The effects of direct pulp capping in young posterior permanent teeth and 10 years: a brief history,,... A variety of proteins are incorporated into the dentin matrix during dentinogenesis capping procedure primary. With 1.25 % sodium hypochlorite: 2-year results exposing the pulp cap can be performed various dentin forming! Antibacterial but may not be determined by clinical signs, symptoms or radiologic appearance be as effective at hemorrhage as. Jr, Holland R. response of mechanically exposed pulps of non-human primate teeth or can. With 1.25 % sodium hypochlorite shows increased pulpal inflammatory response but has advantages... Evaluation of adhesive pulp capping a histopathologic study of direct pulp-capping procedures performed dental... Accomplished, and the bleeding 1.1 what is pulp capping of carious exposures treatment! Undertaken as preparatory work for pulp capping review indirect pulp capping is going to have premolars ( subject teeth are free caries. Leak significantly and lose their antibacterial eugenol release rapidly IRM on bacteria in deep cavities with white MTA R.!
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