PULP CAPPING

Submitted by:

Rockey Shrivastava

Xth Batch BDS

Roll - 30

Guided by:

Dr. J N Shukla

Dr. Rahul Mishra

Dr. Madhulika Srivastava

CONTENTS

1. INTRODUCTION

2. TREATMENT MODALITIES

3. TYPES OF PULP CAPPING

4. INDIRECT PULP CAPPING

5. PATENT DENTIN MEASURING DEVICE

6. DIRECT PULP CAPPING

7. FEATURES OF SUCCESSFUL PULP CAPPING

8. PULP CAPPING MATERIALS

9. CONCLUSION

10.REFERENCES

INTRODUCTION

TREATMENT MODALITIES

PULP TREATMENT

CONSERVATIVE RADICAL

1. Protective base 1. Pulpectomy

2. Indirect pulp therapy 2. Root filling

3. Direct pulp therapy

4. Pulpotomy

PULP CAPPING

• DIRECT PULP CAPPING

• INDIRECT PULP CAPPING

Definition

The procedure involving a

tooth with a deep carious

lesion where carious dentin

removal is left incomplete,

and the decay process is

treated with a biocompatible

material for some time in

order to avoid pulp tissue

exposure is termed as

indirect pulp capping.

INDIRECT PULP CAPPING THERAPY

INDICATIONS

When pulp inflammation has been judged to be minimal

and complete removal of caries would cause pulp

exposure

• Any signs of

pulpal or

periapical

pathology

• Soft leathery

dentin covering a

very large area of

the cavity, in a non

restorable tooth

CONTRAINDICATIONS

PROCEDURE

The tooth is anesthetized and isolated with rubber dam

All the caries except that immediately over the pulp is removed (use large round bur at low speed)

A zone of AFFECTED demineralized dentin is left behind

Not all undermined enamel is removed

A sedative dressing of either zinc oxide eugenol or calcium hydroxide is placed

CONTD..

The tooth may then be restored with ZOE or amalgam

The formation of reparative dentin beneath the caries (average rate – 1.4 microns per day)

The treated tooth is re entered after 6 to 8 weeks and the remaining caries is excavated

Pulpal protection with adequate base and permanent restoration

(If the restoration has a good margin and at the recall visit a layer of secondary dentin is evident , reentry

is not necessary)

PATENT DENTIN MEASURING DEVICE1. Electronically measures the

thickness of dentin layer above the

pulp chamber during crown

preparation with a simple touch of

probe

2. Color coding:

Green light – safe zone

Orange light - limit of safe zone

Red light – danger of penetrating

through the dentin

3. Allows the safe preparation of

delicate cases (elongated , tilted or

deciduous tooth)

Definition:

The procedure in which the small exposure of the pulp which is encountered

• During cavity preparation or

• Following a traumatic injury or

• Due to caries, with a sound surrounding dentin, is dressed with an appropriate biocompatible radio-opaque base in contact with the exposed pulp tissue prior to placing a restoration is termed as a direct pulp capping

DIRECT PULP CAPPING

LIMITATIONS IN PRIMARY TEETH

• Internal resorption

• Calcifications

• Chronic pulp inflammation

• Necrosis

• Intraradicular involvement

INDICATIONS

• Small mechanical exposures less than 1 mm

which is surrounded by sound dentin

• Light red bleeding from the exposure site that

can be controlled by cotton pellet

• Traumatic exposures in a dry, clean field, which

report to the dental office within 24 hours

CONTRAINDICATIONS

• Pain at night

• Spontaneous pain

• Tooth mobility

• Thickening of periodontal membrane

• intraradicular radiolucency

• Excess bleeding at the exposure site

• Purulent or serous exudate

CALCIUM HYDROXIDE

TECHNIQUE

• Hemostasis

• Disinfect cavity

• Calcium hydroxide

IRM resin modified

GIC

dentin bonding

system

Restoration

DENTIN BONDING

SYSTEM

• Hemostasis

• Disinfect cavity

• Bonding system

• Adhesive

• Restoration

PULP EXPOSURE

FEATURES OF SUCCESSFUL PULP CAPPING

• Maintenance of pulp vitality

• Lack of undue sensitivity or pain

• Minimum inflammatory response

• Lack of internal resorption and intraradicular

pathosis

PULP CAPPING AGENTS

• Calcium hydroxide

• Isobutyl cyanoacrylate

• Resin bonding agents (hybridization)

• Laser

• Propolis

• Other materials ( antibiotics, corticosteroids,

polycarboxylate cements, dentin, albumin, acid,

alkaline phosphatase, chondroitin sulfate,

collagen, calcium – eugenol cement, calcitonin,

barium and strontium hydroxide, native

enriched collagen solution, hydroxyapatite)

CALCIUM HYDROXIDE

• Calcium hydroxide is the material of choice.

• Herman in 1930 1st

introduced Ca(OH)2 for pulp capping.

• Ca(OH)2 causes necrosis of adjacent pulp tissue and inflammation of contiguous tissue.

• Dentin bridge formation occurs at the junction of necrotic and inflamed tissue

Pure calcium

hydroxide

ADVANTAGES AND DISADVANTAGES OF

CALCIUM HYDROXIDE

A D V A N T A G E S

• Initially bactericidal

then bacteriostatic.

• Promotes healing and

repair

• High pH stimulates

fibroblasts

• Neutralization of

acids

• Stops internal

resorption

• Inexpensive and easy

to use

• Particles may

obturate open tubules

D I S A D V A N T A G E S

• Doesn’t exclusively

stimulate

Dentinogenesis

• May dissolve after 1yr

• May degrade during

acid etching and

tooth flexure

• Marginal failure with

amalgam

condensation

• Doesn’t adhere to

dentin or resin

restoration

3 MAIN CALCIUM HYDROXIDE PRODUCTS

• Pulpdent paste:52.5% calcium hydroxide suspended in aqueous methyl cellulose sol.

• Hydrex : two paste system - calcium hydroxide, barium sulfate, titanium dioxide and a selected resin.

• Dycal.

ISOBUTYL CYANOACRYLATE

• Hemostatic and bacteriostatic

properties.

• Less inflammation than calcium

hydroxide

• Doesn’t produce continuous barrier of

reparative dentin.

RESIN BONDING AGENTS

• Suggested as means to

achieve a hermetic seal at

the dentin/pulpal interface

by means of resinous

‘’hybrid’’ layer.

• 4-methacryloxyethyl

trimellitate anhydride(4-

META) bond can be used

on exposed pulp.

LASER

• Andreas Moritz in

1998 evaluated the

effect of Co2 laser

on direct pulp

capping.

• Success rate-89%

PROPOLIS

• Recently used material.

• Equally effective as calcium hydroxide.

• Sabir et al (2005) conducted experiments.

Partial dentinal bridge formation was seen in

rats after application of propolis in their study.

CONCLUSION

Pulp capping is a procedure that maintains pulp

vitality and function, promotes healing/repair,

prevents breakdown of peri radicular

supporting tissues, and promotes formation of

secondary dentin

BIBLIOGRAPHY

• Textbook of pedodontics - Shobha Tandon 2nd edition

(2009)

• Chawla HS et al. Calcium Hydroxide as a root canal filling

material in primary teeth – A pilot study . J. Indian Soc

Pedo Prev Dent: 16 (3); 90 – 91, 1998

• Suneda YT et al . A histopathological study of direct pulp

capping with adhesive resins. Oper Dent: 20; 223 –

229,1995

• Sabir A, Tabbu CR, Agustiono P, Sosroseno W.

Histological analysis of rat dental pulp tissue capped with

propolis. J Oral Sci. 47(3): 135 – 8, Sep, 2005

• Stewart DJ and Kramer IRH. Effects of calcium hydroxide

on the unexposed pulp, J. Dent. Res: 37;758,1958