[3] A direct pulp cap is a one-stage procedure, whereas a stepwise caries removal is a two-stage procedure over about six months. Remaining dentin thickness(0.5-2mm) Choice of indirect pulp capping agent. Several materials have been used for this procedure. Two different types of pulp cap are distinguished. It is only feasible if the exposure is made through non infected dentin and there is no recent history of spontaneous pain (i.e. This is a step wise procedure and a long procedure which takes about 6 months or more to complete. [11] CaOH also has a high pH and high solubility, thus it readily leaches into the surrounding tissues. the criteria for successfully conducted indirect pulp capping were evaluated. Most importantly, its toxicity to human pulp cells once again makes it an unacceptable material of choice. [5] Bogen et al 7 reported a high survival rate of 97.96% for pulp capping with mineral trioxide aggregate (MTA) in carious exposures. The difficulty with this technique is estimating how rapid the carious process has been, how much tertiary dentine has been formed and knowing exactly when to stop excavating to avoid pulp exposure.[8]. One study of indirect pulp capping recorded success rates of 98.3% and 95% using bioactive tricalcium silicate [Ca3SiO5]-based dentin substitute and light-activated calcium hydroxide [CA(OH)2]-based liner respectively. These results show no significant difference, nor do the results from an indirect pulp capping experiment comparing calcium silicate cement (Biodentine) and gl… Capping of the inflamed pulp. Selection was based on caries to or deeper than half the distance to the pulp. Oral Surg Oral Med Oral Pathol. This is due to its superior properties of good biocompatibility and adhesive nature, providing coronal seal to prevent bacteria infiltration. (1991), bacteria-inoculated root canals of extracted human teeth were treated with CaOH for 1 hour against a control group with no treatment and the results yielded 64-100% reductions in all viable bacteria. Since pulp capping is not always successful in maintaining the vitality of the pulp, the dentist will usually keep the status of the tooth under review for about 1 year after the procedure. 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. 2002;24(3):241-8. 10. [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. 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 the reported literature, the prognosis of direct pulp capping is unpredictable, with the lowest success rate in carious pulp exposures in the adult dentition. The color of the carious lesion changes from light brown to dark brown, the consistency goes from soft and wet to hard and dry so that Streptococcus Mutans and Lactobacilli have been significantly reduced to a limited number or even zero viable organisms and the radiographs show no change or even a decrease in the radiolucent zone. Results: The success rate of direct capping was 80.1% after 1 … [14], CaOH does however have significant disadvantages. This report included 22 operators and a total of 299 teeth. Disadvantages have also been described for MTA. Other studies also support claims of Biodentine’s and MTA’s superiority over calcium hydroxide in terms of success rate in pulp capping procedures [107,108]. Compend Contin Educ Dent. 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. Studies on indirect pulp capping had clinical success ranging from 73 to 97% after a follow-up period of 2 weeks to 11 years . Logistic regression was performed to identify significant clinical and demographical factors associated with the success of the indirect pulp capping. Direct pulp capping Indirect pulp capping 15. 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. J Clin Pediatr Dent. Only age had a significant effect on the pulpal survival rate: the success rate was 90.9% in patients younger than 40 years and 73.8% in patients 40 years or older (P = .0480). Calcium hydroxide liners increased the success rate of IPT. [9], Materials that fall under this category include 4-META-MMA-TBB adhesives and hybridizing dentine bonding agents. J Clin Pediatr Dent. These materials, protect the pulp from noxious agents (heat, cold, bacteria) and stimulate the cell-rich zone of the pulp to lay down a bridge of reparative dentin. An Indirect pulp cap is where, in a permanent tooth, most of the decay is removed. [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. The following materials have been studied as potential materials for direct pulp capping. [9] The material comprises a blend of tricalcium silicate, dicalcium silicate and tricalcium aluminate; bismuth oxide is added to give the cement radiopaque properties to aid radiological investigation. The overall success rate was 82.6%. Factors affecting the outcomes of direct pulp capping using Biodentine. [13][16] It is suggested that an adhesive coronal restoration be used above the CaOH lining to provide adequate coronal seal. But success rates for pulpotomy decreases over time from 90% or more initially (6-12 months) to 70% or less after 3 years or more. 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. No statistical significant difference between the groups was observed (P = 0.62). [9] CaOH cement is not adhesive to tooth tissues and thus does not provide a coronal seal. Grey MTA preparations can potentially cause tooth discolouration. Success expectations for indirect and direct pulp caps. The prognosis of pulp capping (both direct and indirect) varies with success rates ranging from 13 percent to 100 percent. Indirect pulp capping in the primary dentition: a four year follow-up study. [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%. This can lead to the pulp of the tooth either being exposed or nearly exposed which causes pulpitis (inflammation). However, they are not a material of choice for direct pulp capping. RESULTS: The overall success rate was 100% in the absence of preoperative pain. To prevent the pulp from deteriorating when a dental restoration gets near the pulp, the dentist will place a small amount of a sedative dressing, such as calcium hydroxide or MTA. irreversible pulpitis) and a bacteria-tight seal can be applied. At 6 months, the success rate was 89.6% with MTA, and remained steady at 73% with calcium hydroxide (P = 0.63). 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. glass ionomer or resin-modified glass ionomer) over CaOH before packing the final restorative material. One study further demonstrated that CaOH causes release of growth factors TGF-B1 and bioactive molecules from the dentine matrix which induces the formation of dentine bridges. They had pulp dressing by indirect pulp capping technique.Results: MTA dressing (indirect pulp capping technique) is associated with 55% of the success meanwhile the use of calcium hydroxide is associated with 60% succes rate. When dental caries is removed from a tooth, all or most of the infected and softened enamel and dentin are removed. In this study, the success rate for Biodentine™ after 24 months became 77.8% due to the lower recall rate and for Fuji IX™ was 66.7%. 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