Ways of Maintaining Pulp Vitality: Narrative Literature Review
Article Sidebar
Main Article Content
Abstract
Background: Dental caries and traumatic injuries pose significant challenges to preserving the vitality of the dental pulp, with implications for tooth survival and overall oral health. Traditional approaches to managing these conditions have evolved, reflecting advancements in dental materials and a better understanding of pulp biology.
Objective: This review aims to elucidate the effectiveness and implications of various vital pulp therapy techniques—indirect pulp capping, direct pulp capping, and pulpotomy—in preserving pulp vitality amidst dental caries and traumatic injuries.
Methods: A comprehensive literature search was conducted across both physical libraries and online databases, including PubMed and Google Scholar, focusing on peer-reviewed articles that discuss vital pulp therapy techniques and the materials used. A total of 32 articles were selected based on predefined inclusion and exclusion criteria.
Results: The review identifies indirect pulp capping, particularly the stepwise approach, as the most conservative method, offering significant benefits in terms of promoting natural healing processes and reducing the risk of pulp exposure. Direct pulp capping, utilizing materials such as Mineral Trioxide Aggregate (MTA) and Biodentin, demonstrates a high success rate in forming a protective barrier over exposed pulp tissue, thus preserving pulp vitality. Pulpotomy, indicated for more severe cases, also shows promising results in maintaining the vitality of the remaining pulp tissue, with materials like MTA and Biodentin playing pivotal roles. The evolution of dental materials, including bioactive silicates and resin-based MTA, has significantly contributed to the success of these therapies.
Conclusion: Vital pulp therapies, leveraging contemporary materials and techniques, offer effective strategies for preserving pulp vitality in teeth affected by caries or traumatic injuries. The choice of technique and material is crucial, with indirect pulp capping, direct pulp capping, and pulpotomy each serving distinct clinical scenarios. These therapies not only support the structural integrity and health of the tooth but also align with the principles of minimally invasive dentistry.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Clarkson JE, Ramsay CR, Ricketts D, Banerjee A, Deery C, Lamont T, et al. Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care. BMC Oral Health. 2021;21(1):336.
White DA, Tsakos G, Pitts NB, Fuller E, Douglas GVA, Murray JJ, et al. Adult Dental Health Survey 2009: common oral health conditions and their impact on the population. BDJ. 2012;213(11):567-72.
Kidd EAM. How ‘Clean’ Must a Cavity Be before Restoration? Caries Res. 2004;38(3):305-13.
Bressani A, Mariath A, Haas A, Garcia-Godoy F, Araujo F. Incomplete caries removal and indirect pulp capping in primary molars: A randomized controlled trial. Am J Dent. 2013;26:196-200.
Manhas S, Pandit IK, Gugnani N, Gupta M. Comparative Evaluation of the Efficacy of Stepwise Caries Excavation vs Indirect Pulp Capping in Preserving the Vitality of Deep Carious Lesions in Permanent Teeth of Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent. 2020;13 (Suppl 1)(0974-7052 (Print)):S92-S7.
Schwendicke F, Dörfer CE, Paris S. Incomplete Caries Removal:A Systematic Review and Meta-analysis. J Dent Res. 2013;92(4):306-14.
Piva E, Da Rosa WL, Rubin Cocco A, Silva TM, Mesquita LC, Galharça AD, et al. Systematic review of dental pulp capping materials. J Biomed Mater Res. 2016;32:e89.
Islam R, Islam MRR, Tanaka T, Alam MK, Ahmed HMA, Sano H. Direct pulp capping procedures - Evidence and practice. Jpn Dent Sci Rev. 2023;59(1882-7616 (Print)):48-61.
Hilton TJ. Keys to Clinical Success with Pulp Capping: A Review of the Literature. Oper Dent. 2009;34(5):615-25.
Da Rosa WLO, Cocco AR, Silva TMD, Mesquita LC, Galarça AD, Silva AFD, et al. Current trends and future perspectives of dental pulp capping materials: A systematic review. J Biomed Mater Res B Appl Biomater. 2018;106(3):1358-68.
Andrei M, Vacaru RP, Coricovac A, Ilinca R, Didilescu AC, Demetrescu I. The Effect of Calcium-Silicate Cements on Reparative Dentinogenesis Following Direct Pulp Capping on Animal Models. Molecules. 2021;26(9):2725.
Modena KCDS, Calvo AM, Sipert CR, Colombini-Ishikiriama BL, Dionísio TJ, Navarro MFDL, et al. Molecular Response of Pulp Fibroblasts after Stimulation with Pulp Capping Materials. Braz Dent J. 2020;31(3):244-51.
Barthel CR, Levin LG, Reisner HM, Trope M. TNF‐α release in monocytes after exposure to calcium hydroxide treated Escherichia coli LPS. Int Endod J. 1997;30(3):155-9.
Tawil PZ, Duggan DJ, Galicia JC. Mineral trioxide aggregate (MTA): its history, composition, and clinical applications. Compend Contin Educ Dent. 2015;36(4)(2158-1797 (Electronic)):247-64.
Marques MS, Wesselink PR, Shemesh H. Outcome of Direct Pulp Capping with Mineral Trioxide Aggregate: A Prospective Study. Int Endod J. 2008;41(2)(1878-3554 (Electronic)):128-50.
Schwendicke F, Brouwer F, Schwendicke A, Paris S. Different materials for direct pulp capping: systematic review and meta-analysis and trial sequential analysis. Clin Oral Investig 2016;20(6)(1436-3771 (Electronic)):1121-32.
Lipski M, Nowicka A, Kot K, Postek-Stefańska L, Wysoczańska-Jankowicz I, Borkowski L, et al. Factors affecting the outcomes of direct pulp capping using Biodentine. Clin Oral Investig. 2018;22(5):2021-9.
Toida Y, Kawano S, Islam R, Jiale F, Chowdhury AA, Hoshika S, et al. Pulpal response to mineral trioxide aggregate containing phosphorylated pullulan-based capping material. Dent Mater J. 2022;41(1):126-33.
Lozano-Guillén A, López-García S, Rodríguez-Lozano FJ, Sanz JL, Lozano A, Llena C, et al. Comparative cytocompatibility of the new calcium silicate-based cement NeoPutty versus NeoMTA Plus and MTA on human dental pulp cells: an in vitro study. Clin Oral Investig. 2022;26(12):7219-28.
Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review--Part III: Clinical applications, drawbacks, and mechanism of action. J Endod. 2010;36(3)(1878-3554 (Electronic)):400-13.
About I. Recent trends in tricalcium silicates for vital pulp therapy. Curr Oral Health Rep. 2018;5:178-85.
Arandi NZ, Thabet M. Minimal Intervention in Dentistry: A Literature Review on Biodentine as a Bioactive Pulp Capping Material. BioMed Res Int. 2021;2021:1-13.
Gomes‐Cornélio AL, Rodrigues EM, Salles LP, Mestieri LB, Faria G, Guerreiro‐Tanomaru JM, et al. Bioactivity of MTA Plus, Biodentine and an experimental calcium silicate‐based cement on human osteoblast‐like cells. Int Endod J. 2017;50(1):39-47.
Kaur M, Singh H, Dhillon JS, Batra M, Saini M. MTA versus Biodentine: Review of Literature with a Comparative Analysis. J Clin Diagn Res. 2017;11(8)(2249-782X (Print)):ZG01-ZG5.
Grech L, Mallia B Fau - Camilleri J, Camilleri J. Investigation of the physical properties of tricalcium silicate cement-based root-end filling materials. Dent Mater 2013;29(2)(1879-0097 (Electronic)):e20-e8.
Li X, Yoshihara K, De Munck J, Cokic S, Pongprueksa P, Putzeys E, et al. Modified tricalcium silicate cement formulations with added zirconium oxide. Clin Oral Investig. 2017;21(3)(1436-3771 (Electronic)):895-905.
Natale LC, Rodrigues MC, Xavier TA, Simões A, De Souza DN, Braga RR. Ion release and mechanical properties of calcium silicate and calcium hydroxide materials used for pulp capping. Int Endod J. 2015;48(1):89-94.
Bhavana V, Chaitanya KP, Gandi P, Patil J, Dola B, Reddy RB. Evaluation of antibacterial and antifungal activity of new calcium-based cement (Biodentine) compared to MTA and glass ionomer cement. J Conserv Dent. 2015;18(1)(0972-0707 (Print)):44-6.
Kim J, Song Y-S, Min K-S, Kim S-H, Koh J-T, Lee B-N, et al. Evaluation of reparative dentin formation of ProRoot MTA, Biodentine and BioAggregate using micro-CT and immunohistochemistry. Restor Dent Endod. 2016;41(1):29.
Gutmann JL, Lovdahl PE. Chapter 7 - Problem-Solving Challenges in Dentin Hypersensitivity and Vital Pulp Therapy. In: Gutmann JL, Lovdahl PE, editors. Problem Solving in Endodontics (Fifth Edition). Saint Louis: Mosby; 2011. p. 132-49.
Igna A. Vital Pulp Therapy in Primary Dentition: Pulpotomy—A 100-Year Challenge. Children (Basel). 2021;8(10):841.
Jassal A, Nawal RR, Yadav S, Talwar S, Yadav S, Duncan HF. Outcome of partial and full pulpotomy in cariously exposed mature molars with symptoms indicative of irreversible pulpitis: A randomized controlled trial. Int Endod J. 2023;56(3):331-44.