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Presentation Outline
Determination of Pulp status
Indirect Pulp capping
Direct Pulp capping
Materials used for capping
Related studies
Determining Pulp status
1. Visual and tactile examination of carious dentin and associated
periodontium
2. Radiographic examination of
a. periradicular and furcation areas
b. pulp canals
c. periodontal space
d. developing succedaneous teeth
3. History of spontaneous unprovoked pain
4. Pain from percussion
5. Pain from mastication
6. Degree of mobility
7. Palpation of surrounding soft tissues
8. Size, appearance, and amount of hemorrhage associated with
pulp exposures
Paediatric pulp therapy for primary
and young permanent teeth involves
the following techniques:
1. Indirect pulp capping
2. Direct pulp capping
3. Coronal pulpotomy
4. Pulpectomy
Hunter recommended covering an exposure
with a mixture of sorghum molasses and
the droppings of the English sparrow and
claimed a 98% success rate.
Phillip Pfaff
1756 gold foils
Indirect Pulp Capping
Hugh M Kopel : is defined as the
application of a medicament over a thin
layer of remaining carious dentin, after deep
excavation, with no exposure of the pulp.
Optimum Ph for
pyrophosphate Serum Flow
activity
Ca 2+ Inhibitory
dependent pyrophosphate
pyrophospha
te
Uncontrolled
mineralizatio
n
Sciaky and Pisanti ; Attalla and
Noujaim calcium ions from the
capping material were not involved
in the bridge formation.
Stark et al calcium ions from the
capping medicament do enter into
bridge formation
Seltzer and Bender identified the
osteogenic potential of Ca(OH)2.
It is capable of inducing calcific
metamorphosis, resulting in
obliteration of the pulp chamber and
root canals.
Lim and Kirk - obliteration of the
pulp chamber and root canals and
internal resorption is not a major
concern for pulp capping.
Advantages Disdvantages
Bacteriostatic bactericidal
Healing & Repair
Stimulates Fibroblasts No adherence to dentin
Stimulates Enzyme systems Recurrent caries if lost
Stops internal resorption Cavosurface microleakage
Obturates open tubules
Ideal intracanal medication
Inexpensive & easy to use
Zinc oxide eugenol
Used as an indirect pulp capping agent
Glass and Zander - ZOE, in direct contact with the
pulp tissue, produced chronic inflammation, a lack of
calcific barrier, and an end result of necrosis.
Sveen reported 87% success with the capping of
primary teeth with ZOE in ideal situations of pulp
exposure
Tronstad and Mjr - compared ZOE with calcium
hydroxide, found ZOE more beneficial for inflamed,
exposed pulps and felt that the production of a
calcific bridge is not necessary if the pulp is free of
inflammation following treatment
Dentin Bonding Agents
Formation of hybrid layer provides
adequate sealing
Resin covering prevents displacement of
composite into pulp chamber.
Primer, adhesive work in wet environment
Guven 2011 EMD when used in conjunction with MTA, dycal and
Gic increased their biocompatibility
Carisolv
Chemo mechanical caries removal method