Apply pressure with a moist sterile cotton pellet on the pulp stump to control hemorrhage. The American Association of Endodontists (AAE) Consensus Conference Recommended Diagnostic Terminology states that mature permanent teeth clinically diagnosed with irreversible pulpitis are treated with pulpectomy and root canal filling because inflamed vital pulp is not capable of healing. Teeth were extracted and then histologically evaluated at 1 week and 2, 3, 4, and 6 months. Electronic database MEDLINE via Ovid, PubMed, and Cochrane databases were searched. Clipboard, Search History, and several other advanced features are temporarily unavailable. A better insight into mechanisms of toxicity of dental materials is important for understanding the potential of these materials to cause adverse health effects in a clinical setting. It is recommended that practitioners gather additional information in each of the referenced areas before engaging in pulp therapy for children. In cases of persistent bleeding, partial pulpotomy might be indicated. Especially in young permanent teeth with immature roots, the pulp is … The survival rate was 96% for primary molars (mean survival time, 146 weeks) and 93% for permanent teeth (mean survival time, 178 weeks). The structure of the dental pulp is similar to the other connective tissues in the body. After placement of a layer of resin-modified glass ionomer as liner over carious dentin, the teeth were restored. • deep carious lesions where caries excavation was conservative and direct pulp exposures were avoided • either Ca(OH)2 or zinc oxide–eugenol (ZOE) in a one- or two-stage procedure. A medicament is then placed over the carious dentin to stimulate and encourage pulp recovery. This review is divided into 2 parts: the first aims to illustrate the basic biology of the pulp and the effects on the pulp due to various procedures; the second focuses on the clinical aspects of treatment and the use of various dental materials during different vital pulp therapy procedures performed in the primary and permanent teeth. MTA, BA, or calcium hydroxide is laid over the pulp stump to a thickness of 2–3 mm. Evaluation of Resin-Based Material Containing Copaiba Oleoresin (. Carious or traumatically exposed primary and permanent teeth, Vital pulp, which responds to sensitivity tests, Limited to moderate restorative treatment. If there is the ability to retain the tooth in the mouth via pulpectomy and careful monitoring of the tooth to reduce or eliminate local infection, while waiting for a permanent molar to erupt (in the case of second primary molar infection), this treatment option may be performed with careful monitoring as a transitional treatment. Cover the capping material with glass ionomer and restore permanently. Hand searching was performed through reference lists of endodontic textbooks, endodontic-related … 2020 Aug 25;9(9):2738. doi: 10.3390/jcm9092738. Caries first comes into contact with the odontoblasts. Treatment is performed in the appropriate fashion with strict adherence to the proper technique. Krakow AA, Berk H, Gron P. Therapeutic induction of root formation in the exposed incompletely formed tooth with vital pulp. Munoz-Sanchez ML, Linas N, Decerle N, Nicolas E, Hennequin M, Cousson PY. As the pulp is important for tooth nutrition, innervations, and immunocompetency, the maintaining of this precious tissue increases a tooth' mechanical resistance and survival rate. Vital pulp therapy. Young permanent teeth Vital pulp therapy for teeth diagnosed with a normal pulp or reversible pulpitis Protective liner. Odontoblasts synthesize mainly type 1 collagen, type V collagen, proteoglycans, dentin sialoprotein, and alkaline phosphatase. It is a highly specialized layer for the synthesis and secretion of the organic components of the dentin and has an epithelial layer that serves as a liner for the dental pulp. Irreversibly injured odontoblasts are replaced by cells that migrate from this layer. New approches in vital pulp therapy in permanent teeth. Other studies had given a lower prognosis to indirect pulp therapy, however, especially in permanent teeth. In a different randomized clinical study, Nair and colleagues investigated the pulpal response to direct pulp capping in healthy human teeth with MTA versus calcium hydroxide cement (Dycal) as control. 2016 Jan;44:1-7. doi: 10.1016/j.jdent.2015.12.005. The term, maturogenesis , was recently introduced by Weisleder and Benitez and defined as physiologic root development not restricted to the apical segment. Cell poor zone: also called the cell free zone of Weil because it is relatively free of cells. The Vital Pulp Therapy of Permanent Teeth: A Dental Practitioner's Perspective from Saudi Arabia. J Endod. Place calcium hydroxide or glass ionomer directly over the carious region. The investigators concluded that the defense system in younger pulps was accomplished by calcification and in adult pulp is performed by self-defense proteins and regeneration of vessels. The rationale behind this treatment is the encouragement of young healthy pulps to initiate a dentin bridge and wall off the exposure site. The primary goal of pulp therapy is to maintain the integrity and health of the teeth and their supporting tissues while maintaining the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes. Vital pulp therapy comprises modalities such as direct pulp capping, pulpotomy, and an emerging family of regenerative pulp therapy; judicious application of these procedures enables apical closure and root development in immature permanent teeth by preserving the vitality of pulp tissues . At the molecular level, HEMA and TEGDMA have shown to cause cell death/apoptosis in the pulp cells by a decrease in important transcription factors, such as nuclear factor κB (NF-κB) and increase in c-Jun N-terminal kinases (JNK). Clean canal walls with moistened sterile cotton pellet. Failures Other studies have shown that MTA induced cells to secrete IL-8 and IL-1β. Once a tooth is affected by caries, some form of intervention is necessary to prevent further inflammation and ultimately necrosis. The odontoblasts are particularly important because they are responsible for dentinogenesis both during tooth development and in the mature tooth. Epub 2015 Dec 10. NF-κB is the major transcription factor that is involved in the regulation of a variety of genes responsible for survival of the cells. Vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp therapy. The paste is condensed into the radicular pulp chamber after careful pulp extirpation, cleaning of the canal, and irrigation with saline. Recently a new material has been introduced, BioAggregate (BA) (Innovative BioCeramix, Vancouver, British Columbia, Canada). Vital pulp therapy (VPT) is performed in cases of trauma, caries, and restorative procedures to preserve the vital pulp tissue. In children and young adults, teeth with traumatic pulp exposure can be treated successfully (96%) with partial pulpotomy and calcium hydroxide. Vital pulp therapy should be attempted whenever the pulp is diagnosed to be vital. The key to the success of vital pulp therapy … Hence, this discussion has 2 parts: first, the materials that are placed in direct contact with the pulp, and second, restorative materials placed in the tooth after excavation of caries. Third, primary teeth are space maintainers for permanent successor eruption, maintain arch length and help to guide permanent dentition into place. When decay or tooth preparation extends into the coronal pulp, and the pulp is deemed vital (as described previously), a pulpotomy may be performed. If the pulp tissue is nonvital or the bleeding cannot be controlled at the level of the orifice, a pulpectomy should be performed. The cellular components of this layer include mainly macrophages and lymphocytes. Certain treatments are also used in deciduous teeth, please see 'Endodontic role in Paediatrics' lesson in the Paediatrics topic for more information. Pulpotomy treatment is a very common form of vital pulp therapy. Remove soft leathery caries affected tooth structure until dentin consistency changes or pulp exposure is imminent. • Accepted endodontic therapy for primary teeth can be divided into two categories: vital pulp therapy (VPT) and root canal treatment (RCT). Nair and colleagues also demonstrated decreased inflammation when MTA was used compared with calcium hydroxide. Vital pulp therapy is performed to preserve the health status of the tooth and its ultimate position in the arch for the expected life of the tooth. The coronal chamber should be filled with glass ionomer or resin-modified glass ionomer. Witherspoon DE. The best sealing agents seem to be MTA or glass ionomer. At the cellular level, MTA has also been shown to induce the recruitment and proliferation of undifferentiated cells to form a dentinal bridge, while reducing inflammation compared with calcium hydroxide. HHS Sodium Hypochlorite Reduces Postoperative Discomfort and Painful Early Failure after Carious Exposure and Direct Pulp Capping-Initial Findings of a Randomized Controlled Trial. Cao Y, Song M, Kim E, Shon W, Chugal N, Bogen G, Lin L, Kim RH, Park NH, Kang MK. The vitality of dental pulp is essential for long-term tooth survival. Aeinehchi and colleagues compared the use of MTA and calcium hydroxide in direct pulp capping cases using 11 pairs of third molars (patients 20–25 years old) with pulps mechanically exposed and capped with either MTA or calcium hydroxide, covered with zinc oxide–eugenol, and restored with amalgam. Pulpotomy is a vital pulp therapy in which a portion of the coronal pulp tissue is surgically removed, and the remaining radicular tissue is covered with suitable material that protects the pulp from further injury and permits and promotes healing. Vital pulp therapy in cariously exposed permanent teeth and its limitations. Methods: The aim of pulp therapy in primary and young permanent teeth is to maintain a functional tooth so that arch integrity is preserved in a growing child. Elmsmari F, Ruiz XF, Miró Q, Feijoo-Pato N, Durán-Sindreu F, Olivieri JG. Similar to MTA, this material induced secretion of IL-1β, IL-6, and IL-8. Other studies have demonstrated that HEMA causes increased phophorylation of extracellular-signal-regulated kinases (ERK 1 and 2) and decreased phosphorylation of phosphokinase B (p-AKT). Int J Environ Res Public Health. Treatment. The procedure involves amputation of the coronal portion of the pulp and treatment of the remaining radicular pulp stumps. On the molecular level, MTA has been shown to induce the secretion of angiogenic factors, such as vascular endothelial growth factor, which plays an important role in healing. [Article in Polish] Makowiecki P, Trusewicz M, Tyszler L, Buczkowska-Radlińska J. There are several different treatment options for vital pulp When decay or tooth preparation extends into the pulp chamber of the primary incisor or canine, first, an assessment of the vitality of the pulp must be made. 2020 Jun 28;10(7):972. doi: 10.3390/biom10070972. Studies have previously shown that HEMA induces apoptosis in different cell types and also in dental pulp stem cells and in odontoblast-like cells. Pulp tissue is necessary for tooth nutrition, innervation and immunocompetency. Alqaderi H, Lee CT, Borzangy S, Pagonis TC. Overall, the success rate was in the range of 72.9%-99.4%. Dent Res J (Isfahan) 2015; 12: 406–417; Alqaderi H, Lee CT, Borzangy S, Pagonis TC: Coronal pulpotomy for cariously exposed permanent posterior teeth with closed apices: A systematic review and meta-analysis. Odontoblastic layers appeared earlier; less hyperemia, inflammation, and necrosis were noted; and dentinal bridges were more pronounced in the MTA-treated teeth. Another study, by Matsuzaka and colleagues, demonstrated that expression of core binding factor alpha-1 subunit and dentin sialoprotein was higher in the younger pulp whereas the adult pulp demonstrated higher levels of vascular endothelial growth factor and heat shock protein 27. Vital pulp therapy is effective as long as proper assessment of the situation is made. Ballal NV, Duncan HF, Rai N, Jalan P, Zehnder M. J Clin Med. Studies have reported this material to have similar cytotoxicity levels as MTA De-Deus and colleagues found that BA was as biocompatible as MTA and another study reported that BA up-regulated the gene expression of collagen 1, osteocalcin, and osteopontin in osteoblasts and differentiation of human periodontal ligament fibroblasts compared with MTA. Cell-rich zone: lies subadjacent to the cell-poor zone. In terms of bacterial penetration, Kakoli and colleagues showed that bacterial infection of the dentinal tubules occurs to a lesser extent in older patients than in younger patients. This should be done before the procedure via radiographic assessment or by direct examination of pulp and its color, texture, and bleeding during the procedure. Current best evidence provides inconclusive information regarding factors influencing treatment outcome, and this emphasizes the need for further observational studies of high quality. Apexification is defined as a method of inducing a calcified barrier in a root with an open apex or the continued apical development of an incompletely formed root in teeth with necrotic pulp. Direct pulp capping is defined as the placement of a medicament on a pulp that has been exposed in the course of excavating the last portions of deep dental caries. It has been recommended that vital pulp treatment should be performed only in young patients 2 , 51 , 52 because of the high healing capacity of pulp tissue in young patients in comparison with old patients. Cases of permanent tooth mean long-term preservation of the tooth in a healthy state in the mouth. The indirect comparison of success rates for 4 follow-up periods and the indirect comparison of clinical factors influencing the success rate of each treatment were performed by z test for proportion (P < .05). MTA has demonstrated significantly greater frequency of dentin bridge formation, thicker and less porous dentin, and less pulp inflammation compared with calcium hydroxide. Dental caries is a progressive infection of the dentin, which may lead to inflammation and ultimately necrosis of the pulp. If the caries does progress to the pulp, it leads to inflammation, which is caused by several proinflammatory cytokines, such as interleukin (IL)-1β and tumor necrosis factor α, and chemokines, which cause cell death, increased vascular permeability, and an increase in inflammatory cells into the area along with production of acute phase proteins. Indirect pulp therapy: an alternative to pulpotomy in primary teeth. Outcome of Partial Pulpotomy in Cariously Exposed Posterior Permanent Teeth: A Systematic Review and Meta-analysis. Disinfect the pulp wound and cavity with 2% chlorhexidine gluconate. Published by Elsevier Inc. All rights reserved. Remove all peripheral caries before removing the deepest caries. Vital pulp therapy can be used in immature and fully formed permanent teeth. 2 Vital pulp therapy is performed to preserve and maintain the health of the pulpal tissue in cases of exposure due to trauma, caries and/or restorative procedures. Conclusions: … The tooth itself, however, is the best space maintainer, and space loss in the primary molar area is a significant long-term issue for patients. Another study showed that MTA causes neutrophils to be recruited to the site of injury, which is important in the process of inflammation. Hence, the second part of this review deals with the clinical aspects of treatment of the primary and permanent dentition. The aim of vital pulp therapy is to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. The random effect method of weighted pooled success rate of each treatment and the 95% confidence interval were calculated by the DerSimonian-Laird method. In addition to these, in primary teeth it is important to preserve the tooth until its … Generally, sodium hypochlorite has not been used to clean the pulp canals of primary teeth. This article reviews the rudiments of pulp therapy for children. 2002 Apr;28(1):29-37. doi: 10.1111/j.1747-4477.2002.tb00364.x. It is expected that the teeth will maintain vitality with resolution of symptoms (if present) and completion of root development in immature teeth after vital pulp therapy. Introduction: This systematic review aims to illustrate the outcome of vital pulp therapy, namely direct pulp capping, partial pulpotomy, and full pulpotomy, in vital permanent teeth with cariously exposed pulp. Ali AH, Thani FB, Foschi F, Banerjee A, Mannocci F. J Clin Med. Canals should be cleaned carefully but not significantly instrumented (primary roots are narrow and curved and there is a risk of perforation or extension beyond the apex). The radicular orifices are assessed to determine that bleeding can be controlled only by direct pressure with a damp cotton piece for a minute or 2. The potential risks are direct damage to the cells (cytotoxicity) and induction of immune-based hypersensitivity reactions. Indirect pulp capping has been defined as a procedure in which a small amount of carious dentin is retained in deep areas of cavity preparation to avoid an exposure of the pulp. Vital pulp therapy for cariously exposed permanent teeth remains one of the most controversial areas in dentistry. BA has also been shown have antifungal and antibacterial activity. This study shows that indirect pulp therapy performed in primary and permanent teeth of young patients may result in a high 3-year survival rate. COVID-19 is an emerging, rapidly evolving situation. The aim of vital pulp therapy is to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. Kakehashi et a1 (I 6), clearly showed that the key factor in pulpal healing after exposure is the absence of infection. The porosity of this dentinal bridge potentially allows recolonization of bacteria, thereby leading to failure of pulp capping procedures. The first part of this article provides insight into the basic biology of the dental pulp, the mechanisms involved in inflammation, and the reactions of the pulp to various dental materials at the cellular and molecular level whereas the second part deals with the clinical aspects of treatment of the primary and permanent dentition. The teeth will be followed up both clinically and radiographically for 1 year after treatment. Recent research has shown that MTA, when placed in direct contact with the human dental pulp cells, differentiated them into odontoblast-like cells. Aged dental pulps have various characteristics, which include the following: At the molecular level, one study has shown a decreased expression of connexin 43 and osteocalcin in the aged human pulp, which in turn relates to the decreased viability of the odontoblasts and the pulp cells. A material that further seals, such as glass ionomer or resin-modified glass ionomer, should then be used to fill the coronal pulp chamber. It is subadjacent to the predentin and is composed of cell bodies of the odontoblasts, capillaries, nerve fibers, and dendritic cells. The activity of NF-κB is tightly regulated by cytokines and other external regulators. BA is white nanoparticle ceramic cement with many different applications, like MTA. Akhlaghi N, Khademi A: Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature. 2008; Jul; 34(7 Suppl):S25-28. Vital pulp therapy Pulp capping Indirect pulp capping [ICP] Direct pulp capping [DCP] Pulpotomy Apexogenesis 7. Ultimately, the goal of treating the exposed pulp with an appropriate pulp capping material is to promote the dentinogenic potential of the pulpal cells. Thus, in clinical terms, a necrotic infected pulp is required for apical periodontitis to be present. Doumani MD, Arnous WA, Alsafadi MF, Alnazer HA, Alanazi SM, Alotaibi KS, Al-Ammari AI. Couto RSD, Rodrigues MFSD, Ferreira LS, Diniz IMA, Silva FS, Lopez TCC, Lima RR, Marques MM. Inflammation is a tightly regulated process and its main function is to eliminate pathogens and remove damaged tissue with the aim of restoring tissue homeostasis. Jun 15 ; 10 ( 3 ):300-308. doi: 10.3390/ijerph17176340 prognosis indirect. Remove only the diseased pulp and preserve the vital pulp therapy performed to preserve,... In pulpal healing after exposure is imminent ' lesson in the literature has demonstrated... 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