This document discusses various aspects of direct pulp capping procedures including indications, materials, and techniques. It provides information on different types of pulp capping materials like calcium hydroxide, MTA, Biodentine and their properties and mechanisms of action in pulp healing and dentin bridge formation. The document also outlines the steps of direct pulp capping techniques including isolation, controlling bleeding, application of the capping material and restoration. Bases are described as providing insulation, bulk build up and blocking of undercuts under restorations.

2. 4
o Healing/ Repair.
o Pulp’s vitality and function.
o Normal responsiveness to
electrical and thermal pulp tests.
o Preventing breakdown of the
peri-radicular supporting tissue.
oFormation of secondary dentine.

3. Importance of remaining dentin
thickness
0.5 mm
1 mm
2 mm
Remaining
dentin
thickness
25 %
10 %
Minimal
or Nil
Effect of
toxic
substances

4. Causes of Pulpal Inflammation
Types of stimulus Examples of stimulus
Physical Thermal, electrical
Mechanical Handpiece,
traumatic occlusion
Chemical Dental materials, Caries
Biologic Bacteria from saliva

5. 6
•Immature permanent teeth or
mature permanent teeth with
simple restorative needs.
II- Indications of direct pulp capping

6. 7
Small pinpoint pulp exposure=1mm
•Recent traumatic (<24 h)/Mechanical pulp
exposure

7. 8
•Little or no bleeding at the exposure site

8. 9
•NO PULP
VITALITY

9. 10
•No pulp calcification

10. •Inflammatory signs/ symptoms 13
•primary teeth root resorption

11. 14
•Pre-operative
tooth sensitivity

12. 15
•Large
pulp exposures
•Uncontrolled
bleeding

13. 16
•Non-restorable tooth
or restorable with low
prognostic
Dentin Bridge

14. Classification and types
• CAVITY SEALERS: Varnish, Adhesive sealers
• CAVITY LINERS: Glass ionomer, Calcium hydroxide
• Bases: - 1. Zinc phosphate cement.
2. Reinforced zinc oxide / eugenol cement.
3. Zinc polycarboxylate cement.
4. Glass ionomer cement.

15. Cavity sealers
• Varnish
• Adhesive sealers
• Provide protective coating and barrier to leakage
• Coat all walls of the cavity
• Provide various degrees of seal

16. Varnish
• Material applied in thin film thickness usually 2 –
5 microns.
• It could be applied to all prepared cavities on
both enamel and dentin.
• Protective coating and Barrier to leakage
• Seals the dentinal tubules and reduces leakage
around a restoration.
• Provides no thermal
insulation

17. Varnish
Composition:
• Organic resin or synthetic gum dissolved in
solution of ether, chloroform or acetone.
• This solution evaporates rapidly after
placement on the tooth leaving a thin layer of
semi-permeable membrane.
• The thickness of this layer is 5 – 25 microns
depending on the type of the solvent and the
number of applications.

18. • Application process
– Applied with either a small disposable
applicator or a cotton pellet.
– Thin coating of the varnish on the walls, floor,
and margin of the cavity preparation.
– Apply a second coat.

19. Contraindication:
- Composite – free monomer layer dissolves the varnish
- Ca(OH)2/ ZOE beneficial affects are lost
- Polycarboxylate – interferes with adhesion
- GIC – blocks fluoride penetration.

20. Adhesive sealers
• Provide sealing as well as bonding at the
interface between restoration and cavity
preparation walls.

21. Concerns about use of adhesive sealers
under amalgam
• Barrier to corrosion products
• More technique sensitive than varnishes
• Expensive and time consuming
• Pooling of resin
• Incorporation into amalgam

22. Liners:
Definition: It is liquid in which CaOH and zinc oxide
(occasionally) are suspended in a solution of natural
or synthetic resins.

23. Composition:
1. Ca(OH) / ZnO – Therapeutic agent
2. Ethyl alcohol – Solvent
3. Ethyl cellulose – Thickening agent
4. Barium sulfate – Radiopacifier
5. Fluorides – Anticariogenic

24. Manipulation:
Trade names: Dycal and Life
It is available as 2 paste systems both of which contain
Ca(OH) and one consists of accelerator

25. Equal amounts of material from each tube is collected over a
glass slab or mixing pad with help of probe (Applicator) both
are mixed till homogeneous colour is achieved and with
same instrument it is carried.

26. - to deepest portion of the cavity and since it is fluid in
consistency it readily flows or gets painted over the cavity
over which the thermal insulating base or temporary
restoration is provided.

27. Properties:
1. Acts as a thin barrier between the restoration and the
remaining dentine and protects the pulpal tissue from
irritation caused by physical, mechanical, biological, or
chemical agents .
2. Like cavity varnish it neither possesses mechanical properties
nor provides thermal insulation.
3. Should not be applied on cavity margins.

28. Uses:
1. As pulp capping agent due to its sealing ability.
2. As anticariogenic cement because it stimulates the
production of secondary or reparative dentin.
3. Prevents post operative sensitivity or pain.
4. It is compatible with all types of restorative materials.

29. 17
IV- Pulp capping materials
•Calcium Hydroxide Ca(OH)2
•Mineral TrioxideAggregate MTA
•Tri-calcium phosphate
•Bioaggregate
•Biodentine
•Bonding Systems

30. 18
•The most common direct
pulp-capping agent
•Antibacterial and
disinfects the superficial
pulp
•High pH (about 12.5)
Pure Calcium
hydroxide
Calcium hydroxide Ca(OH)2:

31. 19
How does Ca(OH)2 work??
•Liquefaction necrosis of the superficial pulp
•Neutralization of toxicity in deeper layers
•Coagulative necrosis…Irritation of adjacent
pulp
•Minor inflammation response… Hard tissue
barrier

32. 20
•Pure calcium hydroxide are more
caustic than Hard-setting calcium
hydroxide pastes (Dycal, Life,…)
but both have been shown to
initiate the same type of healing
Properties:

33. 21
• Dentin bridges beneath calcium
hydroxide pulp caps contain ‘tunnel
defects’, therefore an additional
base material is necessary to seal the
exposed pulp from the external
environment.
•Calcium hydroxide materials tend to soften, disintegrate,
and dissolve over time.

34. 22
Mineral Trioxide Aggregate or MTA:
ProRoot
To seal communications between
the root canal system and the
external tooth surface at all
levels and recently indicated in
pulp treatment as direct pulp
capping.
Dr M.Torabinejad

35. 23
Composition:
•Tricalcium silicate
•Tricalcium aluminate
•Tricalcium oxide
•Silicate oxide
Mixed with sterile water in a 3:1 powder-to-liquid ratio,
MTAsets in 5 minutes

36. 24
Application of MTA

37. 25
Properties:
•Low or no solubility
•PH value10.2 after mixing and rises to 12.5 after 3 hours
•Antibacterial effect
•Induces pulpal cell proliferation
•Stimulation of mineralized tissue formation

38. 26
Process not yet known
Tri-calcium oxide + tissue fluids = calcium hydroxide
Hard-tissue formation
How does MTAwork??

39. 28
Tri-calcium phosphate:
- Bone regeneration procedures (promotes effects on
hard tissue formation by osteoblasts)
- Studies showed that dentinal bridge
formation does take place, by direct apposition, on the
pulpal wall
The bridge:
•Contiguous
•Thick
•Minimal pulpal inflammation
•Odontoblasts directly under and in contact with the
bridge

40. 29
Bio-Aggregate
Indicated as:
• Repair of Root Perforation
• Repair of Root Resorption
•Apexification
• Pulp Capping
Bio-Aggregate is a root canal
repair material composed of
bio-ceramic nano-particles

41. 30
Pure white powder and liquid mixed together to form
a thick paste-like mixture.

42. 32
Biodentine™ :
Active Biosilicate
Technology™ /calcium
Silicate based cement
Dentin substitute from Septodont

43. 33
Indications:
•Endodontic indications (repair of perforations or
resorptions, apexification, root-end filling)
•Permanent dentine substitute and temporary enamel
substitute
•Restoration of deep or large crown carious lesions
•Direct pulp capping in adults presenting healthy pulp

44. 34
Formulation:
Powder
Tri-calcium Silicate (C3S) Main core material
Di-calcium Silicate (C2S) Second core material
Calcium Carbonate and Oxide Filler
Iron Oxide Shade
Zirconium Oxide Radiopacifier
Liquid
Calcium chlorideAccelerator
Hydrosoluble polymer Water reducing agent

45. 40
1-Anesthesia
2- Rubber dam
VI- Techniques of direct pulp capping

46. 41
3- Chlorhexidine solution
4- Rinse with anesthetic or sterile saline

47. 42
5- sterile cotton
pellet to control
bleeding
6-Mix capping agent

48. 43
7-Apply to exposure site
8- Base/liner then restore

49. The bestPermanent filling process consists of
covering the pulp capping material with a RMGIC
followed by a hermeticcomposite resin
restoration to prevent bacterial leakage and
recontamination of the exposed area.
46

50. Bases
• Insulation
• Bulk build up
• Blocking of undercuts

51. • Resin composite exhibits low thermal
diffusivity that a thermal insulating base
should be unnecessary
• Insulating base for thermal protection should
be used under metallic restorations
• Thickness 0.5-0.75 mm