Vital Pulp Therapy In Cariously Exposed Permanent Teeth And Its Limitations

Abstract

Vital pulp therapy for cariously exposed permanent teeth remains one of the most controversial areas in dentistry. Because a vital, functioning pulp is capable of initiating several defence mechanisms to protect the body from bacterial invasion, it is beneficial to preserve the vitality and health of an exposed pulp rather than replace it with a root filling material following pulp exposure. There is no consensus on the survival rate of formerly cariously exposed pulps. Observation time, judgement criteria, pulpotomy/pulp capping technique and, most importantly, pulpal status at the time of treatment, vary to a great extent amongst studies. In mature teeth, a pulp exposed by caries is usually removed and the root canals are cleaned, shaped and filled. Amongst the methods for preservation of a cariously exposed pulp, partial pulpotomy has yielded a markedly high success rate in young teeth. Major limitations in the success of vital pulp therapy in cariously exposed permanent teeth exist. The lack of predictability and long-term success greatly influence decision-making. The decision-making itself is unreliable primarily due to the difficulty of accurately diagnosing the ability of the pulp to repair. While there are indications for vital pulp therapy in young permanent molars, it must be remembered that ultimately, none of these procedures enjoy the long-term success of complete root canal therapy.

Incorporation of anti-inflammatory agent into calcium hydroxide pulp capping material: An in vitro study of physical and mechanical properties

“…The pulp capping materials should also provide good sealing ability 3,4) . The major problems with vital pulp therapy are the unpredictable severity of the inflammatory condition of the underlying tissue and variable long-term clinical success 5,6) . Chronic inflammation in dental pulp tissue may lead ultimately to degenerative pulp response or pulp necrosis.…”

The Rehabilitation of Permanent Teeth with Complicated Crown Fracture by MTA Pulpotomy and Re-Attachment: Case Series Report Study and Literature Review

“…In addition, in cases where MTA is used, the dentine bridge has been shown to be thicker and more regular, the rate of bridge formation is greater and as the impermeability is very good, the underlying tissues are better protected with less inflammation and hyperemia [20]. Following amputations made with MTA, it has been reported that colouring in the teeth may be seen [21]. Therefore, the use of white-coloured MTA is recommended [22].…”

Discussing a Forensic Dental Examination of 1861 – A Scientific and Historic Overview

“…Moreover, failure to protect the pulp can lead to infection caused by remaining bacteria. In any case, the vitality of the dental pulp of an aged person appears to be weaker than that of a young person [28]. Discussing about caries, it is important to note that just in the 1870's, a foot-powered drill and a fully adjustable chair were created by an innovator called James Beall Morrison in order to treat caries more effectively [29].…”