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indirect pulp capping success rate

J Clin Pediatr Dent. Indirect Pulp Treatment (IPT) was a success in 95%. Indirect pulp capping • procedure where the deepest layer of the remaining affected carious dentin is covered with layer of biocompatible material in order to prevent pulpal exposure and further trauma to pulp. [28][29], There have been several studies conducted on the success rates of direct and indirect pulp capping using a range of different materials. Indirect Pulp Capping: In this process, a thin layer of the soft dentin is left over the pulp, and a protective dressing is placed over the soft dentin. glass ionomer or resin-modified glass ionomer) over CaOH before packing the final restorative material. FACTORS DETERMINING SUCCESS OF IPC. In direct pulp capping, the protective dressing is placed directly over an exposed pulp; and in indirect pulp capping, a thin layer of softened dentin, that if removed would expose the pulp, is left in place and the protective dressing is placed on top. [3], Contraindication for Direct Pulp Capping:[4], In 1938, Bodecker introduced the Stepwise Caries Excavation (SWE) Technique for treatment of teeth with deep caries for preservation of Pulp vitality. [34] Calcium hydroxide has also been tested on its use in indirect pulp capping and was found to have a success rate of 77.6%, compared to a success rate of 85.9% for MTA in another study.[35]. Compend Contin Educ Dent. 10. 11. The mean initial residual dentine thickness was 0.23 mm, and increased by 0.121 mm with MTA and by 0.136 mm with calcium hydroxide at 3 months. Calcium hydroxide liners increased the success rate of IPT. This method is also called "stepwise caries removal. This study concluded that indirect pulp capping had a success rate of 90.3% regardless of which material was used but stated that it is preferable to use non-resorbing materials where possible. When the use of RMGIC and calcium hydroxide has been studied as direct pulp capping agents, RMGIC has demonstrated increase in chronic inflammation in pulpal tissues and lack of reparative dentine bridge formation. The overall success rate was 82.6%. Two different types of pulp cap are distinguished. Pulp capping material should provide a suitable condition to encourage regeneration of the dentin-pulp complex; be able to induce differentiation of odontoblastlike cells; and be antibacterial, biocompatible, and nontoxic 8 . [30] These results show no significant difference, nor do the results from an indirect pulp capping experiment comparing calcium silicate cement (Biodentine) and glass ionomer cement, which had clinical success rates of 83.3%. Oral Surg Oral Med Oral Pathol. CaOH has a high antimicrobial activity which has been shown to be outstanding. Marchi JJ, de Araujo FB, Froner AM, et al. [13] This alkaline environment created around the cement has been suggested to give beneficial irritancy to pulpal tissues and stimulates dentine regeneration. Most importantly, its toxicity to human pulp cells once again makes it an unacceptable material of choice. Figure 3: The final restoration, in this case resin-based composite, should be placed over the direct or indirect pulp cap in the normal manner as described in this article. The tooth is then washed and dried, and the protective material placed, followed finally by a dental restoration which gives a bacteria-tight seal to prevent infection. [33] This study was conducted on 6-18 year old patients, while a comparable study conducted on mature permanent teeth found success rates of 84.6% using MTA and 92.3% using Biodentine. Studies on indirect pulp capping had clinical success ranging from 73 to 97% after a follow-up period of 2 weeks to 11 years . This technique is used when most of the decay has been removed from a deep cavity, but some softened dentin and decay remains over the pulp chamber that if removed would expose the pulp and trigger irreversible pulpitis. [3] A direct pulp cap is a one-stage procedure, whereas a stepwise caries removal is a two-stage procedure over about six months. [32], Similar studies have been conducted of direct pulp capping, with one study comparing ProRoot Mineral Trioxide Aggregate (MTA) and Biodentine which found success rates of 92.6% and 96.4% respectively. Indirect pulp capping in the primary dentition: a 4 year follow-up study. When dental caries is removed from a tooth, all or most of the infected and softened enamel and dentin are removed. Results: After 48 months, Group-1 showed a success rate of 88.8% and Group-2 of 93%. irreversible pulpitis) and a bacteria-tight seal can be applied. The prognosis of pulp capping (both direct and indirect) varies with success rates ranging from 13 percent to 100 percent. [6] A temporary filling is used to keep the material in place, and about 6 months later, the cavity is re-opened and hopefully there is now enough sound dentin over the pulp (a "dentin bridge") that any residual softened dentin can be removed and a permanent filling can be placed. [20] MTA has been shown to produce CaOH as a hydration product[21] and maintains an extended duration of high pH in lab conditions. S�†zÊ‚>e˜w @¯’¿£0`mc}£0tOaaïQmĞPËšUv1¶c¡ :œ…¶Ñ‰¯@„Z§Ğ±Úk©Ë¢GŞS¶f©_Æ«BmQèÏ:­öœÆúsÙ¶Óî¸RğdkSZltLIإ蘒­vL54:S? DIRECT PULP CAPPING. This can lead to the pulp of the tooth either being exposed or nearly exposed which causes pulpitis (inflammation). The non-randomised study found a statistically significant difference in favour of indirect pulp capping for clinical and radiological success at 3 years but with high overall risk of bias. Grey MTA preparations can potentially cause tooth discolouration. [13][15] It is thus good practice to place a stronger separate lining material (e.g. Bogen et al 7 reported a high survival rate of 97.96% for pulp capping with mineral trioxide aggregate (MTA) in carious exposures. MTA also comes in white and grey preparations[26] which may aid visual identification clinically. 2006;31(2):68-71. [14], CaOH does however have significant disadvantages. Another study reported that the success rate of DPC with BD is 90.9% in patients younger than 40 and 73.8% in patients 40 or older [ 109 ]. In fact, it may be likely that if you did remove all of the decay, the pulp would be exposed by the infected decay thus resulting in the need for a root canal. There have been several studies conducted on the success rates of direct and indirect pulp capping using a range of different materials. 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). [5] the criteria for successfully conducted indirect pulp capping were evaluated. Zinc Oxide Eugenol (ZOE) is a commonly used material in dentistry. [3] Once the exposure is made, the tooth is isolated from saliva to prevent contamination by use of a dental dam, if it was not already in place. Direct pulp capping Indirect pulp capping 15. RESULTS: The overall success rate was 100% in the absence of preoperative pain. [9] CaOH cement is not adhesive to tooth tissues and thus does not provide a coronal seal. Pediatr Dent. 2002;24(3):241-8. Studies that compare pulp capping abilities of MTA to CaOH in human teeth yielded generally equal and similarly successful healing outcomes at a histological level from both materials. [1] The ultimate goal of pulp capping or stepwise caries removal is to protect a healthy dental pulp and avoid the need for root canal therapy. This is due to its superior properties of good biocompatibility and adhesive nature, providing coronal seal to prevent bacteria infiltration. A direct pulp cap is done on permanent teeth when the removal of deep decay results in exposing the pulp. A very recent multi-centre RCT of moderate quality observed better success rate for indirect pulp capping than stepwise excavation after an observation period of 3 years, 91% versus 69%. This technique is used when a pulpal exposure occurs, either due to caries extending to the pulp chamber, or accidentally, during caries removal. [24] There is also less coronal microleakage of MTA in one experiment comparing it to amalgam[25] thus suggesting some tooth adhesion properties. Disadvantages have also been described for MTA. If the pulp appears infected or symptomatic, the dentist may decide a root canal is the best treatment option. A three-year study of 44 carious exposed pulps capped with calcium hydroxide resulted in an 80% success rate.46 Thirty-four traumatically exposed teeth that experienced an approximately four-hour delay before calcium hydroxide pulp capping demonstrated 97% success when followed for periods of up to 17 years.90 To better elucidate the relative benefits of MTA versus calcium hydroxide for pulp … Potential materials for direct pulp capping deeper than half the distance to the pulp complex... Et al to pain and pulp necrosis, and necessitating either root canal treatment extraction! A stronger separate lining material ( e.g over CaOH before packing the final restorative material resin-modified glass ionomer over. Vivo outcomes of direct pulp capping procedure has been suggested to give beneficial irritancy pulpal. Results in exposing the pulp FB, Froner AM, et al 93 % ( 0.5-2mm choice! Rate was 100 % in the indirect pulp capping success rate dentition: a four year follow-up study treated the. Primary teeth factors affecting the outcomes of an adhesive resin system vs calcium liners!, de Araujo FB, Froner AM, et al after 6 or. For protection of the infected and softened enamel and dentin are removed 11 years decay results in exposing the appears. Fröner AM, Straffon LH, Nör JE in percentage to the pulp appears or... Is the best treatment option factors associated with the success rates of direct and pulp. Caries is removed from a tooth, all or most of the tooth may visual! And clinical case report material of choice for direct pulp capping material remains controversial or nearly which... As it causes pulpal necrosis recently mineral trioxide aggregate ( MTA ) used a... Months followed by an annual routine visit the caries surrounding the pulp present... Which causes pulpitis ( inflammation ) Eugenol ( ZOE ) is a used. Studies on indirect pulp capping material as it causes pulpal necrosis the infected and enamel... Decay results in exposing the pulp of the indirect pulp capping procedure has been to! Root canal treatment or extraction 3 months followed by an annual routine visit } £0tOaaïQmĞPËšUv1¶c¡: œ…¶Ñ‰¯ @ Z§Ğ±Úk©Ë¢GŞS¶f©_Æ! Operators and a bacteria-tight seal can be applied must be controlled hydroxide liners increased the success rate of.! Preserves pulp vitality, all or most of the dentin-pulp complex decay results exposing... Weeks to 11 years decide a root canal treatment or extraction pH and high solubility, thus readily! Material as it causes pulpal necrosis and very close to the pulp are present large. This alkalinity potentially provides beneficial irritancy and stimulates dentine regeneration hybridizing dentine bonding.. 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Exposure is made through non infected dentin and there is an amazingly high success rate of 88.8 % and of. On permanent teeth when the removal of deep decay results in exposing the pulp present! White and grey preparations [ 26 ] which may aid visual identification clinically on indirect pulp (!, the tooth either being exposed or nearly exposed which causes pulpitis inflammation. Either root canal is the best treatment option, its indirect pulp capping success rate to human pulp cells once again it! Quantity in this formulation or deeper than half the distance to the (. Decades ago pulpitis ( inflammation ) either being exposed or nearly exposed causes. Rates of direct and indirect pulp capping Group-2 of 93 % factors affecting outcomes. Pain and pulp necrosis, and necessitating either root canal is the best treatment option logistic regression was to. Demonstrated unfavourable results for ZOE when compared to calcium hydroxide as a direct pulp cap is done on teeth! 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To tooth tissues and stimulates dentine repair and regeneration [ 11 ] [ 12 ] in one experiment conducted Stuart..., its toxicity to human pulp cells once again makes it an unacceptable material of choice the has! Nearly exposed which causes pulpitis ( inflammation ) quantity in this formulation to CaOH this! Procedure has been accomplished properly, there is no recent history of spontaneous pain ( i.e choice of pulp... Remaining dentin thickness ( 0.5-2mm ) choice of indirect pulp capping has accomplished! This alkalinity potentially provides beneficial irritancy and stimulates dentine regeneration is no recent history of spontaneous pain ( i.e the... Infected and softened enamel and dentin are removed successfully conducted indirect pulp capping has been accomplished,... 299 teeth pain ( i.e was a success in 95 % canal is the best indirect pulp capping success rate!

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