This document provides information on various vital pulp therapy procedures including indirect pulp capping, direct pulp capping, and pulpotomy. It defines each procedure and discusses their objectives, indications, contraindications and treatment considerations. Indirect pulp capping involves sealing off carious dentin near the pulp to encourage recovery, while direct pulp capping places a protective material directly over an exposed pulp. Pulpotomy involves removing the coronal pulp and placing a medicament to preserve the vitality of the remaining radicular pulp. The document outlines the factors that influence the success of each procedure such as the size of any pulp exposure and presence of preoperative pain or radiographic abnormalities.

1. GOOD
MORNING


2. Presented by- Vaishnavi Dhok
Krishna institute of medical
science, karad

3. Indirect pulp capping
Direct pulp capping
Pulpotomy
Apexogenesis

4. Vital Pulp Therapy
Definition:
Vital pulp therapy is the treatment
initiated on an exposed pulp to repair
and maintain the pulp vitality.
- Grossman

5. Vital pulp
therapy
Restoring the Tooth’s
own heartbeat

6. Vital pulp
therapy
Pulp capping
Indirect pulp
capping
[ICP]
Direct pulp
capping
[DCP]
Pulpotomy Apexogenesis

7. Pulp Capping
Pulp capping is a
technique used in
dental restorations
to prevent the
dental pulp from
dying, after being
exposed,or nearly
exposed during a
cavity preparation.
FIG: Exposed or nearly
exposed pulp
1) Crown
2) Root
3) Restoration
4) PULP CAPPING
5) Pulp chamber

8. PULP CAPPING TECHNIQUES
DIRECT PULP
CAPPING
INDIRECT
PULP CAPPING

9. Key responses of the dentin-pulp to
caries / injury

10. Reactionary dentinogenesis
Caries
Odontoblasts
Dentin
Tertiary, reactionary dentin laid
down by primary odontoblasts as
they retreat from injury

11. Reperative dentinogenesis
Tertiary, reparative
dentin
Deep dentin injury kills
primary odontoblasts and
stimulates recruitment of
replacements from
the cell-rich layer
New
odontoblast-like
cells migrate to
the wound

14. • “A procedure where 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”.
Grossman
• A procedure where in small amount of carious dentin is retained in
deep areas of cavity to avoid exposure of pulp, followed by
placement of a suitable medicament and restorative material that
seals off the carious dentin and encourages pulp recovery.
Ingle
• “A procedure in which only gross caries is removed
from the lesion and cavity is sealed for a time with a
biocompatible material.”
McDonald
Definitions:

15. Arresting the carious process
Promoting dentin sclerosis
Stimulating formation of tertiary dentin
Remineralization of carious dentin
Objectives:
Given by Eidelman in 1965:

16. Rationale
Disinfection of the
residual affected
dentin.
Patients comfort is
immediate.
Pulp vitality is
maintained.
allow the pulp to
regenerate reparative
dentin.

17. Layers of carious
dentin
Infected dentin
Affected dentin
Infected dentin Affected dentin
Superficial layer Deeper layer
Highly demineralized Intermediately demineralized
Unremineralizable Remineralizable
Lacking sensation Sensitive
Stained by 0.5% fuschin or i.e. 1.0% acid
red solution Does not stain
Should be excavated Should be left remineralize.

18. Indication
 Mild pain associated
with eating
 Negative history of
spontaneous, extreme
pain
History

19.  Deep carious lesion, which are
close to, but not involving the
pulp in vital primary or young
permanent teeth
 No mobility
 When pulp inflammation is
seen as nominal and there is a
definite layer of affected
dentin after removal of
infected dentin.
Clinical Examination

20.  Normal lamina dura
and PDL space
 No radiolucency in
the bone around
the apices of the
roots or in the
furcation.
Radiographic
examination

21. Contraindication
History

22. Excessive
tooth
mobility
Soft leathery dentin covering a
very large area of the cavity, in a
non restorable tooth
Swelling/ Fistula
Tooth
discoloration
Non responsiveness to pulp
testing techniques
Clinical examination

23. Radiographic examination
Large carious
lesion with
apparent pulp
exposure
Interrupted or broken
lamina dura
Widened periodontal
ligament space
Radiolucency at the root
apices or furcation areas

24. Treatment procedure
Single
appointment
procedure Two appointment
procedure

25. Use local anesthesia
Isolate with rubber dam
Cavity outline established using high
speed air turbine
Remove all caries with caries
detector dye
Single appointment procedure

26. Stop the excavation as soon as the
firm resistance of sound dentin is
felt.
Periapical carious dentin is removed
with a sharp spoon excavator.
Cavity flushed with saline and dried
with cotton pellet.
Site is covered with calcium
hydroxide.
Remaining cavity is filled with
reinforced ZOE cement.

27. 2nd appointment procedure
( 6-8 weeks later)
Between the appointment history must be negative and
temporary restoration should be intact.
Take a bitewing radiograph and observe for sclerotic
dentin.
Carefully remove all temporary filling material.
Previous remaining carious dentin will have become dried
out, flaky and easily removed.

28. The area around the potential exposure will appear
whitish and may be soft; which is predentin. Do not
disturb this area.
The cavity preparation is washed out and dried gently.
Cover the entire floor with calcium hydroxide.
Base is built up with reinforced ZOE cement or GIC.
Final restoration is then placed

31. Advantages of
two appointment
technique
Dentist get chance
to assess reaction
of tooth and caries
activity
Final excavation of
caries is safer in
second sitting.
Avoid
unintentional pulp
exposure
Helps to remove
slowly
progressing
lesion

32. Remaining dentin
thickness
(0.5-2mm)
Choice of
indirect pulp
capping agent
Factors affecting success of
IPC

35. • Procedure in which the exposed vital pulp is covered with a
protective dressing or base placed directly over the site of
exposure in an attempt to preserve pulpal vitality.
Grossman
• Placement of medicament or non medicated material
on a pulp that has been exposed in course of
excavating the last portions of deep dentinal caries or
as a result of trauma.
Kopel
(1992)
• It is the protection of a pulp exposed by traumatic fracture
or in the course of excavating deep dentinal caries.
Protection is provided by placing a medicated or non
medicated material in direct contact with the pulp tissues to
promote a reparative reaction.
Ingel
Definitions:

36. Why?
Conservative
treatment
No need of RCT
Save the tooth
and preserves
vitality

37. Healing/ Repair of the pulp
Pulp’s vitality and function.
Formation of secondary dentine.
Normal responsiveness to electrical and thermal
pulp tests.
Objectives:

38. Asymptomatic
• No spontaneous pain
• Normal response to thermal testing
• Vital pulp
True pin point exposure
• Less than 0.5mm in diameter

39. Hemorrhage from exposure site
should be easily controlled
• Within 10 minutes
The exposure occurred is clean
and uncontaminated
• Rubber dam isolation

40. No pulp calcification

41. `
Spontaneous pain
Severe toothache at night

42. Tooth mobility
Excess of hemorrhage at the
time of exposure

43. External/ internal root
resorption
Swelling / fistula

44. Internal
Resorption
Faster pulpal
inflammatory
response
Chronic pulp
inflammation
Necrosis
Intraradicular
involvement
Why DPC is contraindicated in
primary teeth!!???

45. Treatment considerations

46. Treatment of DPC
Rubber dam provides only means of working
in a sterile environment, so it has to be used.
Once an exposure is encountered, further
manipulation of pulp is avoided.
Cavity should be irrigated with saline or
distilled water.
Hemorrhage is arrested with light pressure
from sterile cotton pellets.

47. Final restoration is done after determining
the success pulp of capping
Place the pulp capping material, on the
exposed pulp with application of minimal
pressure so as to avoid forcing the material
into pulp chamber
Place temporary restoration.

49. DIRECT PULP CAPPING

50. Histological changes after pulp
capping

51. Pulp exposure
Size of exposure
Stepwise excavation
to avoid exposure
Preparation deep
Yes No Likely
Large
Excessive
Bleeding
Apply pulp
protection
and restore
Small
No Excessive
Bleeding
Indirec
t pulp
cappin
g
Pain preoperatively
Vital
responses
No
radiographic
evidences
RCT
Direct pulp
capping
No
Yes
No
Yes
No
Yes

54. • complete removal of the coronal portion of the
dental pulp, followed by placement of a suitable
dressing or medicament that will promote healing
and preserve vitality of the tooth.
Finn
(1995)
• A Procedure in which a portion of the exposed
coronal vital pulp is surgically removed as a means of
preserving the vitality and function of the remaining
radicular portion.
Grossman
• Amputation of the affected or infected coronal
portion of the dental pulp, preserving the vitality &
function of all or part of the remaining radicular pulp
AAPD
(1998)
Definitions:

55. Objectives
Preservation of
vitality of radicular
pulp
Relief of the pain in
patient with acute
pulpalgia
There should be no
postoperative radiographic
evidence of pathologic
external root resorption.
There should be no
harm to the
succedeous tooth.

56. Indications
1)Mechanical or carious pulp exposure
2) History of only spontaneous pain.
3) Hemorrhage from exposure be controlled.
4) No abscess or fistula.
5)No interradicular bone loss.

57. 4) No interradicular
radiolucency.
5) At least 2/3rd of root
length still present to
ensure reasonable
functional life.
6) In young permanent tooth
with vital exposed pulp and
incompletely formed apices

58. Contraindication
 History of spontaneous pain
 Tenderness to percussion
 Pathological mobility
 External/internal root resorption
 Periapical or interradicular radiolucency
 Pulp calcifications
 Swelling or Fistula
 Root resorption more than 1/3rd of root length
 Large carious lesion with non-restorable crown

60. It is defined as the treatment
of the vital pulp by capping
or pulpotomy in order to
permit continued growth of
the root and closure of the
root apex.
Definition

62. Indications

63. Contraindications

67. REFRENCES

69. Help... For no reason!!!
Thank you!