PULP CAPPING

Submitted by:
Rockey Shrivastava
Xth Batch BDS
Roll - 30

Guided by:
Dr. J N Shukla
Dr. Rahul Mishra
Dr. Madhulika
Srivastava

CONTENTS
1. INTRODUCTION
2. TREATMENT MODALITIES
3. TYPES OF PULP CAPPING
4. INDIRECT PULP CAPPING
5. PATENT DENTIN MEASURING DEVICE
6. DIRECT PULP CAPPING
7. FEATURES OF SUCCESSFUL PULP CAPPING
8. PULP CAPPING MATERIALS
9. CONCLUSION
10.REFERENCES

INTRODUCTION

TREATMENT MODALITIES

PULP TREATMENT

CONSERVATIVE
1. Protective base
Pulpectomy
2. Indirect pulp therapy
filling
3. Direct pulp therapy
4. Pulpotomy

RADICAL
1.
2. Root

PULP CAPPING

DIRECT PULP CAPPING

INDIRECT PULP CAPPING

INDIRECT PULP CAPPING THERAPY

Definition
The procedure involving a
tooth with a deep carious
lesion where carious dentin
removal is left incomplete,
and the decay process is
treated with a biocompatible
material for some time in
order to avoid pulp tissue
exposure is termed as
indirect pulp capping.

INDICATIONS
When pulp inflammation has been judged to
be minimal and complete removal of caries
would cause pulp exposure

CONTRAINDICATIONS
Any signs of
pulpal or
periapical
pathology
Soft leathery
dentin covering
a very large
area of the
cavity, in a non
restorable tooth

PROCEDURE
The tooth is anesthetized and isolated with rubber dam
All the caries except that immediately over the pulp is
removed (use large round bur at low speed)
A zone of AFFECTED demineralized dentin is left behind
Not all undermined enamel is removed
A sedative dressing of either zinc oxide eugenol or
calcium hydroxide is placed

CONTD..
The tooth may then be restored with ZOE or
amalgam
The formation of reparative dentin beneath the
caries (average rate 1.4 microns per day)
The treated tooth is re entered after 6 to 8 weeks
and the remaining caries is excavated
Pulpal protection with adequate base and permanent
restoration
(If the restoration has a good margin and at the
recall visit a layer of secondary dentin is evident ,
reentry is not necessary)

PATENT DENTIN MEASURING DEVICE

1. Electronically measures the

thickness
of
dentin
layer
above
the
pulp
chamber
during crown preparation with
a simple touch of probe
2. Color coding:
Green light safe zone
Orange light
zone
Red light
penetrating
the dentin

- limit of safe

danger of
through

3. Allows the safe preparation

of delicate cases (elongated ,
tilted or deciduous tooth)

DIRECT PULP CAPPING

Definition:
The procedure in which the small exposure of the
pulp which is encountered
During cavity preparation or
Following a traumatic injury or
Due to caries, with a sound surrounding
dentin, is dressed with an appropriate
biocompatible radio-opaque base in contact
with the exposed pulp tissue prior to placing a
restoration is termed as a direct pulp capping

LIMITATIONS IN PRIMARY TEETH

Internal resorption
Calcifications
Chronic pulp inflammation
Necrosis
Intraradicular involvement

INDICATIONS

Small mechanical exposures less than 1

mm which is surrounded by sound dentin
Light red bleeding from the exposure site
that can be controlled by cotton pellet
Traumatic exposures in a dry, clean field,
which report to the dental office within
24 hours

CONTRAINDICATIONS
Pain at night
Spontaneous pain
Tooth mobility
Thickening of periodontal membrane
intraradicular radiolucency
Excess bleeding at the exposure site
Purulent or serous exudate

PULP EXPOSURE
CALCIUM HYDROXIDE
TECHNIQUE
Hemostasis
Disinfect cavity
Calcium hydroxide
IRM
resin
modified GIC
dentin bonding
system
Restoration

DENTIN BONDING
SYSTEM

Hemostasis

Disinfect cavity

Bonding system

Adhesive

Restoration

FEATURES OF SUCCESSFUL PULP

CAPPING
Maintenance of pulp vitality
Lack of undue sensitivity or pain
Minimum inflammatory response
Lack of internal resorption and
intraradicular pathosis

PULP CAPPING AGENTS

Calcium hydroxide
Isobutyl cyanoacrylate
Resin bonding agents (hybridization)
Laser
Propolis
Other materials ( antibiotics,
corticosteroids, polycarboxylate
cements, dentin, albumin, acid, alkaline
phosphatase, chondroitin sulfate,
collagen, calcium eugenol cement,
calcitonin, barium and strontium
hydroxide, native enriched collagen
solution, hydroxyapatite)

CALCIUM HYDROXIDE
Calcium hydroxide is the
material of choice.
Herman in 1930 1st
introduced Ca(OH)2 for pulp
capping.
Ca(OH)2 causes necrosis of
adjacent pulp tissue and
inflammation of contiguous
tissue.
Dentin bridge formation
occurs at the junction of
necrotic and inflamed tissue
Pure calcium
hydroxide

ADVANTAGES AND DISADVANTAGES OF

Doesnt exclusively
stimulate
Initially CALCIUM HYDROXIDE

Dentinogenesis

bactericidal then
bacteriostatic.

Promotes healing
and repair

May dissolve after

1yr

High pH
stimulates
fibroblasts

May degrade
during acid etching
and tooth flexure

Marginal failure
with amalgam
condensation

Doesnt adhere to
dentin or resin
restoration

A D VA N TA G E S

Neutralization of
acids

Stops internal
resorption

Inexpensive and
easy to use

Particles may
obturate open
tubules

D I S A D VA N TA G E S

3 MAIN CALCIUM HYDROXIDE PRODUCTS

Pulpdent paste:52.5% calcium hydroxide

suspended in aqueous methyl cellulose
sol.
Hydrex : two paste system - calcium
hydroxide, barium sulfate, titanium
dioxide and a selected resin.
Dycal.

ISOBUTYL CYANOACRYLATE

Hemostatic and bacteriostatic

properties.
Less inflammation than calcium
hydroxide
Doesnt produce continuous
barrier of reparative dentin.

RESIN BONDING AGENTS

Suggested as means to
achieve a hermetic
seal at the
dentin/pulpal interface
by means of resinous
hybrid layer.
4-methacryloxyethyl
trimellitate
anhydride(4-META)
bond can be used on
exposed pulp.

LASER

Andreas Moritz
in 1998
evaluated the
effect of Co2
laser on direct
pulp capping.
Success rate89%

PROPOLIS

Recently used material.

Equally effective as calcium hydroxide.
Sabir et al (2005) conducted
experiments. Partial dentinal bridge
formation was seen in rats after
application of propolis in their study.

CONCLUSION

Pulp capping is a procedure that

maintains pulp vitality and function,
promotes
healing/repair,
prevents
breakdown of peri radicular supporting
tissues, and promotes formation of
secondary dentin

Y
T
S
N
A UE
Q ?
?
?

S
N
IO

?
?

BIBLIOGRAPHY

Textbook of pedodontics - Shobha Tandon 2nd

edition (2009)

Chawla HS et al. Calcium Hydroxide as a root

canal filling material in primary teeth A pilot
study . J. Indian Soc Pedo Prev Dent: 16 (3); 90
91, 1998

Suneda YT et al . A histopathological study of

direct pulp capping with adhesive resins. Oper
Dent: 20; 223 229,1995

Sabir A, Tabbu CR, Agustiono P, Sosroseno W.

Histological analysis of rat dental pulp tissue
capped with propolis. J Oral Sci. 47(3): 135 8,
Sep, 2005

Stewart DJ and Kramer IRH. Effects of calcium

hydroxide on the unexposed pulp, J. Dent. Res:
37;758,1958