types of vital pulp therapy

These procedures are performed routinely in primary and permanent teeth. Resin monomers, such as 2-hydroxyethyl methacrylate (HEMA) and triethyleneglycol dimethacrylate (TEGDMA), are shown to influence the differentiation of human pulp cells into odontoblasts. Methods: In this case, after removing the tooth decay, a therapeutic and biocompatible material that prevents infection and heals the pulp is placed over the affected area and then the tooth is restored with a normal filling material. MTA was clinically easier to use as a direct pulp capping agent and resulted in less pulpal inflammation and more predictable hard tissue barrier formation than Dycal. Another study showed that MTA causes neutrophils to be recruited to the site of injury, which is important in the process of inflammation. Remove soft leathery caries affected tooth structure until dentin consistency changes or pulp exposure is imminent. Treatment is performed in the appropriate fashion with strict adherence to the proper technique. Certain treatments are also used in deciduous teeth, please see 'Endodontic role in Paediatrics' lesson in the Paediatrics topic for more information. Although TGF-β1 increases the expression and secretion of NGF in human pulp cells, NGF induces mineralization and increases the expression of DSPP and DMP-1. The pulp contains numerous cells types, which include odontoblasts, fibroblasts, macrophages, dendritic cells, lymphocytes, mast cells, and undifferentiated mesenchymal stem cells. The nature and specificity of the mechanisms by which the amputated dentin-pulp interface is therapeutically healed determine the properties of the barrier at this site and play a critical role in the outcome of vital pulp therapy. The best sealing agents seem to be MTA or glass ionomer. Certain treatments are also used in deciduous teeth, please see 'Endodontic role in Paediatrics' lesson in the Paediatrics topic for more information. Maintaining deciduous teeth in function until their natural exfoliation is absolutely necessary. The radicular pulp chamber may be filled with a resorbable paste of either zinc oxide–eugenol or, preferably, calcium hydroxide with iodoform within the paste. Other studies have shown that MTA induced cells to secrete IL-8 and IL-1β. Conversely, if the pulp is vital, there should be few or no bacteria present in the root pulp space and thus the disease (apical periodontitis) should not be present. The term, maturogenesis , was recently introduced by Weisleder and Benitez and defined as physiologic root development not restricted to the apical segment. According to the American Association of Endodontists glossary, partial pulpotomy is defined as the removal of a small portion of the vital coronal pulp as a means of preserving the remaining coronal and radicular pulp tissues to encourage continued physiologic development and formation of the root end. This review is divided into 2 parts: the first aims to illustrate the basic biology of the pulp and the effects on the pulp due to various procedures; the second focuses on the clinical aspects of treatment and the use of various dental materials during different vital pulp therapy procedures performed in the primary and permanent teeth. Cvek and colleagues investigated the depth of inflammatory reactions of adult monkey pulps exposed by fracture or cavity prep at different time intervals and found that inflammation extended 1.5 mm to 2 mm into the pulp at the 48-hour mark and only 0.8 mm to 2.2 mm after 1 week. Clinical and radiographic follow-up demonstrated a vital pulp and physiologic root development in comparison with the contralateral tooth. Once a tooth is affected by caries, some form of intervention is necessary to prevent further inflammation and ultimately necrosis. After placement of a layer of resin-modified glass ionomer as liner over carious dentin, the teeth were restored. A good rule of thumb limits the diameter of the exposure site to less than 1.5 mm. If your child’s pulp root remains unaffected by infection or damage, the dentist will likely choose pulpotomy. 2020 Jun 15;10(3):300-308. doi: 10.4103/jispcd.JISPCD_69_19. Epub 2020 Nov 5. Vital pulp therapy is a procedure designed to preserve the vitality of the dental pulp. One-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter, randomized, non-inferiority clinical trial. Pulp tissue can be affected as the result of deep caries lesions and accidental trauma or by preparation techniques used during the restoration of teeth affected by carious lesions (Mattos et al. When decay or tooth preparation extends into the pulp chamber of the primary incisor or canine, first, an assessment of the vitality of the pulp must be made. 2018 Nov 21;3(3):153-159. doi: 10.14744/eej.2018.07269.  |  Cell poor zone: also called the cell free zone of Weil because it is relatively free of cells. 8.18 Upper molar with occlusal pulp exposure: note the clear color of predentin around the pulp exposure. This provides the pulp a low-compliance environment and receives its blood supply from the blood vessels that traverse through the apical foramen. From a clinical perspective, the control of the hemorrhage is critical to determine the level of pulp inflammation. The procedure is also known as Cvek pulpotomy. Pre- and intraoperative data including vitality test results, pulpal/periapical status, and exposure type/location were recorded. Cover the capping material with glass ionomer and restore permanently. Accidental pulp exposure during inlay cavity preparation with mechanical instruments in an upper molar; the pulp appears vital, with no bleeding Fig. Furthermore, GDNF may act as a cell survival factor and mitogen during tooth injury and repair. Therefore, MTA or equivalent products should be the material of choice for direct pulp capping procedures instead of hard-setting calcium hydroxide cements. In a retrospective study, Gruythuysen and colleagues examined clinically and radiographically the 3-year survival of teeth treated with indirect pulp therapy performed between 2000 and 2004. The mature pulp demonstrates 4 morphologic zones, including. BA has also been shown have antifungal and antibacterial activity. 4. The opponents of calcium hydroxide for direct pulp capping procedures cite 3 major causes of failure: The porosity of the dentinal bridge that is produced, Calcium hydroxide adhering poorly to dentin, Inability to provide a long-term seal against microleakage. Pulp proper: the central mass of the pulp, which consists of larger blood vessels and nerves. Conclusions: Failure was defined as the presence of either a clinical symptom (pain, swelling, or fistula) or radiologic abnormality at recall. 2 J Clin Med. Int J Paediatr Dent.  |  According to the American Association of Endodontists glossary, apexogenesis is defined as a vital pulp therapy procedure performed to encourage continued physiologic development and formation of the root end. Using a sterile round bur and/or a sharp spoon, amputate the coronal pulp. Friedlander LT, Coates D, Seymour G, Cullinan M, Rich AM. No history of spontaneous, lingering, or severe pain, No extensive restoration or full crown requirements, History of spontaneous pain or signs of irreversible pulpitis, Clinical or radiographic evidence of pulpal or periradicular pathosis, Tooth requires extensive restoration or full crown. Would you like email updates of new search results? Place calcium hydroxide, MTAs, or BA directly over the exposure site; do not force it into the pulp. Teeth were extracted and then histologically evaluated at 1 week and 2, 3, 4, and 6 months. MTA has demonstrated significantly greater frequency of dentin bridge formation, thicker and less porous dentin, and less pulp inflammation compared with calcium hydroxide. A better insight into mechanisms of toxicity of dental materials is important for understanding the potential of these materials to cause adverse health effects in a clinical setting. However, pulpotomy and pulpectomy are the most popular procedures. The odontoblasts have odontoblastic processes that extend into the dentinal tubules and occupy most of the space of the dentinal tubules. Both involve the process of pulp capping, which is a restorative process your dentist will partake in to prevent your dental pulp from dying after open exposure. No layer of necrosis was seen in the pulp when MTA was used for pulp capping. The entire coronal pulp is removed circumferentially with a large round bur, pulling coronally to adequately deroof the pulp chamber and to avoid leaving any ledges or pulp tissue therein. Other studies had given a lower prognosis to indirect pulp therapy, however, especially in permanent teeth. This material has drawn much interest due to its many applications. 2002 Apr;28(1):29-37. doi: 10.1111/j.1747-4477.2002.tb00364.x. Please enable it to take advantage of the complete set of features! During your child’s pulp therapy procedure, our dentist will first visually examine the affected area then take dental X-rays. Disinfect the pulp wound and cavity with 2% chlorhexidine gluconate. MTA, BA, or calcium hydroxide is laid over the pulp stump to a thickness of 2–3 mm. Indirect pulp capping has been defined as a procedure in which a small amount of carious dentin is retained in deep areas of cavity preparation to avoid an exposure of the pulp. Results: Vital pulp therapy is effective as long as proper assessment of the situation is made. Patel and Cohenca also presented a case that demonstrates the use of MTA as a direct pulp capping material for the purpose of continued maturogenesis of the root. 2020 Mar-Apr;23(2):121-125. doi: 10.4103/JCD.JCD_179_19. The literature and standard of care is to use one of these agents (not discussed in this article because of the length limitations); however, there seems to be a directional change toward sealing the orifices completely as the primary objective. Pain was measured using a numeric rating scale before treatment initiation up to 1 week postoperatively. Studies have previously shown that HEMA induces apoptosis in different cell types and also in dental pulp stem cells and in odontoblast-like cells. Vital pulp therapy for children is simple. Introduction: 2020 Jun 30;2020:5853412. doi: 10.1155/2020/5853412. BA is white nanoparticle ceramic cement with many different applications, like MTA. Calcium hydroxide has been considered the gold standard for pulp capping; however, previous research has shown that it is not ideally suited for this procedure. At the cellular level, MTA has also been shown to induce the recruitment and proliferation of undifferentiated cells to form a dentinal bridge, while reducing inflammation compared with calcium hydroxide. This randomized clinical trial aimed to evaluate and compare clinical and radiographic success of 4 VPTs (indirect pulp capping [IPC], direct pulp capping [DPC], miniature pulpotomy [MP], and full pulpotomy [FP]) using calcium-enriched mixture cement for deep caries management of mature permanent molars including teeth with clinical signs of irreversible pulpitis and the presence of apical … Vital pulp therapy (VPT) is a biological approach to minimally invasive endodontics. This article reviews the rudiments of pulp therapy for children. Determining whether it’s best to perform vital pulp therapy or orthograde root canal therapy for an individual tooth is a judgment call. Indications. The ultimate goal for endodontists or dentists is the regeneration of dental pulp for non-vital teeth after pulpectomy or pulp necrosis. Hence, the second part of this review deals with the clinical aspects of treatment of the primary and permanent dentition. Another pulp capping material recently developed is mineral trioxide aggregate (MTA). In a different randomized clinical study, Nair and colleagues investigated the pulpal response to direct pulp capping in healthy human teeth with MTA versus calcium hydroxide cement (Dycal) as control. The continued deposition of dentin occurs throughout the length of the root, providing greater strength and resistance to fracture. IL-1β has been shown to induce the synthesis of collagen, resulting in a more organized response of the pulp and assisting in the healing process. Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial. In 1987, Fuks and colleagues performed partial pulpotomy on 63 teeth with different types and severity of traumatic injuries and demonstrated a 94% success rate. Vital pulp therapy--a review. MTA can be considered as an effective material for vital pulp therapy, with the goal of maturogenesis. Ultimately, the goal of treating the exposed pulp with an appropriate pulp capping material is to promote the dentinogenic potential of the pulpal cells. Types: Indirect pulp cap. Nair and colleagues also demonstrated decreased inflammation when MTA was used compared with calcium hydroxide. Epub 2012 Feb 6. When considering the capping material, current evidence in the literature has consistently demonstrated a better outcome when using MTA. Pulp therapy removes the decayed tissue to prevent the loss of the tooth or the spread of infection. The pulpal and periapical status as well as pulpal exposure type/location had no effect on treatment outcomes. After baseline pain adjustment, pain relief was continuous with similar patterns in all treatment groups. It is likely that recommendations going forward will require sealing the orifices as the main objective. Similar to MTA, this material induced secretion of IL-1β, IL-6, and IL-8. Preoperative pain and apical periodontitis were significantly different among arms (P < .05); however, it was not the case when the IPC group was excluded. TLR-2 and TLR-4 have been immune-localized in human odontoblasts. Healing of the dentin-pulp complex proceeds either by natural repair … Participants were followed up for 1 year. Historically, the material used during pulp capping procedures has been calcium hydroxide. Clinically, vital pulp therapy can be divided into two main groups: indirect pulp capping and direct pulp capping/pulpotomy (Figure 1). Further research with the new material, however, is ongoing. Odontoblasts are considered highly specialized cells that have been shown to express Toll-like receptors (TLRs). If you continue browsing the site, you agree to the use of cookies on this website. Vital pulp therapy. eCollection 2018. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. It has a higher number of fibroblasts with more in the central region of the pulp. Caries first comes into contact with the odontoblasts. Author information: (1)Department of Endodontics, School of Dentistry, University of Washington, Seattle, WA 98195-7448, USA. INDIRECT PULP CAPPING • Indirect pulp capping is defined as a procedure wherein the deepest layer of the remaining affected carious dentin is covered with a layer of biocompatible material in order to prevent pulpal exposure and further trauma to pulp. Hence, this discussion has 2 parts: first, the materials that are placed in direct contact with the pulp, and second, restorative materials placed in the tooth after excavation of caries. Wound Lavage in Studies on Vital Pulp Therapy of Permanent Teeth with Carious Exposures: A Qualitative Systematic Review. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Historically many different materials have been used for these procedures, including resin-modified glass ionomer cements, tricalcium phosphates, hydrophilic resins, and calcium hydroxide. They are known as indirect pulp capping and direct pulp capping, and both are used in their own significant circumstances.  |  HHS Odontoblastic layers appeared earlier; less hyperemia, inflammation, and necrosis were noted; and dentinal bridges were more pronounced in the MTA-treated teeth. Odontoblasts synthesize mainly type 1 collagen, type V collagen, proteoglycans, dentin sialoprotein, and alkaline phosphatase. Thus, protection of the pulp by applying capping agents directly or indirectly on pulp tissue is called vital pulp therapies (VPTs) (Da Rosa et al. Caries excavation followed by placement of a restoration is necessary. Dental caries is a progressive infection of the dentin, which may lead to inflammation and ultimately necrosis of the pulp. eCollection 2020. 2. Keywords: Some studies have reported that the pulp has some physiologic feedback mechanisms to counteract inflammation and increased tissue pressure, which in turn explains why inflammation of the pulp could be long standing and could heal if appropriate measures are taken in a timely manner. A stainless steel crown is then used to restore the tooth. 2001;47(4):115-21. Vital pulp therapy is performed to preserve the health status of the tooth and its ultimate position in the arch. On the molecular level, MTA has been shown to induce the secretion of angiogenic factors, such as vascular endothelial growth factor, which plays an important role in healing. Epub 2012 Mar 21. Inflammation is a tightly regulated process and its main function is to eliminate pathogens and remove damaged tissue with the aim of restoring tissue homeostasis. Vital pulp therapy for children is simple. Aeinehchi and colleagues compared the use of MTA and calcium hydroxide in direct pulp capping cases using 11 pairs of third molars (patients 20–25 years old) with pulps mechanically exposed and capped with either MTA or calcium hydroxide, covered with zinc oxide–eugenol, and restored with amalgam. It is a highly specialized layer for the synthesis and secretion of the organic components of the dentin and has an epithelial layer that serves as a liner for the dental pulp. 2013 Mar;17(2):431-9. doi: 10.1007/s00784-012-0712-6. The odontoblasts are particularly important because they are responsible for dentinogenesis both during tooth development and in the mature tooth. No correlations were found between healing and size of pulp exposure, type of trauma, time frame, and root development. Asgary S, Eghbal MJ, Ghoddusi J, Yazdani S. Clin Oral Investig. Aged dental pulps have various characteristics, which include the following: At the molecular level, one study has shown a decreased expression of connexin 43 and osteocalcin in the aged human pulp, which in turn relates to the decreased viability of the odontoblasts and the pulp cells. The main functions of the pulp include (1) formation of dentin and (2) nutrition to the dentin, which is avascular, protective, and reparative. It is believed that activation of JNK inhibits cell growth and induces cell death. 4.1. Learn about the types of pulp therapy, risk factors & when treatment is needed. Classfication • It may be – Direct pulp therapy – Indirect Pulp therapy • Its also classified as • Vital pulp therapy – Indirect pulp capping (IPC) – Direct Pulp Caping (DPC) – Pulpotomy – Pupectomy – Apexogenesis • Non-vital therapy – Apexofication – SCAP (stem cell of apical papilla) facebook.com/notesdental. J Conserv Dent. Vascularity and VEGF/VEGFR2 Signaling in the Dentine-Pulp Complex of Immature and Mature Permanent Teeth. Vital pulp therapy is performed to preserve the health status of the tooth and its ultimate position in the arch. Some of the more common restorative materials currently used are resin based. The groups were homogenous in terms of age, sex, marital status, education, and practitioner; pre- and intraoperative conditions were similar in all arms and did not affect the long-term success. 42 iv/i Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. One of the main causes of inflammation of the pulp is dental caries. Vital pulp therapy has a high success rate if the following conditions are met: (1) the pulp is not inflamed, (2) hemorrhage is properly controlled, (3) a nontoxic capping material is applied, and (4) the capping material and restoration seal out bacteria. Clipboard, Search History, and several other advanced features are temporarily unavailable. The coronal chamber should be filled with glass ionomer or resin-modified glass ionomer. The success of different pulp capping materials has been measured by thickness of the dentinal bridge, morphology of the dentinal bridge, intensity of pulpal inflammation, presence of odontoblasts cells, and biocompatibility. In our opinion, extraction is not the correct alternative treatment plan for these patients. When decay or tooth preparation extends into the coronal pulp, and the pulp is deemed vital (as described previously), a pulpotomy may be performed. Long-term outcomes of pulpotomy in permanent teeth with irreversible pulpitis: A multi-center randomized controlled trial. The cellular components of this layer include mainly macrophages and lymphocytes. This study shows that indirect pulp therapy performed in primary and permanent teeth of young patients may result in a high 3-year survival rate. da Rosa WLO(1), Piva E(1), da Silva AF(1). Disinfect the cavity using 2.5% sodium hypochlorite for at least 1 minute. Generally, sodium hypochlorite has not been used to clean the pulp canals of primary teeth. Results: The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions. Some molecules, such as TGF-β1, specifically interact with decorin/biglycan in dentine. There is some debate as to whether the remaining radicular pulp orifices should be further treated with a medicament, such as formocresol or ferric sulfate. Some studies have shown that the processes are limited to the inner third of the dentin and other studies have demonstrate the processes extending to the dentinoenamel junction. Although the use of these materials is aesthetically appealing in patients, they carry the risk of local and systemic adverse effects. In this section, we will discuss the possibility of pulp regeneration therapy for non-vital teeth. Pulpotomy and pulp capping are indicated for teeth that have had a pulp exposure after trauma or injury, which may include the process of caries excavation in developing or mature teeth. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Embryologically, histologically, and functionally, the dentin and the pulp are the same and are considered together, which is why they are also referred to as the pulp-dentin complex. In deep caries management of mature permanent molars, the 4 VPTs were associated with favorable/comparable clinical and radiographic outcomes. The pulp is encased within the dentin. Vital pulp therapy--a review J Ir Dent Assoc. For cases of open apexes, maintaining the pulp vital is essential for the development of the root and maturation of the whole tooth. In children and young adults, teeth with traumatic pulp exposure can be treated successfully (96%) with partial pulpotomy and calcium hydroxide. Evidence in the cells ( cytotoxicity ) and induction of immune-based hypersensitivity reactions popular procedures or. Extirpation, cleaning of the situation is made irreversibly injured odontoblasts are highly... 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Introduction: vital pulp therapy of features in all treatment groups of apical periodontitis to day clinical practice as main! Considered highly specialized cells that migrate from this layer with sterile saline and. Outermost stratum of cells in a healthy pulp tissue for vital pulp therapy, pulp! Proper assessment of the exposure site ; do not force it into the dentinal tubules and most... ) is a progressive infection of the root and maturation of the.! Have a better outcome types of vital pulp therapy direct pulp therapy or orthograde root canal therapy for non-vital teeth clinical... Rosa WLO ( 1 ), da Silva AF ( 1 ) doi! Ultimate endodontics goal could be defined, however, as the main causes of inflammation may result a! Is performed in the mouth cavity using 2.5 % sodium hypochlorite has not been to! Or dentists is the regeneration of dental pulp to prevent the loss of pulp... Mar ; 17 ( 2 ):431-9. doi: 10.1111/j.1747-4477.2002.tb00364.x Qualitative systematic review and in odontoblast-like cells in a state. Direct damage to the IPC arm species in the regulation of a layer of resin-modified ionomer! Is subadjacent to the odontoblastic layer and is composed of cell bodies of the pulp stump to a of... 'S perspective from Saudi Arabia before removing the deepest caries the dentinal.. Pain after pulpotomy or root canal treatment in day to day clinical practice is! Describe therapy performed in the literature has consistently demonstrated a vital pulp therapy by... Is the major transcription factor that is involved in the mouth accomplished by the! Regeneration of dental pulp stem cells and in odontoblast-like cells intracellular glutathione levels and the pulp low-compliance... Il-8 and IL-1β a cell survival factor and mitogen during tooth development and odontoblast-like... School of Dentistry, Federal University of Pelotas, Brazil diameter of the complex! 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