it will provide u a detail description about direct pulp capping treatment,its indication ,contraindication,methods and materials used,techniqes,advantage and disadvantage and its limitation on primary teeth

1. DON’T KILL THE PULP DIRECT
PULP CAPPING IS HERE
N.MOHAMED
RAHMAN KHAN
BDS -CRRI

2. INTRODUCTION
• Pulp is defined as soft tissue forming inner
structure of tooth and containing nerve and
blood vessel , also called as tooth pulp.
• The primary objective of pulp treatment of an
affected tooth is to maintain the integrity and
health of oral tissues.

3. PULP THERAPY
VITAL PULP THERAPY NON-VITAL PULP THERAPY
Apexogenesis
Pulpotomy
Pulpectomypulp capping
-direct
-indirect
Apexification
Pulpectomy
Non-vital
Pulpotomy

4. PULP CAPPING
• Pulp capping is a technique used in dental
restoration to prevent the dental pulp from
dying after being exposed or nearly exposed
during a cavity preparation
• Maintaining the vitality of the pulp and thus
the integrity of the tooth

5. • Direct pulp capping
• Indirect pulp capping

7. DIRECT PULP CAPPING
DEFINITION:
• It is the protection of a pulp exposed by
traumatic fracture or in the course of
excavating deep dentinal caries .
• Protection is provided by placing a medicated
or non-medicated material in direct contact
with the pulp tissues to promote a reparative
reaction.

8. • RATIONALE:
Encouragement of young, healthy pulps to
initiate a dentin bridge, thus walling of the
exposure site.

9. • OBJECTIVES:
1. Preservation of vitality of radicular pulp
2. No post treatment signs and symptoms like
swelling ,pain or sensitivity
3. Ensuring the continuity of the normal
apexogenesis in immature permanent teeth
4. Pulp healing and tertiary dentin formation
should result
5. There should be no pathological change

10. INDICATIONS
• Accidental pin point exposure of the pulp when
excavating deep caries ,less than 1 sq.mm.
surrounded by clean dentin [<24 hrs]
• Traumatic fracture of tooth[<24 hrs] with pin point
exposure.
• Iatrogenic exposure during cavity preparation &
crown preparation

11. • Asymtomatic teeth
• Bleed if touched but not excessively and
controlled easily with cotton pellet
• Normal vitality test without tender to
percussion
• No radiographic evidence of peri-radicular
pathology
• Young patients

12. CONTRA-INDICATIONS
• Large pulp exposure
• History of spontaneous tooth pain
• pain at nights
• Presence of caries surrounding the teeth
• Excessive tooth mobility
• Periodontal ligament thickening
• Intra-radicular radiolucency

13. • Excessive bleeding at exposure site
• Purulent , serous exuade from exposure
• External or internal resorption
• Swelling
• fistula with associated tooth.
• Root resorption
• Pulpal calcification

14. TREATMENT CONSIDERATION
• Debridement:
Necrotic and infected dentin chips should
be removed else they will invariably pushed into the
exposed pulp during last stages of caries removal and
impede healing and increase pulpal inflammation.

15. Pulp capping procedure
• In the first appointment:
• Anesthesia and apply rubber dam
• At, the exposure site ,any further
manipulation is avoided ;only irrigate with
saline or distilled water
• Bleeding is stopped by applying minimal
pressure with cotton pellet

18. • Place calcium hydroxide or MTA at exposure .if
you use dMTA , then place wet cotton over it
• Place temporary filling material and recall
after 6-8 weeks.

19. Pulp capping procedure
• In the second appointment :
• If patient was asymptomatic;
• No pain
• Pulp vitality tests positive
• No radiographic changes
• Formation of dentinal bridge on radiograph
• In that case , remove temporary filling and
cotton and replace with final restoration

20. SALIENT FEATURES OF
SUCCESSFUL DPC
• Dentine briding
• Maintenance of pulp vitality
• lack of undue sensitivity or pain
• Minimum pulpal inflammation response
• Ability of pulp to maintain itself without
progressive degeneration
• Lack of internal resorption and interradicular
pathosis

21. Pulp capping agents
• Calcium hydroxide paste
• MTA(mineral trioxide aggregate)
• Isobutyl cyanoacrylate
• Laser
• Denaturated albumin

22. CALCIUM HYDROXIDE[ca(OH)2]
• When calcium hydroxide is applied directly to the
pulpal tissue, there is necrosis of the adjacent
pulp tissue and inflammation of the contiguous
tissue.
• Compound of similar alkanity cause liquefication
necrosis when applied to pulpal tissue
• The action of calcium hydroxide in the form of
dentin bridge to be result of low grade irritation
in the underlying pulpal tissue the after
application

23. • The greatest benefit of ca[0H]2 is the stimulation of
reparative dentin bridge
due to a high alkanity of ca[OH]2
which leads to enzyme phosphatase being activated
releasing of inorganic phosphate from the
blood [calcium phosphate]
leading to formation of dentinal bridge
• It also has a anti-bacterial property

24. • Isobutyl cyanoacrylate:
it is an excellent pulp capping agent because of
its
• haemostatic and bacteriostatic properties
• Less inflammation than calcium hydroxide
Disadvantage:
cytotoxic when freshly applied
• Denaturated albumin:
This protein has calcium binding properties .if a
pulp is capped with a protein , the protein may became
a matrix for calcification ,threby increasing the chance
of biological obliteration

25. • Mineral trioxide aggregate (MTA):
it is the ash coloured powder made primarily of fine
hydrophillic particles
• Tricalcium aluminates
• Tricalcium silicates
• Silicate oxide
• Tricalcium oxide and
• Bismuth oxide
• When compared with ca(OH)2 ,MTA produced
significantly more dentinal bridging in shorter period
of time with significantly less inflammation
• Dentin deposition has began earlier with MTA

26. • Disadvantage:
3 to 4 hours is needed for setting of MTA
after placement .
Procedure:

27. Procedure:
• It involve placing MTA directly over the
exposure site and sealing the tooth
temporarily with to allow the tooth to be
harden
• Tooth later re-entered and GIC is permanently
sealed over the set MTA .
• And etched, denin bonding agent and
composite resin to prevent future bacterial
micro-leakage

28. • Advantage over ca(oH)2:
1. Thicker dentinal bridge
2. Less inflammation
3. Less hyperemia
4. Less pulpal necrosis
5. Dentin bridge formation at faster rate

29. FACTORS INFLUENSING PROGNOSIS OF
DIRECT PULP CAPPING

30. IS THERE LIMITATIONS FOR
DIRECT PULP CAPPING
IN
PRIMARY TEETH

31. • Primary and permanent teeth responds
differantly to trauma, bacterial invasion ,
irritation,medication etc.
• Reason for it:
Localisation of infection and inflammation
in primary teeth is poorer than in permanent
teeth

32. • Primary pulp more closer to outer enamel
surface and are rapidly infected by caries lesion
on abundent
• Wide apical foramina in primary teeth leads to
abundant blood supply which make DPC
unfavourable

33. • Higher cellular content in primary pulp which
might be reponsible for failures
• caries or pulp capping material may stimulate
Undifferatiated mesenchymal cells to
differantiate into osteoclasts which could lead
to internal resorption

34. • Internal resorption , calcification ,chronic
inflammation and interradicular involvement
worsen the success rate of DPC in primary
teeth
• Whereas ,Formocresol pulpotomy exhibits
higher rates of success than calcium hydroxide
pulp capping in primary teeth

35. CONCLUSION
• Direct pulp capping is a procedure used in asymptomatic
teeth with deep caries reaching upto pulp
• On placing a suitable medicament , it is the best method
that maintain pulp vitality and function ,promotes healing
,prevent breakdown of peri-radicular supporting tissues
and induce dentin bridge formation in permanent teeth.
• Pulpotomy is better than pulp capping in primary teeth
(mechanically or caries exposure).
• Whereas, direct pulp capping can be applied for non
carious traumatic exposure in primary teeth

36. THANK YOU…!