The document discusses various pulp therapy techniques for young permanent teeth including indirect pulp capping, direct pulp capping, Cvek pulpotomy, apexogenesis, apexification, and regenerative endodontics. Important factors to consider include assessing for signs of reversible pulpitis. Indirect pulp capping involves sealing a deep lesion near the pulp with a protective material while direct pulp capping places a material directly over an exposure site after controlling bleeding. Pulpotomy removes inflamed pulp from the crown while leaving healthy tissue in the root canals. Apexogenesis treats immature teeth to allow continued root development while apexification induces a barrier in nonvital open apices. Regenerative endodontics aims

1. Pulp Therapy In Young Permanent Teeth
Dr Isma Sajjad
Assistant Professor
Operative Department

2. Methods
Indirect Pulp Capping
Direct Pulp Capping
Cvek Pulpotomy
Apexogenesis
Apexification
Regenerative Endodontics

3. Important factors
It is important to assess the situation correctly before embarking on the treatment for all
techniques in which the pulp is preserved. It is important that:
 There is no history of spontaneous pain
 There is no swelling, mobility, or discomfort to percussion
 There is a normal periodontal appearance radiographically
 Pulp tissue appears normal and vital
 Cessation of bleeding from the pulp exposure site with isotonic irrigation
occurs within 2 minutes.

4. Aims and objective of pulp capping
 Provide conducive environment for reactionary dentine formation.
 Promote remineralization of dental caries.
 Preserve /maintain pulpal health .

5. Indirect pulp capping
Indications :
Large carious lesion in close proximity to the pulp.
Normal laminadura.
Normal periodontal ligament space.
No interradicular or periapical radiolucency.
Contraindications :
Large carious lesion with apparent pulp exposure.
Interrupted or broken laminadura ,Widened periodontal ligament space.
Radiolucency at the root apices or furcation areas.

6. Indirect pulp capping

7. Procedure of indirect pulp capping
A very large carious lesion with a
definite risk of pulp exposure.
Remove caries from the
amelodentinal junction
Remove further soft caries from all areas
except where the operator considers that
such removal will expose the pulp.

8. Indirect pulp capping
Place a lining material placement of definitive
composite

9. Materials for Indirect Pulp capping
Traditionally, operators use calcium hydroxide for indirect pulp capping which has a
good success rate. Alternatives suggested include adhesive resins and glass ionomer
cements or silicate-based material including mineral trioxide aggregate (MTA) and
Biodentine®.
A recent randomized controlled trial found that although a higher clinical success
rate, measured by the thickness of the dentine bridge, was observed in the MTA group
than in the calcium hydroxide group after 3 months.

10. Direct pulp capping
Steps :
Caries removal (Iatrogenic pulp exposure) or Traumatic injuries .
Hemostatic agent (control bleeding at site of pulp exposure )
 various concentrations of NaOCl.
 2% chlorhexidine.
 MTAD (DENTSPLY Tulsa Dental Specialties, Tulsa, Oklahoma).
 30% hydrogen peroxide (Superoxol).
 Ferric sulfate; disinfectants,such as Tubulicid (Global Dental Products, North Bellmore,New York).
 Epinephrine.
 Direct pressure with cotton pellets soaked in sterile water or saline.
 Lasers
 Sodium hypochlorite in concentrations of 1.5% to 6% is currently regarded as the most effective, safe, and inexpensive
hemostatic solution for pulp capping and partial and complete pulpotomy procedures.

11. Direct pulp capping

12. Direct pulp capping

13. Direct pulp capping

14. Direct pulp capping

15. Pulpotomy
The pulpotomy procedure involves removing only part of the pulp,
eliminating tissue that has inflammatory or degenerative changes and
leaving intact the underlying healthy pulp tissue.

16. Cvek pulpotomy
Cvek described a pulpotomy technique in which only the superficial 2 to 3 mm of
hyperplastic inflamed tissue was removed with a water-cooled, high-speed diamond
bur97 to place the wound in a healthy site. Hemostasis was then secured before
capping with an appropriate material.
 Persistent bleeding from an inflamed pulp usually indicates that the tissue should
be resected at a deeper level to preserve a vital apical pulp stump.

17. Pulpotomy

18. Apexogenesis

19. Apexogenesis

20. Apexogenesis

21. Apexification
Apexification, or root-end closure, is the process in which a nonvital,
immature, permanent tooth that has lost the capacity for further root
development is induced to form a calcified barrier at the root terminus.

22. Apexification

23. Calcium hydroxide induced Apical barrier

24. Apexification

25. MTA induced Apexification

26. Apexification

27. Role of Regenerative Endodontics
 Regenerative Endodontic approach referring to create new tissue in previously
necrotic tooth which leads to continued physiological growth of immature root.
 Identified population of stem cells, the so-called stem cells from apical papilla
(SCAP) cells a hidden treasure with enormous potential for tissue regeneration
and bio root engineering.
 The potential of bioengineering is huge, and work continues to optimize scaffolds
that may encourage revascularization of the pulp space and to explore the options
of seeding cell populations into the properly sterilized pulp spaces of immature
teeth.

28. Technique

29. References
Pathways of pulp 12th edition
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