Direct and Indirect Pulp Capping: A Brief History, Material Innovations, and Clinical Case Report.

Among the goals of pulp capping are to manage bacteria, arrest caries progression, stimulate pulp cells to form new dentin, and produce a durable seal that protects the pulp complex. This article will provide a general discussion of direct and indirect pulp capping procedures, offering practitioners a pragmatic and science-based clinical protocol for treatment of vital pulp exposures. A clinical case will be presented in which a novel light-cured resin-modified mineral trioxide aggregate hybrid material was used to manage a mechanical vital pulp exposure that occurred during deep caries excavation.

Biological response of pulps submitted to different capping materials.

Pulp capping is a procedure that comprises adequate protection of the pulp tissue exposed to the oral environment, aiming at the preservation of its vitality and functions. This study evaluated the response of the dental pulps of dog teeth to capping with mineral trioxide aggregate (MTA) or calcium hydroxide P.A. For that purpose, 37 teeth were divided into two groups, according to the capping material employed. Two dogs were anesthetized and, after placement of a rubber dam, their pulps were exposed in a standardized manner and protected with the experimental capping materials. The cavities were then sealed with resin-modified glass ionomer cement and restored with composite resin. After sixty days, the animals were killed and the specimens were processed in order to be analyzed with optic microscopy. It was observed that MTA presented a higher success rate compared to calcium hydroxide, presenting a lower occurrence of infection and pulp necrosis.

Histologic evaluation of pulpotomy performed with ethyl-cyanoacrylate and calcium hydroxide.

The aim of this study was to evaluate histological aspects of the pulp-dentin complex of dogs submitted to pulpotomy and capped with ethyl-cyanoacrylate and calcium hydroxide. Thirty dog teeth were divided into 2 groups of 15 as follows: Group 1 - ethyl-cyanoacrylate; Group 2 - calcium hydroxide. The pulpotomies were carried out following all of the treatment precautions recommended for dogs. After 30 days the specimens were submitted to histological preparation and were then blindly evaluated by a histologist. Data were analyzed statistically by the Fisher exact test, comparing the two groups. After 30 days, the presence of a hard tissue barrier was observed in 83.3% of Group 1, and in 100% of Group 2 (p = 0.478). A continuous hard tissue barrier was observed in 50% of the ethyl-cyanoacrylate group and 75% of the calcium hydroxide group (p = 0.652). It can be concluded that both materials induced hard tissue barrier formation, but Group 2 had a higher percentage than Group 1, with no significant statistical differences; the differences observed between the different barriers (continuous/non-continuous) were not significant between groups and there was no pulpal necrosis in either group.

Biological response of pulps submitted to different capping materials / Resposta biológica de polpas submetidas a diferentes materiais capeadores

Pulp capping is a procedure that comprises adequate protection of the pulp tissue exposed to the oral environment, aiming at the preservation of its vitality and functions. This study evaluated the response of the dental pulps of dog teeth to capping with mineral trioxide aggregate (MTA) or calcium hydroxide P.A. For that purpose, 37 teeth were divided into two groups, according to the capping material employed. Two dogs were anesthetized and, after placement of a rubber dam, their pulps were exposed in a standardized manner and protected with the experimental capping materials. The cavities were then sealed with resin-modified glass ionomer cement and restored with composite resin. After sixty days, the animals were killed and the specimens were processed in order to be analyzed with optic microscopy. It was observed that MTA presented a higher success rate compared to calcium hydroxide, presenting a lower occurrence of infection and pulp necrosis.

O capeamento pulpar é um procedimento que consiste na adequada proteção do tecido pulpar exposto ao meio oral, objetivando a preservação de sua vitalidade e suas funções. O objetivo deste trabalho foi observar a resposta da polpa dental de cães ao capeamento com o agregado de trióxido mineral (MTA) ou hidróxido de cálcio P.A. Para tanto, 37 dentes foram divididos em dois grupos, de acordo com o material capeador utilizado. Dois cães foram anestesiados e após o isolamento absoluto do campo operatório, realizou-se exposição padronizada da polpa, proteção com os materiais capeadores testados e selamento das cavidades com cimento modificado de ionômero de vidro. Os dentes foram então restaurados com resina composta. Após sessenta dias, os animais foram sacrificados e as peças foram processadas para a análise microscópica dos dentes. Observou-se que o MTA apresentou maior índice de sucesso em relação ao hidróxido de cálcio, evidenciando menor ocorrência de infecção e necrose pulpar.

Histologic evaluation of pulpotomy performed with ethyl-cyanoacrylate and calcium hydroxide / Avaliação histológica de pulpotomia realizada com etil-cianoacrilato e com hidróxido de cálcio

The aim of this study was to evaluate histological aspects of the pulp-dentin complex of dogs submitted to pulpotomy and capped with ethyl-cyanoacrylate and calcium hydroxide. Thirty dog teeth were divided into 2 groups of 15 as follows: Group 1 - ethyl-cyanoacrylate; Group 2 - calcium hydroxide. The pulpotomies were carried out following all of the treatment precautions recommended for dogs. After 30 days the specimens were submitted to histological preparation and were then blindly evaluated by a histologist. Data were analyzed statistically by the Fisher exact test, comparing the two groups. After 30 days, the presence of a hard tissue barrier was observed in 83.3 percent of Group 1, and in 100 percent of Group 2 (p = 0.478). A continuous hard tissue barrier was observed in 50 percent of the ethyl-cyanoacrylate group and 75 percent of the calcium hydroxide group (p = 0.652). It can be concluded that both materials induced hard tissue barrier formation, but Group 2 had a higher percentage than Group 1, with no significant statistical differences; the differences observed between the different barriers (continuous/non-continuous) were not significant between groups and there was no pulpal necrosis in either group.

O objetivo do presente estudo foi avaliar o aspecto histológico do complexo dentino-pulpar de cachorros quando capeado após a pulpotomia com etil-cianoacrilato e hidróxido de cálcio. Trinta dentes de cães foram divididos em 2 grupos de 15 da seguinte forma: Grupo 1 - Etil-cianoacrilato; Grupo 2 - Hidróxido de cálcio. A pesquisa foi realizada tomando-se todos os cuidados recomendados para o tratamento com os cães. Após 30 dias do procedimento realizado os espécimes foram submetidos ao preparo histológico e logo após foram avaliados de forma cega por um histologista. Os resultados foram analisados estatisticamente através do Teste Exato de Fisher. No grupo 1, 83,3 por cento e no grupo 2, 100 por cento dos dentes apresentaram a barreira de tecido duro (p = 0,478). A barreira de tecido duro contínua foi observada em 50 por cento dos casos tratados com etil-cianoacrilato e em 75 por cento dos com hidróxido de cálcio (p = 0,652). Pode-se concluir que tanto o grupo 1 como o grupo 2 induziram a formação da barreira de tecido duro, porém o grupo 2 teve um percentual maior do que o grupo 1, não havendo diferença estatisticamente significante; a diferença observada entre as estruturas das barreiras (contínuas e não-contínuas) não foi significante. A necrose pulpar não foi observada em nenhum grupo.

Respuesta pulpar ante el recubrimiento pulpar directo: revisión de la literatura / Pulp response to direct pulp capping: a review of the literature

El recubrimiento pulpar directo es considerado un procedimiento controversial, debido a que la información concerniente al uso de esta técnica es escasa y ha sido desarrollada sobre la base de razonamientos empíricos y como consecuencia hay desconfianza por parte de los clínicos hacia estos procedimientos conservadores, a pesar de los avances en la práctica del recubrimiento directo. Se han empleado muchos materiales para el recubrimiento pulpar directo y se ha aceptado el hidróxido de calcio como el material de elección, debido a su capacidad comprobada para obtener altos porcentajes de éxito. Actualmente se está evaluando la posibilidad de la utilización de los adhesivos dentinarios como recubridores pulpares. Por una parte se ha sugerido su capacidad para la inducción de una cicatrización exitosa, por otro lado se han descripto resultados poco favorables usando la técnica de grabado total seguido del recubrimiento con agentes adhesivos como procedimiento para el recubrimiento pulpar directo

Avaliaçäo clínica e microscópica de um sistema adesivo aplicado em proteçöes pulpares diretas de dentes humanos / Clinical and microscopical evaluation of an adhesive system applied in direct pulp protection of human teeth

Devido à necessidade de serem avaliados os resultados de capeamento pulpar em humanos por períodos de longa duraçäo, utilizando um sistema adesivo, foram efetuadas análises aos níveis clínico, radiográfico e microscópico. Foram utilizados 48 dentes terceiros molares, de pacientes com idade variando entre 18 e 35 anos. Após o preparo de cavidades de Classe I na face oclusal, foram feitas exposiçöes padronizadas, das quais 24 capeadas com hidróxido de cálcio P.A. (grupo controle) e 24 com o sistema adesivo ALL BOND 2 (grupo experimental). Os dentes assim tratados permaneceram na boca sob controle clínico e radiográfico, por 7, 45, 90 e 120 dias, e depois de extraídos foram processados para exame microscópico dos dentes pulpares...

Long term clinical assessment of direct pulp capping.

Appropriate definitions, history and success rates of direct pulp capping procedures are reviewed. Two of the disadvantages of this form of treatment are infection of the pulp, either preoperatively or postoperatively due to a non-sterile procedure or bacterial leakage at the capping site. Past results of directly capping potential inflamed pulps have been unsatisfactory, but now an increasing number of endodontists advocate capping when conditions are favourable. Direct capping should only be used on vital pulp which has been accidentally injured and shows no other symptoms. Direct capping with calcium hydroxide should not be used on pulp which has been exposed as a result of penetrating caries. Clinical studies 2338 cases have shown that the risk of failure is increased if the pulp is diseased before capping, but that the age of the tooth does not have an adverse effect. It also appears that capping performed by skilled practitioners is more successful than that performed by students. The results of a re-examination of 110 patients, a minimum of 4 years after they had received direct capping treatment from students, showed a success rate of 80 per cent. In skilled hands, the success rate for direct capping with calcium hydroxide is now 90 per cent provided that a hermetic seal is obtained.