Login
Register
Identity1
Authentification2

BLOG

Restorative Outcomes You Can Expect from Vital Pulp Therapy
09.06.2020

Restorative Outcomes You Can Expect from Vital Pulp Therapy

Goal awareness is essential to success in any endeavor. That said, the primary goal of restorative treatment is preserving tooth vitality through vital pulp therapy. Exposed pulp poses a problem when you’re attempting to treat a patient’s permanent tooth. It’s especially challenging when you lack adequate clinical guidance and when the pulp in question is carious.

What is the most suitable treatment?

Two perspectives exist:

  • a pulpectomy
  • knowledge that the survival of endodontically treated teeth ranks lower than vital teeth.

Each perspective has validity. And more extensive (and available) clinical data can clarify those outcomes – along with related therapeutic solutions.[1]

The goal, of course, is protecting the vitality of the dental pulp that has experienced large areas of decay or trauma.

Vital pulp therapy applies restorative materials directly or indirectly on the affected pulp tissue. Regeneration is the goal for tissues impacted by decay or trauma – though current therapies are less likely to stimulate present dentine.

The issue of dentinogenesis

Primary ondontoblasts and dental pulp stem cells can prompt tertiary dentine development. The dentinogenesis will be recognized as reactionary and reparative in this instance.

The process in question has variables that serve to promote reactionary and/or reparative dentinogenesis. And it’s further recognized that extracellular dentine equally involves additional factors during the dentinogenesis process.

These factors and related clinical data are worth exploring to gain further understanding and clarity.

What vital pulp therapy accomplishes for regenerative procedures

Three procedures are classified as vital pulp therapies.

  • Direct pulp capping
  • Indirect pulp capping
  • Pulpotomy

Direct pulp capping

This procedure covers an exposed dental pulp with a protective material.

Indirect pulp capping

The application of a protective material on a thin layer of dentine over the partially exposed dental pulp.

Pulpotomy

The surgical removal of the coronal pulp portion that’s inflamed within the exposed pulp tissue. This saves the remaining healthy tissue.

Each procedure gives you (as a clinician) an attempt at effective pulp capping. Outcomes include:

  • Appropriate sealing ability
  • Maintaining the vitality of pulp tissues
  • Promoting the formation of a dentinal bridge and other tissues such as neural cells.

These root canal therapy alternatives are for teeth that have immature or mature apices. Pulp exposure with reversible injury and that lack signs of inflammation create a more conservative approach.

Data across several studies indicates that the effectiveness of direct and indirect pulp capping can be affected by the chosen biomaterials and their biological properties.

Beyond dental pulp tissue regeneration here’s what else is working for immature permanent teeth

Apexogenesis

This procedure enables the immature permanent teeth to continue root end development.

Apexification

Provides a calcified barrier at the immature root end. The procedure places biocompatible material next to periapical tissue.

Research indicates that the interactions between dental materials and cells achieve best results in terms of biocompatibility and pulp inflammation.

The goal…

”…treating the exposed pulp with an appropriate pulp capping material…promote the dentinogenic potential of the pulpal cells.” [2]

The biocompatibility outcomes and the variety of materials used is rather extensive. Each have their success ratios and measurable data that indicates procedural effectiveness.

An available clinical treatise thoroughly outlines the use of various pulp capping materials. Overall, vital pulp therapy relies on case selection.

Assessment difficulty and the related decision involves whether the pulp’s status is reversible or irreversible. An age based decision is not universally accepted.

Vital pulp therapy is recommended for younger patients. Their pulp tissue has a higher healing capacity compared with older patients.

Again, clinical data is not sufficient to reveal the impact of patient age on treatment outcome. Vital pulp therapy has been shown to successfully treat patients ranging in age from six to 70. Data highlighted the healing potential of pulp tissue following the removal of disease cause.

Vital pulp therapy

Restorative therapy. Pictures come from the clinical article “Calcium hydroxide and MTA in vital pulp therapy” by dr. Francesca Cerutti and dr. Davide Guglielmi available on our e-Learning platform.

A wise material choice for vital pulp therapy

The reduction of bacterial growth and an effective seal within the root canal system is a preferred outcome for regenerative procedures – including vital pulp therapy.

PD™ MTA White promotes compatibility with the dentinal wall. And it creates a perfect seal for healing while reducing the number of retreatment procedures.

Related to the clinical procedure reviewed above, PD™ MTA White is useful as a pulp capping material and for the pulpotomy of primary teeth in children and adolescent patients.

Other notable benefits of PD™ MTA White include:

  • Bismuth oxide free ingredients to eliminate staining and discoloration
  • Optimized particle size for homogeneous and complete wetting during mixing
  • Simplicity of manipulation allowing tailored use for clinical cases
  • Washout resistance and non-resorbability
  • Radiopaqueness
  • Perfect marginal sealing
  • Optimal use via smart individual dose

Count on PD™ MTA White in combination with the MAP System to enhance precise placement and predictable treatment outcomes.

Specific product information and additional supportive clinical data associated with vital pulp therapy and PD™ MTA White is available from Produits Dentaires SA.

This article was based on the paper “Calcium hydroxide and MTA in vital pulp therapy” by dr. Francesca Cerutti and dr. Davide Guglielmi. The original document (in English) is available on our e-Learning platfom.


[1] “Calcium hydroxide and MTA in vital pulp therapy” by dr. Francesca Cerutti and dr. Davide Guglielmi

[2]  “Calcium hydroxide and MTA in vital pulp therapy” by dr. Francesca Cerutti and dr. Davide Guglielmi