Vital pulp capping: a worthwhile procedure.
Despite the progress made in the field of pulp biology, the technique and philosophy of direct vital pulp capping remains a controversial subject. Clinicians are well aware of the immediate and long-term success rates after root canal therapy, but are less certain of the success of vital pulp capping. Researchers have demonstrated that exposed pulps will heal and form reparative dentin. It is realized now that the variable prognosis of vital pulp capping is predominately a restorative issue. The factors that can produce a successful vital pulp cap are discussed in conjunction with two popular techniques. (+info)
Management of extensive carious lesions in permanent molars of a child with nonmetallic bonded restorations--a case report.
The badly decayed molar teeth of a 12-year-old were restored using resin composite and ceramic restorations. The maxillary first left permanent molar, which had an extensive carious lesion that had destroyed most of the coronal hard tissues of the tooth, was restored to shape and function with a heat-treated resin composite onlay restoration. The restoration was followed up for two years. The mandibular right first molar had a failing large amalgam restoration with extensive recurrent caries. After a three-month period of pulp-capping, the tooth was restored with a bonded ceramic onlay restoration. A nine-month follow-up of this restoration is provided. The maxillary right first molar, which also had a failing large amalgam/resin composite restoration, was restored with a direct resin composite restoration. Under traditional treatment regimens, these extensive cavities would have been treated using more invasive procedures such as pin-retained restorations or elective root canal therapy, post placement, core build-up and crowning. Bonded non-metallic restorations avoid the trauma, time and cost that accompany such extensive procedures and offer a more conservative approach. (+info)
Evidence for bacterial causation of adverse pulpal responses in resin-based dental restorations.
The widespread use of resin and resin-monomers for bonding of dental restorations to dentin has occurred because of a fundamental shift in the view that injury to the pulp is induced by restorative procedures. While, for many years, the toxic effects of restorative materials were thought to be of crucial importance in the development of adverse pulpal responses, the key role of bacterial leakage at the restoration-tooth interface is now well-recognized. Consequently, if optimal conditions for the preservation of pulpal health are to be ensured, dental restorations should provide an impervious seal against the surrounding tooth structure. However, polymerization shrinkage and contraction stresses induced during setting, as well as a variety of technical difficulties encountered during the clinical operation, often produce less than perfect results. Therefore, modern restorative procedures involving resin and resin-bonded restoratives must still rely on the ability of the pulp to cope with the injurious elements to which it may be exposed during and after the procedure. This review examines factors that may govern the pulp's response to restorative procedures that involve adhesive technologies. An assessment is made of the risks involved as far as the continued vital function of the pulp is concerned. It is concluded that an intact, although thin, wall of primary dentin often enables the pulp to overcome both toxic material effects and the influences of bacterial leakage. In contrast, the pulp may not do equally well following capping of open exposures with resin composites. A dearth of controlled clinical studies in this area of dentistry calls for confirmation that pulpal health prevails over the long term following the use of total-etch and resin-bonding techniques. (+info)
Management of the deep carious lesion and the vital pulp dentine complex.
This article describes the relationship between the carious process and pulp-dentine complex reactions. Where the balance between the two is in favour of the carious process and where conventional cavity preparation leads to a direct pulp exposure, the direct pulp cap technique is described. The success of the technique is addressed and more importantly an alternative technique for caries removal, namely stepwise excavation, is described which may lead to a reduced risk of carious exposure and the need for the direct pulp cap technique. (+info)
Analysis of pulpal reactions to restorative procedures, materials, pulp capping, and future therapies.
Every year, despite the effectiveness of preventive dentistry and dental health care, 290 million fillings are placed each year in the United States; two-thirds of these involve the replacement of failed restorations. Improvements in the success of restorative treatments may be possible if caries management strategies, selection of restorative materials, and their proper use to avoid post-operative complications were investigated from a biological perspective. Consequently, this review will examine pulp injury and healing reactions to different restorative variables. The application of tissue engineering approaches to restorative dentistry will require the transplantation, replacement, or regeneration of cells, and/or stimulation of mineralized tissue formation. This might solve major dental problems, by remineralizing caries lesions, vaccinating against caries and oral diseases, and restoring injured or replacing lost teeth. However, until these therapies can be introduced clinically, the avoidance of post-operative complications with conventional therapies requires attention to numerous aspects of treatment highlighted in this review. (+info)
Thermal coefficients of paste-paste type pulp capping cements.
Thermal coefficients of four kinds of commercially available paste-paste type pulp capping cements were examined. Control reference samples were made of dentin. A thermal coefficient analyzer was used, heating specimens for a few nanoseconds by a xenon flash bulb and measuring thermal changes by using a thermocouple. Thermal coefficients were examined by this non-steady state method. Thermal conductivities of all cements were almost the same or lower than that of dentin. Therefore, when each cement was heated, the penetrating energy was almost the same or lower than that of dentin. The thickness of the cements was converted into that of the dentin by using the obtained thermal conductivity. The 1-mm thickness of the examined cements were equal to between 0.97-mm and 2.10-mm thicknesses of lost dentin. The use of a pulp capping cement provided better pulp protection from thermal stimuli than did the same thickness of dentin. (+info)
Thermal properties of dental materials--cavity liner and pulp capping agent.
We studied the thermal properties of cavity liners that included calcium phosphate as inorganic filler, in contrast to the conventional pulp capping agents. Therefore, thermal diffusivity, specific heat capacity, and thermal conductivity were measured. In addition, thermal conductivity results were compared with those of restorative materials and human dentin to examine thermal insulation effects. The thermal conductivity of cavity liners ranged from 0.23 to 0.28 W m(-1) K(-1), and that of pulp capping agents ranged from 0.44 to 0.48 W m(-1) K(-1). Test results indicated that the thermal conductivity of cavity liner was lower than those of human dentin, pulp capping agent, cast alloy, and composite resin for restoration, hence suggesting that cavity liner has a good thermal insulation effect. (+info)
Histomorphological response of dogs' dental pulp capped with white mineral trioxide aggregate.
This study was conducted to observe the response of dogs' dental pulp to white mineral trioxide aggregate (MTA) when used as pulp capping material. The pulp of 15 dogs' teeth was experimentally exposed and capped with white MTA. The animals were sacrificed two months later and the specimens were prepared for histomorphological study. The pulp capped with white MTA showed a healing process with complete dentin bridge formation in all samples. In some cases, there was not a tubular dentin shape, but only a structure with an interesting morphological aspect sealing the exposure site. Only 2 specimens exhibited pulp inflammation. In conclusion, the data obtained in this study showed that white MTA has the necessary properties of a pulp capping material. (+info)