Trishna PokhrelToday in this article we will discuss about indirect pulp capping. But first of all what is pulp capping ? Pulp cap is a layer of lining or cement material placed on to a thin layer of dentine overlying a macroscopically unexposed pulp (Indirect pulp cap), or directly on to exposed pulp tissue (direct pulp cap) with the intention of presetving pulp vitality.
Indirect pulp capping is defined as the procedure where in small amount of carious dentine is retained in deep areas of cavity to avoid exposure of pulp, followed by placement of a suitable medicament and restorative materials that seals off the carious dentine and encourages the pulp recovery.
Objective of Indirect pulp capping
- Arresting carious process.
- Promoting the dentine sclerosis.
- Vitality should be preserved.
- Remineralization of carious dentine.
- Stimulation formation of tertiary dentin.
Indication:
| History | Clinical Examination | Radiographic Examination |
| - Mild pain associated with eating and no history of spontaneous, extreme pain. | - Deep caries lesion where pulpal inflammation is minimal and complete removal of caries would probably cause pulpal exposure. - No mobility - Normal tooth color |
- Normal laminadura and periodontal ligament space and no radiolucency in bone or surrounding area |
Contraindication:
| History | Clinical Examination | Radiographic Examination |
| - Sharp, Penetrating pain, prolonged night pain | - Mobility of tooth. - Discoloration of tooth - When there is wide spread inflammation or evidence of perapical lesions. |
- Definite pulp exposure. - Break in continuity of lamina dura. - Widening of periodontal ligament space. |
Treatement Procedure:
- There are two-appointment procedure as well as single visits procedure.
Techinique:
A) Single visit procedure
|
At first, local anesthesia was used and proper isolation was done in the tooth. ↓ Remove caries using round bar or spoon excavator from cavity walls and Dentino - Enamel Junction (DEJ) ↓ Calcium hydroxide(Ca(OH)2) is paced over remaining dentine as sedative dressing ↓ Tooth sealed with zinc oxide eugenol and temporary restoration given. |
B) Two - Appointment Procedure:
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After 6-8 weeks, we can re-center and if a reparative dentin bridge is formed, a permanent full coverage restoration can be given. ↓ If some amount of caries remaining, remaining carious dentine can be removed. ↓ Cavity washed out and dried. ↓ Calcium hydroxide(Ca(OH)2) placed and base was applied through Glass Ionomer Cement (GIC). ↓ Final restoration is then placed and stainless steel crown given. |
