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.
Two perspectives exist:
Each perspective has validity. And more extensive (and available) clinical data can clarify those outcomes – along with related therapeutic solutions.
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.
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.
Three procedures are classified as vital pulp therapies.
This procedure covers an exposed dental pulp with a protective material.
The application of a protective material on a thin layer of dentine over the partially exposed dental pulp.
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:
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.
This procedure enables the immature permanent teeth to continue root end development.
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.
”…treating the exposed pulp with an appropriate pulp capping material…promote the dentinogenic potential of the pulpal cells.” 
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.
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.
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:
Count on PD™ MTA White in combination with the MAP System to enhance precise placement and predictable treatment outcomes.
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.