This document provides an overview of vital pulp therapy techniques including direct pulp capping, indirect pulp capping, and pulpotomy. It defines each technique and discusses indications, contraindications, procedures, and materials used. Direct pulp capping involves placing a material directly on an exposed pulp to facilitate reparative dentin formation. Indirect pulp capping treats deep lesions near but not exposing the pulp. Pulpotomy involves removing coronal pulp and placing a medicament on radicular pulp stumps to promote healing. Common materials discussed include calcium hydroxide, MTA, and formocresol. Histologic outcomes and the properties of each material are also summarized.

1. PRESENTED BY DR. SRAVYANJALI

2. CONTENTS
Introduction
Classification
Direct pulp capping
Indirect pulp capping
Pulp capping agents
PULPOTOMY
•FORMOCRESOL PULPOTOMY
•PARTIAL PULPOTOMY
•COMPLETE PULPOTOMY
•GLUTRALDEHYDE PULPOTOMY
NON PHARMACOTHERAPEUTIC PULPOTOMY TECHNIQUE
•ELECTRO SURGICAL PULPOTOMY
•LASER PULPOTOMY
•FERRIC SULPHATE PULPOTOMY
CURRENT CONCEPT IN PULPOTOMY
•PROPOLIS
•APEXOGENESIS
•CONCLUSION
RECENT ADVANCEMENTS IN VITAL PULP THERAPY

3. INTRODUCTION
Vital pulp therapy is designed to preserve and maintain
pulpal health in a teeth that have been exposed to trauma,
caries, restorative procedures, and anatomic anomalies.
The treatment can be completed for permanent teeth that
show reversible pulpal injuries, and the outcomes depend
on a variety of factors.
The prime objective in vital pulp therapy is to initiate the
formation of tertiary reparative dentin or calcific bridge
formation.
(COHEN 11TH EDITION )

4. CLASSIFICATION
VITAL PULP
THERAPY
INDIRECT PULP
CAPPING (IPC)
DIRECT PULP
CAPPING (DPC)
PULPOTOMY APEXOGENESIS

5. DIRECT PULP CAPPING

6. American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference
Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2022:415-23.
DIRECT PULP CAPPING
Direct pulp capping is defined as the “treatment of an exposed vital
pulp by sealing the pulpal wound with a dental material placed
directly on a mechanical or traumatic exposure to facilitate the
formation of reparative dentin and maintenance of the vital pulp.
•(Ingle 7th edition )
When a pinpoint exposure (one millimeter or less) of the pulp is
encountered during cavity preparation or following a traumatic
injury, a biocompatible radiopaque base such as MTA or calcium
hydroxide should be placed in contact with the exposed pulp
tissue. The tooth is restored with a material that seals the tooth
from microleakage.
•(AAPD 2020))

7. Direct pulp capping is defined as “placing a dental material directly on a
mechanical or traumatic vital pulp exposure” and “sealing the pulpal wound to
facilitate the formation of reparative dentin and maintenance of the vital pulp.
(Cohen 11th edition )

8. American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference
Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2022:415-23
OBJECTIVES (AAPD2020)
The tooth’s vitality should be maintained.
No post treatment signs or symptoms such as sensitivity, pain, or
swelling should be evident.
Pulp healing and reparative dentin formation.
There should be no radiographic signs of pathology.
No Internal root resorption or furcation/apical radiolucency.

9. INDICATIONS
Accidental pin point exposure of pulp when excavating deep caries, less than 1 mm surrounded by
clean dentin.
Traumatic fracture of tooth with pin point exposure
Iatrogenic exposure during cavity preparation & crown preparation
Normal vitality test without tender to percussion
No radiographic evidence of periradicular pathology
Young patient
American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference
Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2022:415-23

10. CONTRAINDICATIONS
History of severe spontaneous tooth aches at night
Excessive tooth mobility
Periodontal ligament thickening
Intraradicular radiolucency
Excessive bleeding at exposure site
External or internal resorption
Swelling and fistula with associated tooth

11. Procedureofdpc
Once an exposure is encountered, further
manipulation of pulp is avoided
Cavity should be irrigated with saline or distilled
water or chlorhexidine
Hemorrhage is arrested with light pressure from
sterile cotton pellets

12. Place temporary restoration
Place the pulp capping material, on the
exposed pulp with application of minimal
pressure so as to avoid forcing the material
into pulp chamber

13. Final restoration is done after determining the success which is
done by determination of dentinal bridge, maintenance of pulp
vitality and lack of pain.

15. FACTORS AFFECTING SUCCESS OF DPC
Size of expo: Small 1mm diameter > large exposure
Vascularity of pulp
Sterile > contaminated
Location: pulpal floor > axial wall
Age: Young > Old

16. INDIRECT PULP CAPPING

17. INDIRECT PULP CAPPING
INDIRECT PULP CAPPING is defined as a procedure
wherein small amount of carious dentin is retained in
deep areas of cavity to avoid exposure of pulp,
followed by placement of a suitable medicament and
restorative material that seals off the carious dentin and
encourages pulp recovery
• (Ingle 7th edition )
Indirect pulp capping is defined by the AAPD as “a
procedure performed in a tooth with a deep carious
lesion approximating the pulp but without signs or
symptoms of pulp degeneration”. Indirect pulp
treatment is indicated in a permanent tooth diagnosed
with a normal pulp with no signs or symptoms of pulpitis
or with a diagnosis of irreversible pulpitis
• (Cohen 11th edition)

18. INDICATIONS
Deep carious lesion, which is close to, but not involving
the pulp.
In vital primary or young permanent teeth.
Pulpal inflammation adjudged to be minimal.
PAIN HISTORY
• Mild pain associated with eating.
• Dull aching
• No spontaneous pain

19. • No gingival pathological
condition.
• No mobility and large
carious lesion.
CLINICAL
EXAMINATION
• Normal lamina dura and
PDL space.
• No periapical radiolucency.
• No furaction involvement.
RADIOGRAPHIC
EXAMINATION

20. CONTRAINDICATIONS
Sharp, penetrating pulpalgia indicating acute pulpal inflammation.
• Prolonged night pain
• Discoloration of the tooth.
• Mobility of the tooth.
• Negative reaction of electric pulp testing.
• Soft leathery dentine covering a very large area of the cavity, in a non restorable tooth.
• Definite pulp exposure.
• Any signs of pulpal or periapical pathology.
• Interrupted or broken lamina dura.

21. OBJECTIVES
The vitality of the tooth should be preserved.
The restorative material should seal completely the involved dentine from the oral environment.
No prolonged post-treatment signs or symptoms of sensitivity, pain or swelling should be evident.
Remineralization of carious dentine.
Arresting of carious process.
The pulp should respond favourably and tertiary or reparative dentine should be formed, as
evidenced by radiographic evaluation.
There should be no evidence of internal resorption or other pathologic changes.
AAPD's guidelines on pulp therapy for primary and immature permanent teeth(
MARCH 2013)

22. TREATMENT PROCEDURE

26. OUTCOME OF IPC
3 distinct
types of
new
dentin
formation
take place
Cellular fibrillar dentin -first 2 months
Globular dentin -3 months
Tubular dentin (uniform mineralized dentin): One-fifth of reparative dentin formation
begins in less than 30 days.
After 3 months, 0. 1 mm is formed.
Pulp capping agent
Most frequent used material for indirect pulp capping is Dycal (calcium hydroxide). This is supplied as
two-paste system, one containing base (brown) and other catalyst (white)

27. PULP CAPPING AGENTS

28. The first method of capping exposed pulps, using gold
foils was described by Pfaff in 1756.
Therefore, numerous agents for direct pulp capping have
been recommended. (Dammaschke T, 2008)

29. Ca(OH)2 ZOE MTA
GROWTH
FACTORS
OTHERS
•Corticosteroids and antibiotics
•Polycarboxylate cements
•Inert materials
•Collagen fibers
•Formocresol
•Bonding agents

30. CALCIUM
HYDROXIDE
The use of calcium hydroxide in endodontics was
introduced by Hermann in between 1920-1930.
Calcium hydroxide was most favored as a
pulpotomy agent in the 1940s and mid- 1950s.
“Calcium hydroxide has the ability to form
reparative dentin”, this rationale was introduced by
Teuscher and Zander in 1938.
Calcium hydroxide was introduced to the dental
profession in 1921 and has been considered the “gold
standard” of direct pulp capping materials for several
decades.
Grossmam 13th edition

31. Necrotic zone is further replaced by dentin bridge. (Holland R et al. 1979)
When calcium hydroxide is applied directly to pulp tissue, there is necrosis of the adjacent
pulp tissue and inflammation that cause liquefaction necrosis to the applied to pulp tissue.
Due to a high alkalinity, which leads to enzyme phosphatase being activated and thus
releasing of inorganic phosphate from the blood leading to formation or dentinal bridge.
The greatest benefit of Ca(OH)2 is the stimulation of reparative dentin bridge

32. ADVANTAGES
• Reparative dentin formation
• Antibacterial action
• Pulp protection
• The tissue-dissolving property
DISADVANTAGES
• Pulp obliteration
• Internal resorption
• Lack of adhesion to hard tissues
• Microleakage
• Short working time of self cured preparation

33. HISTOLOGY OF HEALING AFTER PULP
CAPPING WITH CA(OH)2
THREE
DISTINCT
ZONE CAN
BE
VISUALISED:
• Zone of obliteration
• Zone of coagulation
necrosis
• Zone of dentin bridge
formation
• Line of demarcation

34. A calcified barrier may be induced when calcium hydroxide is used as a pulp-
capping agent or placed in the root canal in contact with healthy pulpal or
periodontal tissue
2 WEEKS
6 -8WEEKS
4 WEEKS

35. Because of the high pH of the material, up to 12.5, a superficial layer of necrosis
occurs in the pulp to a depth of up to 2 mm.
Beyond this layer only a mild inflammatory response is seen, and providing the
operating field was kept free of bacteria when the material was placed, a hard tissue
barrier may be formed.

36. The alkaline pH induced not only neutralizes lactic acid from the osteoclasts,
thus preventing a dissolution of the mineral components of dentine, but could
also activate alkaline phosphatases which play an important role in hard
tissue formation.
The hydroxyl group is considered to be the most important component of
calcium hydroxide as it provides an alkaline environment which encourages
repair and active calcification.
The calcified material which is produced appears to be the product of both
odontoblasts and connective tissue cells and may be termed osteodentine. The
barrier, which is composed of osteodentine, is not always complete and is porous.

37. Zinc oxide-eugenol
• ZOE is a Germicidal agent
• Used in indirect pulp capping due to its
• This gives the pulp the chance for healing & regeneration
• Palliative affect
• Excellent initial seal
• Kills bacteria present in carious
lesions
• So arrests the caries process

38. • Glass and Zander found that ZOE, in direct contact with the pulp tissue, produced
chronic inflammation, a lack of calcific barrier, and an end result of necrosis.
• Hembree and Andrews, in a literature review of ZOE used as a DPC material,
could find no positive recommendations. Watts also found mild to moderate
inflammation and no calcific bridges in the specimens under his study, and this
was confirmed by Holland et al.
• Weiss and Bjorvatn, on the other hand, noted negligible necrosis of the pulp in
direct contact with ZOE but stated that any calcific bridging of an exposure site
was probably a layer of dentinal chips.
• Sven reported 87% success with the capping of primary teeth with ZOE in ideal
situations of pulp exposure. He offered no histologic evidence, but Tronstad and
Mör, Comparing ZOE with calcium hydroxide, found ZOE more beneficial for
inflamed, exposed pulps and felt that the production of a calcific bridge is not
necessary if the pulp is free of inflammation following treatment.

39. INDICATION
1. Injurious to pulp when used as DPC agent.
2. Chronic inflammation, Internal resorption (Nixon – 1972)
3. Bridging of exposure site
4. Reparative dentin formation
5. Healing & hard tissue formation (Kitagava – 1968)

40. Mineral Trioxide Aggregate (MTA)
• MTA is a unique material with several exciting clinical applications.
• Mineral Trioxide Aggregate (MTA) was introduced by Mohmoud Taorabinejad at
Loma Linda University, California, USA in 1993
• MTA is biocompatible in nature and have excellent potential in endodontic use.
MTA provide better microleakage protection and it is a traditional endodontic
repair materials.
Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. Journal of endodontics.
1999 Mar 1;25(3):197-205.

41. • MTA is available in two types based on the color known as GRAY AND
WHITE.
• water ratio for MTA should be 3:1
• Mixing can be done on paper pad or on a glass slab using a plastic or
metal spatula to achieve putty like paste consistency.
• Immediately after mixing MTA has a pH of 10.2. After 3 hours of
setting the pH increased to 12.5.
• The pH of set MTA is almost similar to calcium hydroxide
• mixing time should be less than 4 minute.
• Torabinejad et al. (1993) found setting time about 2 hours and 45
minutes (± 5 minutes) of grey MTA and 2 hours and 20 minutes for
white MTA,

42. • MTA being hydrophilic material it requires moisture to set. Presence of
moisture during setting improves the flexural strength of the set cement.
Therefore, it is advised to place a wet cotton pellet over the MTA in the
first visit followed by placement of a permanent restoration at the second
visit. The long setting time is one of the drawbacks of MTA.
• MTA powder must be kept tight to avoid degradation by moisture. if the
mixing time is prolonged; it results in dehydration of the mixture.
• MTA may be placed into the desired location using ultrasonic
condensation, plugger, paper point or specially designed carriers like MTA
PUSHER

44. TYPE OF MTA
GREY MTA = contain tetracalcium almino ferrite { ferrous oxide } which cause GREY
discolouration , not used for ant. Tooth
WHITE MTA = ferrous oxide replaced by magnesium oxide which is not cause discolouration
• COMPOSITION
• MTA contains 50-75% of calcium hydroxide
• Tricalcium silicate
• Tricalcium aluminate
• Tricalcium oxide
• Silicate oxide
• Bismuth oxide
• 15-25% of silicon dioxide
• Bismuth oxide powder has been added to make the aggregate radiopaque
• Main 3 ingrident are
• Portland cement
• Bismuth oxide
• Gypsum
Rao A, Rao A, Shenoy R. Mineral trioxide aggregate—a review. Journal of Clinical Pediatric
Dentistry. 2009 Sep 1;34(1):1-8.

45. Properties of MTA
• PH - 10.2 at the time of mixing
• but after mixing it become 12.5
• Setting time - 3-4 hours.
• Radio opaque.
• Compressive strength - 70 MPa.
• Biocompatible.
• Non mutagenic.
• Less cytotoxicity.
• Sealing ability is very good
• with no marginal gaps.

47. PULPOTOMY

48. Pulpotomy is most widly used technique in vital pulp therapy for primary and young permanent
teeth with carious pulp exposure.
Pulpotomy is defined as the surgical removal of entire coronal pulp leaving intact the vital
radicular pulp within the canals.
A germicidal medicament is then placed over the remaining vital radicular pulp stumps at
their point of communication with the floor of the coronal pulp chamber.
This procedure is done to promote healing and retention of the vital radicular pulp.
Dentin bridging may occur as a treatment outcome of this procedure depending on the type of
medicament used.

49. PULPOTOMY

52. INDICATIONS
According to Dannenberg, pulpotomy are indicated for cariously exposed primary teeth
Absence of pathologic change
Restorability
At least two-thirds remaining root length.
Young permanent teeth with incompletely formed apices
Cariously exposed pulps that give evidence of extensive coronal tissue inflammation

53. CLASSIFICATION
VITAL
PULPOTOMY
Single Sitting:
Formocresol
Electrosurgery
Laser
Two sitting
Gysi triopaste
Easlick's
formaldehyde
Paraform
devitalising
paste
PRESERVATION
Glutaraldehyde
Ferric sulphate
MTA
REGENERATION:
(inductive &
reparative)
Bone
morphogenic
protein
Non- Vital
pulpotory
BEECHWOOD
CRESOL
FORMOCRESOL

54. CONTRAINDICATION
According To Mejare
Root Resorption Exceeds More Than One-third Of The Root Length
Tooth Crown Is Nonrestorable
Hemorrhage Is Observed At The Radicular Canal Orifices
TOP (+) Teeth
Radicular Pulp Necrosis
Radiolucency Exists In The Furcal Or Periradicular Areas

55. FORMOCRESOL PULPOTOMY
• Formocresol was introduced in 1904 by Buckley, who contended that
equal parts of formalin and tricresol would react chemically with the
intermediate and end products of pulp inflammation to form a "new,
colorless, and non-infective compound of a harmless nature
• COMPOSITION
tricresol
19% aqueous formaldehyde
glycerine
water
Formocresol pulpotomy technique currently used as an modification.

56. FORMOCRESOL PULPOTOMY TECHNIQUE IN PRIMARY TEETH
• (ONE APPOINTMENT PULPOTOMY )
This method of treatment should be carried out only on those restorable teeth in
which it has been determined that inflammation is confined to coronal portion of
pulp when coronal pulp is amputed , only vital healthy pulp should remain in the
root canal.
CONTRAINDICATION
• Tooth with spontenous pain
• Pathologic root resorption
• Two third root resorbed
• Internal root resorption
• Interradicular bone loss
• Fistula pus present in chamber

57. PROCEDURE

58. Technique
C O H E N ’ S P A T H W A Y S of the PULP, KENNETH M. HARGREAVES, LOUIS H. BERMAN ELEVENTH EDITION

59. 1. Toxicity: Ranly calculated that, over 3000 pulpotomies must be performed in the same individual for formocresol to reach
toxic level.
2. Systemic distribution: When used in pulpotomies in animals, formaldehyde has been found in periodontal ligament, bone,
dentine and urine.
3. Antigenocity: Thoden Valzen in 1977 has shown immunogenic potential of formaldehyde in rabbits, dogs and guinea pigs.
4. Mutagenicity and cytogenicity: Nongentini in 1980 postulated that mutational changes were achieved by application of
formaldehyde and cytogenicity for 15 minutes, in monkey kidney cells.
Concerns about Formocresol
Milnes AR. Persuasive evidence that formocresol use in pediatric dentistry is safe. J Can Den Assoc. 2006;72:247–8

60. TWO APPOINTMENT PROCEDURE
INDICATION
• If there is sluggish and profuse bleeding at the amputation site.
• Difficulty to control bleeding.
• Thickening of pdl
• History of spontenous pain
CONTRAINDICATION
• Non restorable tooth
• Soon to be exfoliated
• Necrotic tooth

62. Partial pulpotomy/ cvek pulpotomy
• Also known as CVEK pulpotomy is define as the removal of
small portion of vital coronal pulp as a means of preserving
the remaining coronal and radicular pulp tissue.
• The coronal pulp is reduced approximately 2-3 mm in order
to remove necrotic inflamed irreversible damaged tissue.

64. C O H E N ’ S P A T H W A Y S of the PULP, KENNETH M. HARGREAVES, LOUIS H. BERMAN ELEVENTH EDITION

65. COMPLETE PULPOTOMY
• Complete pulp amputation is a more intrusive procedure defined by
AAE as a removal of the coronal portion of vital pulp as a means of
preserving the vitality of remaining radicular portion.

68. ALTERNATIVES TO FORMOCRESOL PULPOTOMY

69. GLUTRALDEHYDE PULPOTOMY
• Suggested by gravenmade that formaldehyde did not
represent ideal pulp fixation.
• Inflammed tissue that produce toxic by product should
be fixed rather then treated with strong disinfectant
• Glutraldehyde solution might replace formocresol in
endodontic therapy because of its fixative properties
and bactericidal effectiveness and result in less
destruction of tisue
• Glutraldehyde found less toxic when using 3.125 % of
concentration

70. •Bactericidal
•Superior fixative properties
•Less necrosis of pulpal tissue
•Less dystrophic calcification in pulp
canals.
•Less toxicity
•Less systemic distribution.
•Low tissue binding – 90% of it is gone
in 3 days
•Less mutagenicity and antigenicity
C O H E N ’ S P A T H W A Y S of the PULP, KENNETH M. HARGREAVES, LOUIS H. BERMAN ELEVENTH EDITION

71. Problems with glutaraldehyde
C O H E N ’ S P A T H W A Y S of the PULP, KENNETH M. HARGREAVES, LOUIS H. BERMAN ELEVENTH EDITION

72. NON PHARMACOTHERAPEUTICPULPOTOMY TECHNIQUE
CONTROLLED ENERGY
• Controlled energy in the form of laser and electrosurgical
heat application to the pulp stump at the canal orifice has
been alternative to pharmacotheraputic .

73. •Mark was the first US dentist routinely to perform electrosurgical pulpotomy in 1993 with a success rate of 99% for
primary molars.
ELECTROSURGICAL PULPOTOMY
The steps in the electrosurgical pulpotomy technique are basically the same as those for the formocresol technique
through the removal of the coronal pulp tissue.
Dental electrode is used to deliver the electric arc. The cotton pellets are quickly removed, and the electrode is placed
1 to 2 mm above the pulpal stump.
The electric arc is allowed to bridge the gap to the pulpal stump for 1 second, followed by a cool-down period of 5
seconds. Heat and electrical transfer are minimized by keeping the electrode as far from the pulpal stump and tooth
structure as possible while still allowing electric arcing.
When the procedure is properly performed, the pulpal stumps appear dry and completely blackened.
C O H E N ’ S P A T H W A Y S of the PULP, KENNETH M. HARGREAVES, LOUIS H. BERMAN ELEVENTH EDITION

75. LASER PULPOTOMY
Several reports have appeared in the literature on the use of the carbon dioxide laser for performing vital pulpotomy
on primary teeth.
Elliott RD, Roberts MW, Burkes J, et al- Evaluation
of the carbon dioxide laser on vital
human primary pulp tissue, Pediatr Dent
21:327, 1999.
Liu JF, Chen LR, Chao SY: Laser
pulpotomy of primary teeth, Pediatr Dent
21:128, 1999.
C O H E N ’ S P A T H W A Y S of the PULP, KENNETH M. HARGREAVES, LOUIS H. BERMAN ELEVENTH EDITION

77. Ferricsulphate pulpotomy
• Method of application is similar to formocresol pulpomy.
• Mechanism: agglutination of blood proteins results from the
reaction of blood with both ferric and sulphate ions.
• Agglutinated proteins form plugs to occlude capillary orifice.
• Minimises the chance of internal resorption

78. After completion of
coronal pulp amputation
and achievement of
hemostasis with moist
cotton pellets
a 15.5% solution of
ferric sulfate is
applied to the
radicular pulp
stumps for 10 to 15
seconds.
Upon removal of the
cotton pellet, the wounds
appear brown, and no
bleeding should be
evident.
If a small amount of
residual bleeding occurs,
one further application of
ferric sulfate should be
considered.
A cement base of
ZOE is placed over
the pulp stumps
and allowed to set.
technique
C O H E N ’ S P A T H W A Y S of the PULP, KENNETH M. HARGREAVES, LOUIS H. BERMAN ELEVENTH EDITION

79. CURRENT CONCEPTS IN
PULPOTOMY
MTA pulpotomy
Portland cement
Nano hydroxy apatite and BMP
Calcium enriched mixture
Allium sativum oil
Lyophilised freeze dried platelet
with calcium hydroxide.
Enamel matrix derivative
Propolis
Ankaferd blood stopper
Platelet rich plasma
Pulpotec
Calcium phosphate cement
Biodentine

80. PROPOLIS
• It is a wax - resin substance that is produced by bees.
• Shown to have antibacterial, antiviral, antifungal, immunostimulation
hypotensive and cytostatic activity mainly due to the presence of lavonoids (2-
phenyl- 1,4-benzopyrone), aromatic acids, and esters.
Rodriguez G, del Carmen W, Carpio C, Hortensia M, Ramos M, Raquel M, et al. Pulpotomies of dead pulps in temporal molars using 10%
propolis tinction. Revista Cubana De Estomatología. 2007; 44. 56.
Ozório JE, Carvalho LF, de Oliveira DA, de Sousa-Neto MD, Perez DE. Standardized Propolis Extract and Calcium Hydroxide as pulpotomy agents in primary Pig
Teeth. Journal of Dentistry for Children. 2012; 79: 53-58.
Lima RV, Esmeraldo MR, de Carvalho MG, de Oliveira PT, de Carvalho RA, da Silva FL Jr, de Brito Costa EM. Pulp Repair after pulpotomy Using Different Pulp
Capping Agents: A Comparative Histologic Analysis. Pediatric Dentistry. 2011; 33: 14-18. 57.

82. APEXOGENESIS

83. Apexogenesis is a histological term used to describe the continued physiologic development
and formation of the root’s apex in vital young permanent teeth can be accomplished by
implementing the appropriate vital pulp therapy. (AAPD)
Rationale
Maintenance of integrity of the radicular pulp tissue to allow for continued root growth.
Indications
• Indicated for traumatized or pulpally involved vital permanent tooth when root apex is
incompletely formed
• No history of spontaneous pain
• No sensitivity on percussion
• No hemorrhage
• Normal radiographic appearance.

84. CASE

85. Contraindications
• Evidence that radicular pulp has undergone degenerative changes
• Purulent drainage
• History of prolonged pain
• Necrotic debris in canal
• Periapical radiolucency

87. RECENT ADVANCEMENTS IN VITAL PULP
THERAPY MATERIALS
THERACAL LC is a light cure, resin-modified,
calcium silicate-filled liner used in direct and
indirect pulp capping which acts as a barrier and
protects the pulp.
Theracal LC is composed of tricalcium silicate
particles in a hydrophilic monomer that releases
calcium and acts as a strong base.
BIODENTINE is a biocompatible material that can
influence healing by promoting the proliferation,
migration, and adhesion of stem cells of the
human tooth pulp.
Biodentin induces the differentiation of pulp cells
into odontoblast-like cells and mineralizes the
formation of foci, similar to mineral trioxide
aggregate and calcium hydroxide

89. ACTIVA BIOACTIVE is a light-cured resin-modified
calcium silicate that was launched in 2014. It stimulates
the formation of mineralized hard tissue. Calcium ions
play a key role in material-induced proliferation and
differentiation of human dental pulp cells. Also, they
stimulate the formation of a connective apatite layer and
seal at the material- tooth interface.
EMDOGAIN is rich in amelogenin and amelin protein
that is capable of inducing a reparative process. Other
natural materials like propolis consisting of flavonoids,
phenolics, iron, zinc, and other various aromatic
compounds have shown dentin bridge formation similar
to that formed by MTA and calcium hydroxide.

90. CONCLUSION:-
“Successful treatment of pulpally involved tooth is to retain it in a healthy condition
so that it may fulfill its role as a useful component of primary and young permanent
dentition.”
- Lewis and Law