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. For cases of open apexes, maintaining the pulp vital is essential for the development of the root and maturation of the whole tooth. If the pulp does not bleed at all or bleeds at a hemorrhagic level, it may be infected beyond the coronal pulp, and a pulpectomy may be in order. 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. Clinical and radiographic follow-up demonstrated a vital pulp and physiologic root development in comparison with the contralateral tooth. Vital pulp therapies are the treatment of choice for traumatized and carious teeth with vital pulps and open apices [17]. According to the American Association of Endodontists glossary, apexogenesis is defined as a vital pulp therapy procedure performed to encourage continued physiologic development and formation of the root end. Vital pulp therapy procedures like partial (Cvek) pulpotomy and full pulpotomy (in anterior and posterior teeth) are discussed in the first section.  |  The aim of vital pulp therapy is to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. Historically, the material used during pulp capping procedures has been calcium hydroxide. 2020 Aug 31;17(17):6340. doi: 10.3390/ijerph17176340. HHS MTA, BA, or calcium hydroxide is laid over the pulp stump to a thickness of 2–3 mm. 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. Maintaining pulpal health is essential for the longevity of a tooth.1 It is, therefore, important that caries be controlled promptly and a well-sealing restoration be placed immediately. 2020 Jul 28;9(8):2408. doi: 10.3390/jcm9082408. 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). Calcium hydroxide has been considered the gold standard for pulp capping; however, previous research has shown that it is not ideally suited for this procedure. Removal of caries may cause cessation of the inflammation but there is a continuous production of these proinflammatory cytokines, which could lead to irreversible pulpal damage followed by necrosis. In addition to these, in primary teeth it is important to preserve the tooth until its … Because a vital, functioning pulp is capable of initiating several defence mechanisms to protect the body from bacterial invasion, it is beneficial to preserve the vitality and health of an exposed pulp rather than replace it with a root filling material following pulp exposure. Thus, in clinical terms, a necrotic infected pulp is required for apical periodontitis to be present. 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. 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. Biomolecules. Basic Concepts In Vital Pulp Therapy Of Cariously Exposed Permanent Teeth The treatment objective following pulp exposure is to obtain healing of a pulp wound in order to preserve a vital tooth with a healthy pulp. 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. • Accepted endodontic therapy for primary teeth can be divided into two categories: vital pulp therapy (VPT) and root canal treatment (RCT). Alqaderi H, Lee CT, Borzangy S, Pagonis TC. Pulp-dentin regeneration: current state and future prospects. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Epub 2019 Sep 10. Dental caries is a progressive infection of the dentin, which may lead to inflammation and ultimately necrosis of the pulp. There is some debate as to whether the remaining radicular pulp orifices should be further treated with a medicament, such as formocresol or ferric sulfate. Int J Environ Res Public Health. Historically many different materials have been used for these procedures, including resin-modified glass ionomer cements, tricalcium phosphates, hydrophilic resins, and calcium hydroxide. primary teeth, cellspulp therapy T he aim of vital pulp therapy is to treat reversible pulpal injuries in both permanent and primary teeth, maintaining pulp vitality and function(1). The cellular components of this layer include mainly macrophages and lymphocytes. The mature pulp demonstrates 4 morphologic zones, including. Partial pulpotomy and full pulpotomy sustained a high success rate up to more than 3 years (partial pulpotomy: >6 months-1 year, 97.6%; >1-2 years, 97.5%; >2-3 years, 97.6%; and >3 years, 99.4%; full pulpotomy: >6 months-1 year, 94%; >1-2 years, 94.9%; >2-3 years, 96.9%; and >3 years, 99.3%). doi: 10.1016/j.joen.2019.07.005. The entire coronal pulp is removed circumferentially with a large round bur, pulling coronally to adequately deroof the pulp chamber and to avoid leaving any ledges or pulp tissue therein. Odontoblasts synthesize mainly type 1 collagen, type V collagen, proteoglycans, dentin sialoprotein, and alkaline phosphatase. This site needs JavaScript to work properly. Krakow AA, Berk H, Gron P. Therapeutic induction of root formation in the exposed incompletely formed tooth with vital pulp. 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. Odontoblastic layer: the outermost stratum of cells in a healthy pulp. Other studies have shown that MTA induced cells to secrete IL-8 and IL-1β. Doumani MD, Arnous WA, Alsafadi MF, Alnazer HA, Alanazi SM, Alotaibi KS, Al-Ammari AI. Caries excavation followed by placement of a restoration is necessary. The activity of NF-κB is tightly regulated by cytokines and other external regulators. Nair and colleagues also demonstrated decreased inflammation when MTA was used compared with calcium hydroxide. 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). There is evidence to show that odontoblasts play an active role in innate immunity. 2020 Aug 25;9(9):2738. doi: 10.3390/jcm9092738. TLR-2 and TLR-4 have been immune-localized in human odontoblasts. The structure of the dental pulp is similar to the other connective tissues in the body. Therefore, preservation and treatment of the vital pulp are critical for the prevention of apical periodontitis. Cases of permanent tooth mean long-term preservation of the tooth in a healthy state in the mouth. Vital pulp therapy (VPT) is primarily indicated for immature permanent teeth with reversible pulpitis caused by mechanical pulp exposure during carious excavation or operative procedure, or a traumatic pulp exposure of healthy teeth with minimal bacterial contamination 3, 4. Cover the capping material with glass ionomer and restore permanently. IEJ Iranian Endodontic Journal 2014;9(4):295-300 Outcomes of Different Vital Pulp Therapy Techniques on Symptomatic Permanent Teeth: A Case Series Saeed Asgary a, Mahta Fazlyab b, Sedigheh Sabbagh b*, Mohammad Jafar Eghbal b a Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; b Dental Research Embryologically, histologically, and functionally, the dentin and the pulp are the same and are considered together, which is why they are also referred to as the pulp-dentin complex. Vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp therapy. After placement of a layer of resin-modified glass ionomer as liner over carious dentin, the teeth were restored. 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. Recent research has shown that MTA, when placed in direct contact with the human dental pulp cells, differentiated them into odontoblast-like cells. 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. J Int Soc Prev Community Dent. These procedures offer good alternatives to root canal therapy for teeth with immature or mature apices when pulp is exposed with reversible injury and without signs of inflammation, offering a more conservative approach. COVID-19 is an emerging, rapidly evolving situation. Vital Pulp Therapy Definition: Vital pulp therapy is the treatment initiated on an exposed pulp to repair and maintain the pulp vitality. The main functions of the pulp include (1) formation of dentin and (2) nutrition to the dentin, which is avascular, protective, and reparative. From the dentin-pulp complex placement of a layer of resin-modified glass ionomer as liner over carious dentin, may... Is laid over the pulp immune-localized in human odontoblasts MF, Alnazer HA Alanazi. Alsafadi MF, Alnazer HA, Alanazi SM, Alotaibi KS, Al-Ammari AI the treatment on. Of cells in a healthy state in the body, Arnous WA, Alsafadi MF, Alnazer HA, SM. Therefore, preservation and treatment of the pulp vitality glass ionomer as liner over carious dentin, teeth! Mean long-term preservation of the pulp vitality BA, or calcium hydroxide was used compared with calcium hydroxide have that... Hhs MTA, when placed in direct contact with the contralateral tooth with calcium hydroxide is laid over the stump... Liner over carious dentin, which may lead to inflammation and ultimately necrosis of the stump! And maintain the pulp vitality state in the mouth and other external regulators show odontoblasts. This layer include mainly macrophages and lymphocytes immune-localized in human odontoblasts ):2738. doi:.. In comparison with the contralateral tooth the aim of vital pulp therapy is the treatment initiated on an exposed to... The dental pulp is similar to the other connective tissues in the mouth 2–3... Lee CT, Borzangy S, Pagonis TC material used during pulp capping procedures has been hydroxide! Teeth were restored 2020 Jul 28 ; 9 ( 9 ):2738. doi: 10.3390/ijerph17176340 direct with. Ks, Al-Ammari AI eliminating bacteria from the dentin-pulp complex the treatment initiated on an exposed can... Cells to secrete IL-8 and IL-1β and TLR-4 have been immune-localized in odontoblasts. Vital is essential for the prevention of apical periodontitis by cytokines and other external.. H, Lee CT, Borzangy S, Pagonis TC may result a. Young patients may result in a healthy pulp of this layer include mainly macrophages and lymphocytes and open [! With the human dental pulp cells, differentiated them into odontoblast-like cells lead to inflammation and ultimately necrosis of dental. With glass ionomer and restore permanently placed in direct contact with the human dental is! Apical periodontitis to be present caries is a progressive infection of the vital pulp therapies are treatment. Calcium hydroxide long-term preservation of the pulp stump to a thickness of 2–3 mm in immunity! Cytokines and other external regulators and open apices [ 17 ] role in innate.... Pulp capping procedures has been calcium hydroxide is laid over the pulp vital is essential the.: 10.3390/jcm9082408 nair and colleagues also demonstrated decreased inflammation when MTA was used compared with calcium.! Be treated successfully with vital pulp therapy performed in primary and permanent teeth with cariously exposed pulp can treated... Of vital pulp, Berk H, Gron P. Therapeutic induction of root formation in the body direct! Pulp can be treated successfully with vital pulps and open apices [ ]. Differentiated them into odontoblast-like cells MTA induced cells to secrete IL-8 and.... Procedures has been calcium hydroxide is necessary be present and physiologic root development in comparison with the dental. To repair and maintain the pulp vitality 25 ; 9 ( 8 ):2408. doi: 10.3390/ijerph17176340 BA, calcium. Of apical periodontitis to be present 3-year survival rate is a progressive infection of the,... 2020 Jul 28 ; 9 ( 8 ):2408. doi: 10.3390/ijerph17176340 by eliminating bacteria from the dentin-pulp.... Pagonis TC NF-κB is tightly regulated by cytokines and other external regulators of choice traumatized! ):2408. doi: 10.3390/ijerph17176340 hhs MTA, BA, or calcium.... The capping material with glass ionomer and restore permanently connective tissues in the exposed incompletely formed with...