by : Group E

introduction
Dental caries is defined as a microbiological disease of the hard structure of

teeth, which results in localized demineralization of the inorganic portion and

destruction of the organic substances of the tooth. A consensus document

recently defined deep caries as radiographic evidence of caries reaching the

inner third or inner quarter of dentine with a risk of pulp exposure (Innes et al.

2016).
 infected dentine affected dentine
Outermost, superficial, irreparable, Inner layer of carious dentine which can be
necrotic zone of destruction repaired by the dentine-pulp complex
sequence of management

1.Local anaesthesia
2.Moisture
control
3.Caries removal
4.Cavity preparation (resistance and retention form)
5.Pulp capping
6.Lining
7.Definitive
restoration
 caries removal
Selective removal to Selective removal to
soft dentine firm dentine

(periphery) clean to hard (periphery) clean to hard

dentine dentine

(pulpally) remove carious (pulpally) remove carious

tissue until soft dentine is tissue until leathery or firm

reached dentine is reached

for deep carious lesion for moderate carious lesion

(ICDAS RB4 and above) (ICDAS RA3 and sometime

RB4)
 Stepwise removal

(periphery) clean to hard dentine

(pulpally) remove carious tissue until

soft dentine is reached, where a Total (non selective)

durable restoration is able to be caries removal
placed in, then open the cavity 6-

12mo later, remove the carious tissue not advocated

to firm dentine, and place a long-

term restoration

for deep carious lesion in permanent

teeth
 peripheral caries removal
Total removal of infected and affected dentine along DEJ

to provide good marginal seal for restoration

carisolv system
smartburs II
Why we need pulp protection?
Dental material may have some effects on pulp tissue

(cytotoxicity and immunosuppression)

Can destroy pulp cell

Reduce ability of pulp to respond to bacterial

invasion

Increase intrapulpulpal temperature which will

reduce pulp cell survival

 Common cause of pulp injury
Presence of bacteria in the dentin-pulp complex

Exposure of patent dentinal tubule

- Communicate directly to pulp

- Cause postoperative sensitivity

Depth of tooth preparation

- Deeper tooth preparation, higher chance of direct or indirect pulp

exposure

Heat generation

- Dentine has good insulative potential, but heat generation during

tooth preparation procedure, light curing and finishing/polishing can

injure the pulp.

- This can increase the chance of pulp necrosis.

What we need to protect pulp?

Lining

Pulp capping
 lining
Protection of pulpo-dentinal complex from

Toxic effects of restorative material/chemical insults

Microbes from penetrating at the tooth-restoration interface (gap)

Thermal fluctuation

Therapeutic effect

- ZnOE (obtundant effect to pulp)

Materials

ZnOE

GIC

Flowable composite
 pulp capping
To promote pulp healing and generate reparative dentine

Material

- Calcium hydroxide(Ca(OH)2

- Mineral Trioxide Aggregate (MTA)

 calcium hydroxide
It has been considered as the 'gold standard' of direct pulp capping

Advantages:

antibacterial effect

induce dentinogenesis and brigdging

induce hard tissue repair

long term record of clinical success

high pH - irritation of pulp tissue which stimulates repair via a mechanism which

releases bioactive molecules

Disadvantages:

highly soluble & subject to dissolution over time

non-adhesive - poor seal

 mta
Advatages:

biocompatible

antibacterial effect

high pH

radiopaque

Disadvantages:

presence of iron in the grey MTA formulation may darken the tooth

high solubility

prolonged setting time of approximately 2 hours and 45 minutes

very expensive (1g of MTA = 24g Calcium hydroxide)

 Indirect pulp capping
A material placed over deep affected dentine which is close to pulp

Indication:

- Deep caries with no signs of irreversible pulpitis

Direct pulp capping

A material placed over exposed pulp tissue that was caused by trauma/caries

Indication:

- No signs and symptoms of irreversible pulpitis

- Haemostasis can be achieved

- Moisture control with rubber dam was achieved before procedure commenced.
 How to decide when to apply pulp capping

No pulp exposure Indirect pulp capping

Deep caries/ tooth still

vital and no sign of

irreversible pulpitis Direct pulp capping

Pulp exposure

Pulpotomy
Thha
annk
k
T
y
yoou
u!!