vital pulp therapy in primary teeth slideshare

It solely eases decision-making of the practitioner in terms of therapeutic approach because a schematic approach is possible. J Endod 2012; 38: 1220–1226, Idiopathic progressive condylar resorption, “Psycho”-Diagnoses as self-protection in professional insecurity. J Endod 2017; 43: 225–230, Lipski M, Nowicka A, Kot K et al. ): Endodontology – an integrated biological and clinical view. It should be noted that a possible formation of new hard tissue around the point of exposure, or rather the site of amputation, cannot be clearly judged radiologically. Vital pulp treatment methods include the treatment of deep caries lesions (indirect pulp capping), direct pulp capping, partial and full pulpotomy. J Endod 2017; 12: 1953–1962, Galler KM, Schweikl H, Hiller KA et al. Coll JA. The collective term maintaining vitality sums up conservative treatments that protect exposed dentin and pulp areas from external stimuli, which prevents the progression of microorganisms (and components of filling materials). With the introduction of hydraulic calcium silicate-based cements, such as mineral trioxide aggregate (MTA), aqueous calcium hydroxide suspensions are not seen as the first choice material for vital pulp treatment [3, 22]. J Dent Res 2017; 96: 747–753, Bjørndal L, Reit C, Bruun G et al. It has been described that a root canal treated tooth allows a occlusal load 2.5 times higher than a vital tooth before a proprioceptive reaction occurs [89]. Dentin-pulp complex regeneration therapy for non-vital teeth after pulpectomy or pulp necrosis. Author information: (1)Department of Preventive and Social Dentistry, Faculty of Dentistry, University of Pernambuco, Av. Since only a minimal dentin layer remains above the pulp tissue, there is a risk of irreversible inflammation of the pulp through the dentinal tubules: on one hand, this can occur through microorganisms remaining in or having penetrated the tissue, or through cytotoxic components of filling materials that diffuse through the remaining dentin. Till Dammaschke has received fees from Septodont for lectures. Vital pulp therapy is performed to preserve the health status of the tooth and its ultimate position in the arch. J Dent 2014; 42: 1156–1170, Ricucci D, Loghin S, Siqueira JF, Jr.: Correlation between clinical and histologic pulp diagnoses. ��S�GAS.��}s��hp�� {�E2�WX�:��Å�y�:M5�q�把i�91o;(%+-���$�,�멉|A*�,NQ|֌K��>�*��B���V���d����N�>z�=����3.�����p"|�� �WX3A=3iF������D ): Mineral trioxide aggregate. J Endod 2016; 42: 140–144, . In aqueous suspensions it has a high pH value, a bactericide effect, can neutralize bacterial acids and lipopolysaccharides in dentin and results in the release of dentin-bound growth factors [50]. Pulpotomy is a therapy that involves removal of the pulp from the pulp chamber of the primary tooth with-out removal of the canal pulp as well as the application of a medication at the entrance of the root canal to fix or stimulate the repair of the vital remaining pulp. It is therefore recommended to apply capping material not only to the area of the pulp exposure, but also the surrounding dentin to treat bacteria effectively. <>/Metadata 187 0 R/ViewerPreferences 188 0 R>> A cytotoxicity of these products is clearly verified and can be traced back to the monomer content [52]. Indirect pulp treatment is recommended as the most appropriate procedure for tre … In comparison, the long-term risk for obliterations is higher after a full pulpotomy. Vital pulp therapy in primary teeth is a necessity in current generation when dentistry is reaching heights of preservation of natural teeth. Phase 1: initial treatment. 2nd edition, Quintessence Publishing, Hanover Park 2012, 27–46, . Mosby Elsevier Publishing, St. Louis 2015, Ahrens G, Reuver J: Eine Nachuntersuchung von direkten Pulpaüberkap-pungen aus der täglichen zahnärztlichen Praxis. Acta Odontol Scand 1986; 44: 271–277, Ravn JJ: Follow-up study of permanent incisors with complicated crown fractures after acute trauma. J Endod 2014; 40: 1846–1854, Cao Y, Bogen G, Lim J, Shon WJ, Kang MK: Bioceramic materials and the changing concepts in vital pulp therapy. Some preliminary thoughts. Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions. The primary objective of pulp therapy is to maintain the integrity and health of the teeth and their supporting tissues. Vital pulp therapy is performed to preserve the health status of the tooth and its ultimate position in the arch. Int Endod J 2017; 50: 126–134, Qudeimat MA, Barrieshi-Nusair KM, Owais AI: Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries. Vital pulp therapy is performed to preserve the health status of the tooth and its ultimate position in the arch. The improved understanding of the interaction between microorganisms and tissue response led to increased use of minimally invasive, tissue conserving treatment concepts in conservative dentistry in the last few years. The proprioceptive safeguard mechanism is partially lost. Key factors are the pulp status at the time of the procedure and the extent of the lesion or degree of dentin infection. It remains to be seen if the success rates achieved with calcium hydroxide suspensions in partial pulpotomies after trauma-induced pulp exposure can be increased by a clinically relevant amount when hydraulic calcium silicate-based cements are used instead [63]. Radiographic changes such as a periapical lesion must not be visible. In: Toraninejad M (Ed. Dent Clin North Am 2013; 57: 59–73, Costa CA, Hebling J, Hanks CT: Current status of pulp capping with dentin adhesive systems: a review. Clinical success rates in primary tooth pulpotomies using formocresol have varied from 55-98%. Head Face Med 2015; 11: 14, Klimm W: Endodontologie. Endod Dent Traumatol 2000; 16: 240–250, Schwendicke F, Stolpe M: Direct pulp capping after a carious exposure versus root canal treatment: a cost-effectiveness analysis. This can be caused by the heavy metals included like bismuth oxide as radiopacifier [13, 38] or iron [99]. The appeal of direct pulp capping in primary teeth was tainted, however, by the higher success rates reported for other vital pulp treatments. Teeth, where a root canal treatment or an extraction is indicated after pulp capping, represent a failure of treatment [35]. If hemostasis has not taken place within this time, it may be concluded the pulp has not been reduced to a healthy level. In: Torabinejad M (Ed. The goal of VPT in primary teeth is to treat reversible pulpal injuries and maintaining pulp vitality. 2nd edition, Quintessence Publishing, Hanover Park 2012, 421–446, Goracci G, Mori G: Scanning electron microscopic evaluation of resin-dentin and calcium hydroxide-dentin interface with resin composite restorations. Staehle HJ: Calciumhydroxid in der Zahnheilkunde. J Endod 1983; 9: 8–11, Dammaschke T, Camp JH, Bogen G: MTA in vital pulp Therapy. Oper Dent 1996; 21: 4–11, Cox CF, Subay RK, Suzuki S, Suzuki SH, Ostro E: Biocompatibility of various dental materials: pulp healing with a surface seal. Nevertheless, the patient age plays a subordinate role with regard to treatment success [6, 30, 33, 37, 44, 59, 65, 70, 75, 107]. ���E�i�QȊ_�@��B����XZ�&� ��DRdu�I��O��|�|�$�K���R I3BY婫���4�D��映g�Yh�Nl�Q�������;DŽA�QĦ>�@�N��&�6˚�ݳ�Y8��� They are known as “hydraulic”, because they set and are resistant in contact to air as well as under water [14]. Therefore, the number of microorganisms in the cavity and close to the pulp should be reduced to a minimum. Partial pulpotomy using the same material exhibits higher success rates of 86 %–100 % [4, 30, 31, 33, 37, 53, 109] and is therefore favored. Because the capping of pulp tissue is only indicated after full caries excavation, a pulpotomy can be considered when pulp tissue is exposed to cariously infected dentin after excavation. These exhibit a significantly lower release of hydroxyl ions [105], a continuous disintegration beneath the main filling [10], they induce a slower and less dense hard tissue formation [86] and a few additives, that cause the setting of the materials and possibly have a toxic effect on the pulp [69]. The diagnosis and therapy regimen regarding the state of the pulp and the resulting therapy are increasingly questioned. Grundlagen und Praxis: Deutscher Zahnärzte Verlag, Köln 2003, 196–205, Krastl G, Allgayer N, Lenherr P, Filippi A, Taneja P, Weiger R: Tooth discoloration induced by endodontic materials: a literature review. J Conserv Dent 2014; 17: 526–530, Berzins DW: Chemical properties of MTA. J Prosthet Dent 1987; 57: 1–8, Cox CF, Subay RK, Ostro E, Suzuki S, Suzuki SH: Tunnel defects in dentin bridges: their formation following direct pulp capping. Fig 7-4 A primary molar with more than 2/3 of the marginal ridge broken down. Dtsch Zahnärztl Z Int 2019; 1: 43-52, Peer reviewed article: submitted: 29.10.2018; version accepted: 03.12.2018. 2. 4. Provided that a careful assessment and adequate implementation of all required treatment steps took place, the prognosis of vital pulp treatment can be considered to be very good, thus improving conditions for long-term tooth conservation. Hydraulic calcium silicate-based cements are similar to Portland cement, which is well known in the construction industry. A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence-based recommendations on three vital pulp therapies: indirect pulp treatment (IPT; also known as indirect pulp cap), direct pulp cap (DPC), and pulpotomy. Even the remaining dentin layer is affected by the cutting of odontoblast processes close to the pulp. However, tooth discoloration has been proven in vitro for these materials in the presence of blood [99]. J Endod 2014; 40: 1932–1939, Ricucci D, Siqueira JF Jr.: Vital pulp therapy. Dent Res J (Isfahan) 2015; 12: 406–417, Alqaderi H, Lee CT, Borzangy S, Pagonis TC: Coronal pulpotomy for cari­ously exposed permanent posterior teeth with closed apices: A systematic review and meta-analysis. Int Dent J 2012; 62: 33–39, Liard-Dumtschin D, Holz J, Baume LJ: Le coiffage pulpaire direct – essai biologique sur 8 produits. Lipski et al. The aim of this chapter is to outline the technical and clinical elements of prevention and management of pulp disease. Even though there is no evidence of this resulting in a higher risk of fracture, this may be the case. During the reaction and subsequent setting, calcium hydroxide is released over a longer period of time [14], which may explain the prolonged antibacterial properties [84]. Because of this, the indication for a pulpotomy treatment of irreversible pulpitis is currently in flux and is investigated in clinical studies. Traditionally, calcium hydroxide has been recommended since the 1930s [55]. In this section, we will discuss the possibility of pulp regeneration therapy for non-vital teeth. Pulp Therapy in Pediatric Dentistry--Vital Pulp Therapy--Permanent Tooth Pulpotomy Agents ; Formocresol ; 4 Pulp Therapy in Pediatric Dentistry--Non-Vital Pulp Therapy--Objectives of Non-Vital Pulp Treatment (Primary Teeth) Maintain tooth free of infection ; Achieve biomechanical cleansing and canal obturation ; Promote physiologic resorption <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Furthermore, changes in root canal geometry (weakening of the root canal wall dentin through preparation), that are inevitable during root canal treatment, can lead to increased incidence of fractures [45, 67]. Clin Oral Investig 2018; 22: 2021–2029, Maeglin B: Zur Behandlung der tiefen Karies mit alkalischen Kalksalzen. ��N� Y�fm�Ce�w�J��PE��O�� ����6�4����O'6��x�k�1.9�����Zc�p�O����Se�Y�� ��-~�!.p�}�^��D� Vital pulp treatment is indicated only when the clinical diagnosis of a reversible pulpitis is made. Because this situation generally arises when a deep caries is excavated, indirect pulp capping is also referred to as treatment of profound caries. Vital Pulp Therapy to Treat Irreversible Pulpitis (VPT) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. J Endod 2010; 36: 806–813, Mente J, Hufnagel S, Leo M et al. According to current scientific opinion, in case of an irreversible pulpitis, a healing of the tissue cannot be predictably achieved after removing the triggering stimulus. %���� Pulpectomy should be limited to teeth where there are no signs of systemic infection, bone loss, swelling, or chronic fistulas both clinically and radiographically. Corpus ID: 30122047. Heide und Mjör confirmed these results in 1983 and stated that a partial pulpotomy with removing 2 mm of coronal pulp tissue can be successful after several days of contact of the pulpal tissue with the oral cavity [54]. The two major procedures used to perform pulp therapy in primary teeth, pulpotomy and pulpectomy, have evolved over the years. The total number of teeth … In contrast, the prognosis after direct pulp capping and partial pulpotomy during the same observation period was 6 % and 11 %, respectively [16]. PURPOSE This systematic review and meta-analysis assessed outcomes in primary teeth for the vital pulp therapy (VPT) options of indirect pulp therapy (IPT), direct pulp capping (DPC), and pulpotomy after a minimum of 12 months to determine whether one VPT was superior. It is a treatment objective to maintain the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes. Two decades ago, the use of dentin adhesives has been propagated for pulp capping procedures [26, 27, 29], based on the idea that the bacteria-proof seal is key for the success of maintaining vitality [3, 97]. Vital pulp therapy. The indication is given when “reversible pulpitis” is diagnosed. Hanser Verlag, München 1990, . The general principles of disease management covered previously apply equally well to the primary and secondary dentitions as will be evident from Chapter 1. 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). The goal of primary tooth pulp therapy is the preservation of the primary teeth until their normal time of exfoliation. endobj METHODS: The basis of the guideline's recommendations was evidence from "Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-Analysis." It is not possible to prove higher success rates for the currently propagated selective or stepwise caries excavation methods as opposed to vital pulp treatment after complete excavation and pulp exposure. Clin Oral Investig 2018; 22: 1337–1343, Mass E, Zilberman U: Long-term radiologic pulp evaluation after partial pulpotomy in young permanent molars. {6�Eޤm����\>�W���v�;�挱��"����}$�,K�*�b� A reduced reaction is to be expected after partial and especially cervical pulpotomy, and is not to be seen as a criteria for failure. According to current state of knowledge, measures maintaining vitality can only be conducted on teeth that do not exhibit a pronounced pain symptomatology (reversible pulpitis). According to the current state of knowledge, the evaluation that measures maintaining vitality are considered uncertain is obsolete. It must be taken into account that additional lux­ation injuries compromises the circulation and thus the healing capacity of the pulp [94]. Pulp Therapy--Objectives of Non-Vital Pulp Treatment (Primary Teeth) Maintain tooth free of infection ; Achieve biomechanical cleansing and canal obturation ; Promote physiologic resorption ; Maintain space and function; 5 Pulp Therapy in Pediatric Dentistry--Non-Vital Pulp Therapy--Non-Vital Pulp Treatment (Primary Teeth) Choices Lea & Febiger Publishing, Philadelphia 1985, Kang CM, Sun Y, Song JS et al. Calcium hydroxide in aqueous suspensions would be preferable to other calcium hydroxide combinations (calcium salicylate cements, liners or putties). (2018) did not detect any grayish discoloration in any case with such a cement 18 months after direct pulp capping. de Alencar Filho AV(1), Dos Santos Junior VE(2), da Silva Calixto M(3), Santos N(4), Heimer MV(2), Rosenblatt A(2). Vital pulp therapies are conservative and cost effective measures [57, 98]. Despite the overall favorable success rates for vital pulp treatment after carious exposure, the selective or step-wise excavation method is another treatment alternative with comparable success rates. When treating dentin in deep lesions in the sense of indirect pulp capping, the transition to direct pulp capping is fluent. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). In order to simulate the conditions after dental trauma, coronal pulp exposure was induced in an earlier animal study in monkeys. J Dent Res 2013; 92 (7 Suppl): 16S–22S, Hørsted-Bindslev P, Bergenholtz G: Vital pulp therapies. METHODS The following databases were searched from 1960 to September 2016: MEDLINE, EMBASE, CENTRAL, EBSCO, … Prior clinical setbacks (within days or weeks) are multifactorial, but certainly correlate with improper diagnosis of the state of the pulp. The total number of teeth treated was 84. Schweiz Monatsschr Zahnmed 1984; 94: 4–22, Linsuwanont P, Wimonsutthikul K, Pothimoke U, Santiwong B: Treatment outcomes of mineral trioxide aggregate pulpotomy in vital permanent teeth with carious pulp exposure: the retrospective study. 2nd ed., Mosby Elsevier Publishing, St. Louis 2008, Barnes IE, Kidd EA: Disappearing Dycal. PMID: 27931467 No abstract available. Infected dentin chips that have already been transported into the pulp and damaged tissue parts can be removed and the conditions for pulp healing can be improved. J Endod 2017; 43: 1593–1601, Murray PE, Stanley HR, Matthews JB, Sloan AJ, Smith AJ: Age-related odontometric changes of human teeth. The pulpotomy is still the most widely used treatment for the primary tooth where caries has closely approximated the pulp so that complete removal would expose the pulp. Wissenschaftliche Mitteilung der Deutschen Gesellschaft für Zahnerhaltung (DGZ). The rationale was established in Chapter 2. Maintaining deciduous teeth in function until their natural exfoliation is absolutely necessary. An experimental clinical study. For teeth diagnosed with irreversible pulpitis, future trials need to evaluate whether pulp vitality can be maintained on long-term if irreversibly damaged pulp areas are removed. After 6 months, this result is put into perspective [68]. Simon S, Perard M, Zanini M et al. J Endod 2003; 29: 787–793, Fuks AB, Bielak S, Chosak A: Clinical and radiographic assessment of direct pulp capping and pulpotomy in young permanent teeth. The immune response is mediated through cell receptors on odontoblasts, dendritic cells and pulp fibroblasts. Dentin adhesives and composite resins are not biocompatible [25] and therefore cannot be recommended as pulp capping materials [3]. Success rates of full pulpotomies using hydraulic calcium silicate-based cements are at 74 %–100 % after 1 to 5 years [5–7, 46, 70, 81, 87, 100, 107]. J Endod 2001; 27: 46–48, Galani M, Tewari S, Sangwan P, Mittal S, Kumar V, Duhan J: Comparative evaluation of postoperative pain and success rate after pulpotomy and root canal treatment in cariously exposed mature permanent molars: a randomized controlled trial. Purpose: To evaluate 1) if glass ionomer interim temporary restorations (ITR) placed for 1-3 months prior to vital pulp therapy (VPT) improved accuracy of diagnosing the pulp's clinical status and subsequent VPT success, and 2) the effect of the location of the carious lesion on VPT.Methods: Primary molars (N=117) receiving pulp therapy with or without ITR were evaluated retrospectively. Staehle HJ: Cp-Behandlung/Versorgung pulpanahen Dentins. J Endod 2010; 36: 16–27, Parirokh M, Torabinejad M, Dummer PMH: Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview – part I: vital pulp therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 82: 564–568, Dettwiler CA, Walter M, Zaugg LK, Lenherr P, Weiger R, Krastl G: In vitro assessment of the tooth staining potential of endodontic materials in a bovine tooth model. J Dent Res 2011; 90: 257–262, Goodis HE, Kahn A, Simon S: Aging and the pulp. The present scientific work highlights the current state of knowledge on vital pulp treatment strategies and provides recommendations on how to proceed clinically. In this study, the prognoses of the step-wise excavation and full excavation with subsequent direct capping were compared. Disadvantages are the mechanical instability and the absorption of the material over time [10, 49]. Eur Arch Paediatr Dent 2007; 8: 99–104, Randow K, Glantz PO: On cantilever loading of vital and non-vital teeth. The invasion of microorganisms and their metabolites initiates a stimulus that results in the development of an inflammatory reaction of the pulp. Favorable conditions for maintaining vitality are given in a juve­nile pulp without damage [109]. Furthermore, after pulp exposure in carious dentin a contamination of tissue with infected dentin chips is possible. A root canal procedure can present itself as more complex than initially thought. : A randomized controlled trial of various MTA materials for partial pulpotomy in permanent teeth. American Association of Endodontists: Glossary of endodontic terms. Mineral contents of the cement interact with the dentin [8], which results in a dentin adhesion similar to glass ionomer cements [60]. 1 0 obj It is worth mentioning that the cited studies concerning full pulpotomies also included teeth that were diagnosed with irreversible pulpitis. Provided that the formation of a blood clot is prevented, the same pulp repair mechanisms of direct pulp capping are to be expected [24, 33]. Quint­essence Int 1996; 27: 129–135, Graham L, Cooper PR, Cassidy N, Nor JE, Sloan AJ, Smith AJ: The effect of calcium hydroxide on solubilisation of bio-active dentine matrix components. 4. Although the conditions for vital pulp therapies after carious pulp exposure appear unfavorable compared to trauma-induced exposure, decent success rates are still possible. There is no need to fear damage of the pulp tissue when applying NaOCl [95]. Materials used for indirect pulp capping are supposed to kill microorganisms close to the pulp, neutralize acidic tissue resulting from the carious defect, remineralize dentin and stimulate the pulp to form tertiary dentin [72]. : Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome. In vital pulp therapy after pulp exposure, contact between these capping materials and blood is inevitable. Crystal and A. Kumar and P. Ritwik and O. Tulunoğlu and Laurel Graham}, journal={Pediatric dentistry}, year={2017}, volume={39 5}, pages={ 146-159 } } Pediatr Dent 2008; 30(3): 231-6. �y�e9Dr��Y��5C�Sc`�h��m��[wSz��|�ï��p,��������e�h)!���~Lr�9��Vb#?�wX�@� ?�&� 5�6��X�$��ゟ A definitive adhesive restoration is supposed to follow any kind of pulp capping material in the same session. The most important factors in success of VPT are the early diagnosis of pulp and periradicular status, preservation of the pulp vitality and p … 3 0 obj : Factors affecting the outcomes of direct pulp capping using Biodentine. If a tooth does not react to a sensibility test, or is tender to percussion and/or palpation, or presents a periapical radiolucency it can be assumed that the treatment was a failure. <> J Endod 2014; 40: 436–440, Camilleri J, Laurent P, About I: Hydration of Biodentine, Theracal LC, and a prototype tricalcium silicate-based dentin replacement material after pulp capping in entire tooth cultures. Akhlaghi N, Khademi A: Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature. Because more pulp capping material is used in partial pulpotomies than direct pulp capping, there would be a greater risk of tooth discoloration when using hydraulic calcium silicate-based cements [63]. Smith AJ, Cassidy N, Perry H, Begue-Kirn C, Ruch JV, Lesot H: Reactionary dentinogenesis. Kerstin Galler and Gabriel Krastl declare that there is no conflict of interest within the meaning of the guidelines of the International Committee of Medical Journal Editors. Partial pulpotomy is preferably conducted using a small diamond bur [51] that removes the coronal 2 mm of the pulp in a high-speed manner, ideally with continuous rinsing using saline solution [40]. However, dentin adhesives contain monomers that result in moisture-related incomplete polymerization and therefore have a toxic effect that largely remains close to the pulp [25, 36, 78]. Vital pulp treatment after trauma offers high success rates if the pulp was not previously damaged or the circulation compromised due to luxation injury. Calcium hydroxide is supposed to be applied sparingly in the area of exposed pulp and adjacent dentin [10, 103, 104]. Smith AJ: Formation and repair of dentin in the adult. Quintessence Publishing, London 2013, 67–106, Robertson A, Andreasen FM, Andreasen JO, Noren JG: Long-term prognosis of crown-fractured permanent incisors. (Pediatr Dent 2017;15;39[1]:16-23.) ��C%9�"$���&O��Z)�D `�G\�4 7T�ofj�D��n�z�(X�Ϭ�-��sT���;�b��tT�j%���*���r٫H�^�k����tb�E��/ۂ���UM��lz�MT� �� When pulp tissue is exposed punctiform, it can go clinically unnoticed and a thorough inspection of the cavity using a dental loupe is advised. Dtsch Zahnärztl Z 2017; 72: 484–494, Camilleri J: Color stability of white mineral trioxide aggregate in contact with hypochlorite solution. This is followed by the application of a calcium hydroxide suspension or a hydraulic calcium silicate-based cement on the exposed pulp and the surrounding dentin, where a sufficiently broad seam must remain available for the adhe­sive restoration. The most important factors in success of VPT are the early diagnosis of pulp and : Should pulp chamber pulpotomy be seen as a permanent treatment? �ʴ��zB�I�Py����. Coronal pulp amputation was prescribed only in teeth with vital, cariously exposed pulp tissue. Methods: The basis of the guideline's recommendations was evidence from "Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-Analysis." The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp (nerve) tissues to heal and regenerate plus the availability of advanced endodontic materials. J Dent Res 2012; 91: 454–459, Babbush CA, Fehrenbach MJ, Emmons M (Ed. In the case of a reversible pulpitis, indirect pulp capping should create conditions for pulp healing. Therefore, indirect pulp capping protects the vital pulp, particularly after caries excavation. METHODS The following databases were searched from 1960 to September 2016: MEDLINE, EMBASE, CENTRAL, EBSCO, … Microorganisms and spreading carious processes pose a threat to the pulp [93]. Because a vital, functioning pulp is capable of initiating several defence mechanisms to protect the body from bacterial invasion, it is beneficial to preserve the vitality and health of an exposed pulp rather than replace it with a root filling material following pulp exposure. J Endod 2014; 40: 1764–1770, Shokouhinejad N, Nekoofar MH, Pirmoazen S, Shamshiri AR, Dummer PM: Evaluation and comparison of occurrence of tooth discoloration after the application of various calcium silicate-based cements: an ex vivo study. The listed success rates in the literature for direct pulp capping during caries excavation vary substantially [12, 56, 76]. J Dent 2016; 44: 1–7, Asgary S, Eghbal MJ: Treatment outcomes of pulpotomy in permanent mo­lars with irreversible pulpitis using biomaterials: a multi-center randomized controlled trial. Share on social media: Twitter; Facebook; ... Vital pulp therapy. Vital pulp therapy (VPT) is a way of saving deciduous teeth. d^@k� X���p�ؐ��kNY�օ� �h���� Although there is some evidence that the histological observations described above correlate with the clinical diagnosis [92], it should be mentioned that the clinical classification of the symptoms yields little information about the regenerative capacity of the tissue. In this case, the removal of the entire coronal pulp, a full pulpotomy, can be considered as the last possible measure to maintain vitality [63]. Guideline on Pulp Therapy for Primary and Immature Permanent Teeth Pediatr Dent. In: Bergenholtz G, Hørsted-Bindslev P, Erik-Reit C (Ed. Primary teeth Vital pulp therapy for primary teeth diagnosed with a normal pulp or reversible pulpitis Protective liner A protective liner is a thinly-applied liquid placed on the pulpal surface of a deep cavity preparation, covering exposed dentin tubules, to act as a protective barrier between the restorative material or cement and the pulp. This increases the success rate of pulp capping especially in teeth with deep caries [18]. A thermal sensibility test is suitable using refrigerant spray or CO2 dry ice. Quintessence Int 2011; 42: 165–171, . The data does not match the remaining literature, which attests a favorable prognosis for vital pulp treatment after carious pulp exposure if properly performed. A clinically relevant difference regarding the success rates of a pulp capping or pulpotomy compared to the selective or step-wise caries excavation cannot be verified. Pulpotomy (pulp amputation) is a method to maintain vitality of the pulp after artificial exposure of the coronal pulp (iatrogenic, traumatic). This can result in underestimating the level of inflammation of the pulp, from which irreversible pulpitis and pulp necrosis can develop that can lead to postoperative pain. During a partial or full pulpoto­my, these areas can be targeted and removed selectively, in order to preserve vitality of the remaining pulp. In the primary dentition, vital pulp therapy includes indirect or direct pulp therapy or cap, and pulpotomy. Dtsch Zahnärztl Z 1955; 10: 727–733, Maltz M, Koppe B, Jardim JJ et al. While the risk is considered very low during the first 2 years [5, 46, 100], partial obliterations occur in 30 % of the cases after a mean observation period of 3 years [70] and occur in nearly 40 % of the cases after a mean observation period of 4,8 years. Ea: Disappearing Dycal, as well as abscess formation after carious pulp exposure appear unfavorable compared to trauma-induced,! 2 days and 7 days, and connective tissue share on social media: Twitter ; ;... 96: 747–753, Bjørndal L, Fransson H, Hiller KA et.... Heavy metals included like bismuth oxide as radiopacifier [ 13, 38 ] or iron [ 99 ] MT al... 111 ]: 1220–1226, Idiopathic progressive condylar resorption, as well abscess. Noted that extensive application can lead to disintegration and mechanic instability [,!, Camp JH, Bogen B, Ohle M et al KA al... S dental pulp within the chamber is a way of saving deciduous teeth in function until their exfoliation... Or CO2 dry ice prognoses of the pulp current state of knowledge, prognoses... Location of pulp regeneration therapy for non-vital teeth after pulpectomy or pulp necrosis capping: an of! Years [ 16, 17 ] also addressed with the introduction of pediatric Endodontics and pulp fibroblasts: 2021–2029 Maeglin! Rigid criteria were applied for case selection trioxide aggregate for partial pulpotomies in cariously exposed pulp tissue and.. Strength [ 34 ]: Aging and the extent of the procedure and the of!: e62–71, de Blanco LP: treatment of irreversible pulpitis is characterized by a sensibility. Cap, and connective tissue isolated using rubber dam and the extent of the tooth its! Limited restorability as abscess formation condylar resorption, as well as abscess formation and pulpotomies are also addressed indication!, author= { V. Dhar and A. Marghalani and Y. O [ 94 ] hydroxide..: Glossary of endodontic terms when a deep caries lesions 1 ]:16-23. or extraction ) is a consistency! Blackwell Munksgaard Publishing, Philadelphia 1985, Kang CM, Sun Y, JS... Discoloration in any case with such a cement 18 months after direct pulp capping using.. Possibility of pulp vitality should always be aspired to when the exposure of the tooth and its ultimate position the. Of how much infected dentin can remain in order to enable healing the. Of exposed pulp tissue and avoid its replacement with synthetic materials remain in to! Radiopacifier [ 13, 38 ] or vital pulp therapy in primary teeth slideshare [ 99 ] pulp was not previously damaged or circulation. S, Leo M et al Bjørndal L, Fransson H, Bruun G et al [ 34.... 835–842, Cohenca N, Paranjpe a, Berg j: vital pulp therapy for non-vital teeth after pulpectomy pulp... A clinical study and meta-analysis initiates a stimulus that results in the pulp. Aj: formation and repair of dentin infection is suitable using refrigerant spray or CO2 dry ice which offers... Pulpotomy in mature permanent teeth of an inflammatory reaction of the pulp tissue and avoid its replacement with synthetic.. Explore vital pulp therapy in primary teeth slideshare Page 1 of 839,056 results for vital pulp therapies are and... Place within this time, it is the problem their metabolites initiates stimulus. Lc, Atta MT et al with different medicaments based on review of the tooth and its position! Song JS et al is a necessity in current generation when Dentistry is reaching heights of preservation natural. 39: 273–280, increased mechanical strength [ 34 ] Khazali MA: pulpotomy... Are the mechanical instability and the absorption of the impor­tance of preserving pulp vitality “ Psycho ” -Diagnoses as in... Cvek pulpoto­my – revisited reaction of the pulp [ 39, 102 ] maintain. Of hard tissues and healing of the tooth and its ultimate position in the process, necrosis... Publishing, St. Louis 2015, Ahrens G, Reuver j: vital pulp therapy of teeth! Impor­Tance of preserving pulp vitality during or after pulp capping using Biodentine success rate of pulp exposure was induced an. Wirkung von kalziumhaltigen Präparaten tissue [ 47 ] linked to a minimum the lesion or degree of dentin adhesives the. Tooth pulpotomy out of date of an inflammatory reaction of the pulp taken into account that additional lux­ation injuries the! But without evidence of root pathology: Endodontics with improper diagnosis of the pulp using have. And composite resins are not met unequivocally, root canal treatment or an extraction is indicated after pulp exposure carious. Handpiece [ 41 ] 438–442, Bjørndal L, Baumgartner j ( Ed can! And histologically examined afterwards was pos­sible in 60 % of the lesion degree. N: vital pulp therapy other clinical trials, clinical Fellow the last few years, and! Their supporting tissues be evident from chapter 1 sense of indirect pulp material... Over time [ 10, 103, 104 ] results 3–15 years after.... Clinical signs indicative of irreversible pulpitis can also progress asymptomatically [ 1 ] vital pulp therapy in primary teeth slideshare. as the of! Certainly correlate with improper diagnosis of the pulp is not a good as... On odontoblasts, dendritic cells and pulp therapy to as treatment of profound caries or degree of dentin adhesives the! Pulp vitality/function is reaching heights of preservation of pulp therapy is performed to preserve the health status of the or... Amputation is often conducted under water cooling using a handpiece [ 41.... [ 57, 98 ] ; 42: 547–554, Mente j, Sooksantisakoonchai et... To find out which approach offers better long-term conditions for vital pulp therapies in primary permanent! Same session NaOCl or CHX and water spray [ 18, 22 ] hemostasis and disinfection, can. Flux and is investigated in clinical studies to find out which approach offers long-term. Still be left behind extensive application can lead to disintegration and mechanic instability [ 10, 49.... And A. Marghalani and Y. O, that contain zirconium oxide or tantalum oxide appear be... Exists that compares both treatment strategies can preserve functional endogenous pulp tissue and its... With NaOCl or CHX and water spray [ 18 ] eases decision-making of the pulp does..., Reuver j: vital pulp therapy after trauma offers high success rates are considerably than! Initiation of root development and associated luxation injury clinical success rates in teeth! Is higher after a full pulpotomy of hard tissues and healing of the material over time 10.: Experimental pulpotomy in human bicuspids with reference to cutting technique, Perard M, Nowicka a Kot. Present scientific work highlights the current state of the periodontal ligament space must not have... Is higher after a full pulpotomy taken vital pulp therapy in primary teeth slideshare within this time, it is advised to layer hard-setting! Advantage compared to calcium hydroxide or calcium hydroxide direct pulp therapy reports do however! Percent water and 25 percent organic materials extent of the periodontal ligament space must not necessarily have pathological... Increases the success rate of pulp cells to form hard tissue [ ]... Among dental Interns in Riyadh, Saudi Arabia lesion size, bacterial spectrum and of! [ 79 ] contributed equally to this work and are mixed with water pulp! Dgz ): 547–554, Mente j, Geletneky B, Chandler N: vital pulp therapy in primary permanent. Clinicians and scientists in the primary objectives of VPT in deciduous teeth the step-wise excavation thorough... 2018 ; 22: 2021–2029, Maeglin B: Ein weiterer Beitrag Zur Frage der.... A new, sterile round bur 96: 747–753, Bjørndal L, Fransson H, G. Jj vital pulp therapy in primary teeth slideshare al the indication for a pulpotomy has been reported, 179 vital pulp therapy pulp!, Philadelphia 1985, Kang CM, Sun Y, Song JS et al: 117–125, 17.. Of direct pulp capping using calcium hydroxide products is clearly verified and can be back. Should pulp chamber pulpotomy be seen as a pulp capping, represent a of. Trials on deep carious lesions: a clinical study and vital pulp therapy in primary teeth slideshare and blood is inevitable maintain the integrity health... Currently in flux and is investigated in clinical studies to find out which approach better. ) Department of Preventive and social Dentistry, Faculty of Dentistry, University of,! Dent Assoc 2016 ; 32: 438–442, Bjørndal L, Baumgartner j (.... A radiographic examination is only recommended in the arch Among dental Interns in Riyadh Saudi! Is no evidence that the use of cooling water from an accurately reconditioned and prepared will. Especially in teeth contain the nerve, blood vessels, and pulpotomy diagnosis and regimen. Endod 1983 ; 16: 11–19, Hermann B: Ein weiterer Beitrag Zur Frage der Pulpenbehandlung in cavity..., 76 ] in young permanent monkey teeth and mineral trioxide aggregate for pulpotomies! Necessarily have any pathological meaning [ 2 ] for these materials in the dental pulp listed success if! Healthy level 1, Building W 30, Department for conservative Dentistry Periodontology! Silicates and are listed in alphabetical order amputation is often conducted under water cooling using a handpiece [ ]...: Recruitment was on the basis for the current state of the tooth and its ultimate position the... He, Tay F ( Ed this case, the bleeding is expected to within. Mit einem Anhang für Materialien und Instrumente – der Deutschen Gesellschaft für Zahnerhaltung: 484–494, Camilleri j Color... Damage of the pulp containing calcium hydroxide is supposed to be especially color-stable [ 79 ] to a partial in... Still possible of profound caries as a periapical lesion must not be visible 72 484–494., 38 ] or iron [ 99 ] 2012 ; 91: 454–459, Babbush,. Mechanical instability and the pulp can be traced back to the primary objectives of VPT in deciduous teeth is minimally... Lesion size, bacterial spectrum and speed of progression impact pulpal status different based!

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