Present status and future directions—Vital pulp treatment and pulp preservation strategies

Abstract

Therapeutic strategies focussed on the pulp preservation, are important when managing vital teeth with deep caries and an exposed pulp. These vital pulp treatments (VPTs); however, are not new, with indirect and direct pulp capping procedures being described as a therapy for carious teeth for over a century. As a result of unpredictable outcomes, the traditional indications for VPT particularly when the pulp was exposed were limited to the treatment of immature teeth with incomplete root formation. Over the last 20 years, the advent of regenerative endodontics and the promotion of biologically based therapies aimed at reducing intervention have reinvigorated VPT with new waves of basic science and clinical research indicating a role for VPT not only in mature cariously affected teeth, but also in teeth with signs and symptoms indicative of irreversible pulpitis. Driven by new materials such as hydraulic calcium silicate cements, a better understanding of pulpal immunity and biology as well and improved tissue handling, VPT has been at the forefront of treatment recommendations made by global Cariology and Endodontic organizations.Care must be exercised, however, as key gaps in scientific knowledge remain alongside severe limitations in educational dissemination amongst dentists. Although research has highlighted that carious injury to the dentine-pulp complex stimulates a wide range of responses and that the interaction between infection, inflammation and repair will eventually impact on the outcome of pulpitis, our ability to accurately and objectively diagnose the true inflammatory state of the pulp remains poor. An overreliance on symptoms leaves clinicians with subjective, crude diagnostic tools by which to inform treatment planning and decision-making, which results in large variations in the treatments offered to patients. Not only is there an urgent need to develop preoperative and intraoperative diagnostic tools, but there is also a paucity of the high-quality comparative evidence required to answer the most important questions and justify treatment options. The aim of this review was to consider the current status of VPT and to discuss the principle problems that are hindering clinical acceptance of these techniques. Potential solutions and opportunities are offered to suggest ways that VPT may become a more consistently prescribed evidencedbased treatment in dental practice.How to cite this article: Duncan, H.F. ( 2022) Present status and future directions-Vital pulp treatment and pulp preservation strategies.

Vital Pulp Therapy of Permanent Teeth with Reversible or Irreversible Pulpitis: An Overview of the Literature

“…The ability to accurately and objectively diagnose the true inflammatory state of the pulp and the lack of consensus in decision-making represent two major issues in the chance to perform VPT on permanent teeth [ 47 ]. In addition, VPT presents a low cost/effectiveness ratio and requires a specific tissue handling and management that could represent a clinical limit [ 48 ].…”

Comparative cytocompatibility of the new calcium silicate-based cement NeoPutty versus NeoMTA Plus and MTA on human dental pulp cells: an in vitro study

“…Vital pulp therapy (VPT) embraces a series of conservative procedures [ 1 ] that aim to treat the dentin-pulp complex that has been injured due to dental trauma, carious lesions, iatrogenic events, or during restorative treatment [ 2 ]. VPT is indicated in those cases where there are signs and/or symptoms of reversible or even irreversible pulpitis, and no periapical lesions of endodontic origin are present [ 3 ].…”

Inflammation of the Human Dental Pulp Induces Phosphorylation of eNOS at Thr495 in Blood Vessels

“…The reparative tertiary dentin is formed by pulpal stem cells following the death of primary odontoblasts with or without opening of the dental pulp after extremely deep dentin caries [ 10 , 11 , 20 , 21 ]. In the treatment of teeth with deep caries and exposed pulp, vital pulp treatment strategies are important to preserve the vitality of the dental pulp [ 21 , 22 ]. When treating a carious lesion with clinical symptoms suggestive of irreversible pulpitis, pulp capping is generally not the treatment of choice [ 23 ].…”