This Wednesday was a great learning experience for me. I had the opportunity to watch the Doctor perform a DO dental caries excavation on tooth #20; however, the caries was very extensive, and there was a pulp/nerve exposure. He then performed a direct pulp cap and bonded over it with composite to complete the restoration, and informed the patient of the possibility of future root canal therapy on that tooth. So I will never forget what a direct, or indirect, pulp capping procedure entails, I did some research on the topic:
Vital pulp capping is a controversial procedure as many clinicians are uncertain of the long-term success when compared to the proven long-term success of root canal therapy. Vital pulp capping basically entails dressing exposed pulp to maintain vitality.
For success, the tooth should be asymptomatic and have bleeding controlled.
There are basically two techniques. First the area is disinfected and then calcium hydroxide placed directly on the pulp. Then the calcium hydroxide should be covered with RMGI or zinc oxide eugenol then dentin bonding agent and permanent restoration placed. The second technique involves total acid etching the cavity preparation created with 32% phosphoric acid then dentin bonding agent and a few layers of primer followed by RMGI and a permanent restoration.
M.C., New York University College of Dentistry, Observation
The result of the direct pulp cap mostly depends on ability of dentist and capping material to prevent microbial leakage.
Indirect pulp capping is a procedure performed when a dentist comes close to the nerve/pulp when excavating caries, but there is no penetration or exposure. This is done to stimulate reparative dentin formation and prevent the need for root canal therapy
