Recent concepts in vital pulp therapy Dr. Sarjeev Singh Yadav
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Vital Pulp Therapy
A look at treatments modalities for cases involving deep dentin involvement and pulp therapy for vital teeth.
John C Comisi, DDS, MAGD
Incomplete Caries Removal
“The Evidence states you will be saving pulps”
John C Comisi, DDS, MAGD
Incomplete Caries Removal
Indirect Pulp Treatment Types: 1.Indirect Pulp Cap (2 Step or Stepwise Method)
2.Partial Caries Removal (1 Step Method)
John C Comisi, DDS, MAGD
John C Comisi, DDS, MAGD
• A cascade of events lead to the mineralization of the collagen based tissue.
• Calcium ions interact with acidic residues and then combine with Phosphates to initiate a nucleation process.
• The collagen matrix provides a spatial template upon which the mineral crystals deposit.
• Collagen is synthesized and subsequently controlled by the odontoblasts.
John C Comisi, DDS, MAGD
Significant Challenges in Clinical Dentistry
Maintaining a vital pulp
Dentin replacement due to caries: Introduction of a variety of dental materials over
the past five decades to solve these issues Calcium Hydroxide Glass Ionomers Composites Calcium Silicates
John C Comisi, DDS, MAGD
More challenging situations
In daily clinical practice, the following situations are encountered in vital, asymptomatic teeth:
• Small pinpoint mechanical pulpal exposure • Carious pulpal exposure • Very deep caries, but no pulpal exposure
Choices: endodontic treatment or vital pulp therapy with pulp capping…
John C Comisi, DDS, MAGD
Apatite Formation
John C Comisi, DDS, MAGD
The Magic of Calcium Hydroxide
High pH/Bactericidal
Stimulates formation of reparative dentin/ability to extract growth factors from the dentin matrix
Ability to neutralize bacterial by-products (acids)
Clinical proven as a direct pulp capping agent
John C Comisi, DDS, MAGD
John C Comisi, DDS, MAGD
Glass
CaO+ Leach
Chemical
Dissolve
CaO are stable forms of Calcium Hydroxide
John C Comisi, DDS, MAGD
Examples of bioactive products for vital pulp therapy
▪ Biodentine ▪ Dycal ▪ EndoSequence ▪ MTA Filapex ▪ MTA - Angelus ▪ Multi-Cal ▪ ProRoot MTA ▪ TheraCal LC
John C Comisi, DDS, MAGD
Bioactive Pulpal Therapies
Direct: Biodentine, Dycal, Endo Sequence, MTA, Multi-Cal, TheraCal
Indirect: ACTIVA BioACTIVE-BASE/LINER, Biodentine, TheraCal
John C Comisi, DDS, MAGD
Bioactive Restoratives with Significant Ion Release
▪ 3M Ketac Products ▪ GC GI and RMGI Products ▪ Pulpdent Bioactive Restoratives ▪ SDI GI and RMGI Products ▪ Shofu Giomer Products
John C Comisi, DDS, MAGD
Constructedfrommedicalgrade,glass-beadreinforcedpolymer
Single-patient-useinstruments
Foruseinslowspeedhandpieceonly
3sizes:RA#4,RA#6,RA#8
John C Comisi, DDS, MAGD
Create access to caries
Cut through harder tooth structure or restoration to reach underlying caries
Caries access instruments: - Fissurotomy type burs - carbide burs/diamonds
appropriate to the shape and location of the lesion,
- air abrasion system
John C Comisi, DDS, MAGD
harderthaninfected(carious)dentin
softerthanhealthy(affected)zonesofdentin
Polymer Bur
John C Comisi, DDS, MAGD
When contacting healthy dentin:
-Tactilely sense a vibration through the handpiece
- Unable to cut healthy dentin
- Prolonged contact with hard surfaces degrades the working end
John C Comisi, DDS, MAGD