a presentation on pulp capping

1. PULP CAPPING
Submitted by:
Rockey Shrivastava
Xth Batch BDS
Roll - 30
Guided by:
Dr. J N Shukla
Dr. Rahul Mishra
Dr. Madhulika Srivastav

2. CONTENTS
1. INTRODUCTION
2. TREATMENT MODALITIES
3. TYPES OF PULP CAPPING
4. INDIRECT PULP CAPPING
5. PATENT DENTIN MEASURING DEVICE
6. DIRECT PULP CAPPING
7. FEATURES OF SUCCESSFUL PULP CAPPING
8. PULP CAPPING MATERIALS
9. CONCLUSION
10.REFERENCES

3. INTRODUCTION

4. TREATMENT MODALITIES
PULP TREATMENT
CONSERVATIVE RADICAL
1. Protective base 1. Pulpectomy
2. Indirect pulp therapy 2. Root filling
3. Direct pulp therapy
4. Pulpotomy

5. PULP CAPPING
• DIRECT PULP CAPPING
• INDIRECT PULP CAPPING

6. Definition
The procedure involving a
tooth with a deep carious
lesion where carious dentin
removal is left incomplete,
and the decay process is
treated with a biocompatible
material for some time in
order to avoid pulp tissue
exposure is termed as
indirect pulp capping.
INDIRECT PULP CAPPING THERAPY

7. INDICATIONS
When pulp inflammation has been judged to be minimal
and complete removal of caries would cause pulp
exposure

8. • Any signs of
pulpal or
periapical
pathology
• Soft leathery
dentin covering a
very large area of
the cavity, in a non
restorable tooth
CONTRAINDICATIONS

9. PROCEDURE
The tooth is anesthetized and isolated with rubber dam
All the caries except that immediately over the pulp is
removed (use large round bur at low speed)
A zone of AFFECTED demineralized dentin is left
behind
Not all undermined enamel is removed
A sedative dressing of either zinc oxide eugenol or
calcium hydroxide is placed

10. CONTD..
The tooth may then be restored with ZOE or amalgam
The formation of reparative dentin beneath the caries
(average rate – 1.4 microns per day)
The treated tooth is re entered after 6 to 8 weeks and
the remaining caries is excavated
Pulpal protection with adequate base and permanent
restoration
(If the restoration has a good margin and at the recall
visit a layer of secondary dentin is evident , reentry
is not necessary)

12. PATENT DENTIN MEASURING DEVICE
1. Electronically measures the
thickness of dentin layer above the
pulp chamber during crown
preparation with a simple touch of
probe
2. Color coding:
Green light – safe zone
Orange light - limit of safe zone
Red light – danger of penetrating
through the dentin
3. Allows the safe preparation of
delicate cases (elongated , tilted or
deciduous tooth)

13. Definition:
The procedure in which the small exposure of
the pulp which is encountered
• During cavity preparation or
• Following a traumatic injury or
• Due to caries, with a sound surrounding
dentin, is dressed with an appropriate
biocompatible radio-opaque base in contact
with the exposed pulp tissue prior to placing a
restoration is termed as a direct pulp capping
DIRECT PULP CAPPING

15. LIMITATIONS IN PRIMARY TEETH
• Internal resorption
• Calcifications
• Chronic pulp inflammation
• Necrosis
• Intraradicular involvement

16. INDICATIONS
• Small mechanical exposures less than 1 mm
which is surrounded by sound dentin
• Light red bleeding from the exposure site that
can be controlled by cotton pellet
• Traumatic exposures in a dry, clean field, which
report to the dental office within 24 hours

17. CONTRAINDICATIONS
• Pain at night
• Spontaneous pain
• Tooth mobility
• Thickening of periodontal membrane
• intraradicular radiolucency
• Excess bleeding at the exposure site
• Purulent or serous exudate

18. CALCIUM HYDROXIDE
TECHNIQUE
• Hemostasis
• Disinfect cavity
• Calcium hydroxide
IRM resin modified
GIC
dentin bonding
system
Restoration
DENTIN BONDING
SYSTEM
• Hemostasis
• Disinfect cavity
• Bonding system
• Adhesive
• Restoration
PULP EXPOSURE

21. FEATURES OF SUCCESSFUL PULP CAPPING
• Maintenance of pulp vitality
• Lack of undue sensitivity or pain
• Minimum inflammatory response
• Lack of internal resorption and intraradicular
pathosis

22. PULP CAPPING AGENTS
• Calcium hydroxide
• Isobutyl cyanoacrylate
• Resin bonding agents (hybridization)
• Laser
• Propolis
• Other materials ( antibiotics, corticosteroids,
polycarboxylate cements, dentin, albumin, acid,
alkaline phosphatase, chondroitin sulfate,
collagen, calcium – eugenol cement, calcitonin,
barium and strontium hydroxide, native
enriched collagen solution, hydroxyapatite)

23. CALCIUM HYDROXIDE
• Calcium hydroxide is the
material of choice.
• Herman in 1930 1st
introduced Ca(OH)2 for pulp
capping.
• Ca(OH)2 causes necrosis of
adjacent pulp tissue and
inflammation of contiguous
tissue.
• Dentin bridge formation
occurs at the junction of
necrotic and inflamed tissue
Pure calcium
hydroxide

24. ADVANTAGES AND DISADVANTAGES OF
CALCIUM HYDROXIDE
A D V A N T A G E S
• Initially bactericidal
then bacteriostatic.
• Promotes healing and
repair
• High pH stimulates
fibroblasts
• Neutralization of
acids
• Stops internal
resorption
• Inexpensive and easy
to use
• Particles may
obturate open tubules
D I S A D V A N T A G E S
• Doesn’t exclusively
stimulate
Dentinogenesis
• May dissolve after 1yr
• May degrade during
acid etching and
tooth flexure
• Marginal failure with
amalgam
condensation
• Doesn’t adhere to
dentin or resin
restoration

25. 3 MAIN CALCIUM HYDROXIDE PRODUCTS
• Pulpdent paste:52.5% calcium hydroxide
suspended in aqueous methyl cellulose
sol.
• Hydrex : two paste system - calcium
hydroxide, barium sulfate, titanium
dioxide and a selected resin.
• Dycal.

26. ISOBUTYL CYANOACRYLATE
• Hemostatic and bacteriostatic
properties.
• Less inflammation than calcium
hydroxide
• Doesn’t produce continuous barrier of
reparative dentin.

27. RESIN BONDING AGENTS
• Suggested as means to
achieve a hermetic seal at
the dentin/pulpal interface
by means of resinous
‘’hybrid’’ layer.
• 4-methacryloxyethyl
trimellitate anhydride(4-
META) bond can be used
on exposed pulp.

28. LASER
• Andreas Moritz in
1998 evaluated the
effect of Co2 laser
on direct pulp
capping.
• Success rate-89%

29. PROPOLIS
• Recently used material.
• Equally effective as calcium hydroxide.
• Sabir et al (2005) conducted experiments.
Partial dentinal bridge formation was seen in
rats after application of propolis in their study.

31. CONCLUSION
Pulp capping is a procedure that maintains pulp
vitality and function, promotes healing/repair,
prevents breakdown of peri radicular
supporting tissues, and promotes formation of
secondary dentin

34. BIBLIOGRAPHY
• Textbook of pedodontics - Shobha Tandon 2nd edition
(2009)
• Chawla HS et al. Calcium Hydroxide as a root canal filling
material in primary teeth – A pilot study . J. Indian Soc
Pedo Prev Dent: 16 (3); 90 – 91, 1998
• Suneda YT et al . A histopathological study of direct pulp
capping with adhesive resins. Oper Dent: 20; 223 –
229,1995
• Sabir A, Tabbu CR, Agustiono P, Sosroseno W.
Histological analysis of rat dental pulp tissue capped with
propolis. J Oral Sci. 47(3): 135 – 8, Sep, 2005
• Stewart DJ and Kramer IRH. Effects of calcium hydroxide
on the unexposed pulp, J. Dent. Res: 37;758,1958