Vital Pulp Therapy

2. WHAT IS VITAL PULP THERAPY?
• 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. GOALS
• Treat reversible pulpal injuries.
• Neutralization of any existing pulpal
contamination.
• Prevention of further contamination (micro-
leakage).

4. TYPES OF VITAL PULP THERAPY
• Indirect Pulp Capping
• Direct Pulp Capping
• Pulpotomy
• Apexification

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

7. 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

8. 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.

12. 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.

14. 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.

17. PULPOTOMY
• 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 apexogenesis in immature
permanent teeth by retaining the vitality of pulp

18. 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

21. IDEAL PROPERTIES OF PULP CAPPING AGENTS

22. 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

24. 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.

25. 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.

26. MTA (MINERAL TRIOXIDE AGGREGATE)
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

29. 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

30. 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.