This document discusses vital pulp therapy, which aims to maintain pulp vitality when it is exposed. It describes different types of vital pulp therapy, including indirect pulp capping, direct pulp capping, pulpotomy, and apexification. Indirect pulp capping covers exposed dentin with a biocompatible material to stimulate tertiary dentin formation and prevent further exposure. Direct pulp capping places a protective material directly over an exposed pulp. Pulpotomy removes a portion of exposed pulp to preserve the remaining radicular pulp. Apexification induces a calcific barrier in a tooth with an open apex. Calcium hydroxide and MTA are commonly used capping agents, with MTA having advantages like better bi

1. Presentation By:
SWALIHA ALTHAF
VITAL PULP THERAPY

2. WHAT IS VITAL PULPTHERAPY?
• Vital pulp therapy is the treatment initiated
on an exposed pulp to repair and
maintain the pulp vitality.
• All these procedures involve removal of
local irritant and placement of
protective material directly or indirectly
over the pulp.
• Common objective is to induce a
physical protective barrier over pulp
to maintain its vitality and function.

3. TYPES OF VITAL PULPTHERAPY
• Indirect Pulp Capping
• Direct Pulp Capping
• Pulpotomy
• Apexification

4. INDIRECT PULP CAPPING
• Indirect pulp capping is defined as a procedure
wherein 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.
• The ultimate objective is to preserve the vitality of
the pulp by completely removing the carious
infected dentin followed by placement of material
that would enable the affected dentin to re-
mineralize by stimulating the underlying
odontoblasts to form tertiary dentin.

5. • Capping agents used: 1) Calcium hydroxide,
2) Zinc Oxide & Eugenol

6. Indications:
• Minimal pulp inflammation
• Complete removal of caries could cause pulp
exposure
Contraindications:
• Teeth with history of pain
• Teeth with inflamed pulp or peri-apical disease

7. DIRECT PULP CAPPING
• Its defined as the 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
the pulpal vitality.

10. Indications:
• Iatrogenic mechanical exposure of pulp in an
asymptomatic vital
tooth with sound dentin at the periphery.
• Small carious exposures in an asymptomatic
permanent tooth with an incomplete root formation.
• Radiographically there should be no thickening of PDL
space and no evidence of a peri-radicular lesion.
Contraindications:
• In cases of carious exposures of primary tooth.
• Large carious exposures in symptomatic permanent
tooth.

11. APEXIFICATION
• Its defined as a method to induce a calcific
barrier across an open apex of an immature,
pulpless tooth.
• Objective: The aim of apexification is to
induce either closure of the open apical
third of the root canal or the formation of an
apical “calcific barrier” against which
obturation can be achieved.
• Agents used: Calcium hydroxide or MTA.

14. PULPOTO
MY
• Its defined as a procedure in which a portion of
exposed vital pulp is surgically removed as a
means of preserving the vitality and function of
the remaining radicular portion. The procedure
is similar in concept to direct pulp capping
except in the amount and extent of pulp tissue
removal.
• Objectives: 1) Preservation of vitality of
radicular pulp.
• 2) Relief of pain in patients with acute
pulpalgia and inflammatory changes in the
tissue.
• 3) Ensuring the continuation of normal

15. Indications:
• Young permanent teeth (Immature apex)
• Deciduous teeth (with coronal pulp inflammation)
• Emergency treatment for permanent teeth (not
definitive treatment)
Contraindications:
• Spontaneous pain
• Swelling or fistula
• Uncontrollable hemorrhage
• Purulent exudate
• Non-restorable tooth
• Periapical lesion

17. IDEAL PROPERTIES OF PULP
CAPPING AGENTS

18. CALCIUM
HYDROXIDE
•In 1920, a new era in the treatment of
exposed pulp began when Hermann
introduced a calcium hydroxide mixture
that induced the bridging of the exposed
pulp with reparative dentin
•Examples : Pulpdent paste and Dycal

19. ADVANTAGES OF CALCIUM
HYDROXIDE
• Initially bactericidal then
bacteriostatic.
• Promotes healing and repair.
• High pH stimulates fibroblasts.
• Neutralizes low pH of acids.
• Stops internal resorption.
• Inexpensive and easy to use.

20. DISADVANTAGES
OF CALCIUM HYDROXIDE
• Does not exclusively stimulate dentinogenesis
• Does exclusively stimulate reparative dentin.
• Associated with primary tooth resorption.
• May dissolve after one year with cavo-surface
dissolution.
• May degrade during acid etching.
• Degrades upon tooth flexure.
• Marginal failure with amalgam condensation.
• Does not adhere to dentin or resin restoration.

21. MTA
(MINERAL TRIOXIDEAGGREGATE)
Composition:
• Tricalcium silicate
• Dicalcium silicate
• Tricalcium aluminate
• Tetracalcium alumino ferrite
• Bismuth oxide
• Traces of free crystalline silica
• Other trace constituents include calcium oxide,
free magnesium oxide, potassium & sodium
sulphate compounds

23. ADVANTAGES OF MTA
• Produces more dentinal bridging with superior
structural integrity than calcium hydroxide in a
shorter span
• Better resistance to bacterial penetration
• Highly biocompatible
• Set MTA is alkaline and may induce
dentinogenesis
• Hydrophilic
• Significant antimicrobial activity
• Presence of blood has little impact on the
degree of leakage of MTA

24. DISADVANTAGES OF MTA
• Discoloration potential.
• Presence of toxic elements in the material
composition.
• Difficult handling characteristics.
• Long setting time.
• High material cost.
• An absence of a known solvent for this
material and the
difficulty of its removal after curing.
• Difficulty in obturation of curved root canals.

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