Dental Pulp Capping and Pulpotomy Techniques

Indirect Pulp Capping

Indicated in deep caries near the pulp without signs or symptoms of pulpal involvement. Goals are to avoid pulpal exposure and block the passage of bacteria. Success is defined by:

• Absence of signs and symptoms of pulpal pathology.
• Correct isolation.
• Careful cleaning of axial walls.
• Good seal of restoration margins.

The procedure involves:

1. Elimination of infected dentin.
2. Placing a biocompatible material on the layer of demineralized, uninfected dentin to inactivate remaining bacteria.
3. Remineralizing the lesion by forming reparative dentin.

Materials include: Zinc oxide eugenol and Dycal.

Direct Pulp Capping

Indicated in temporary teeth only when the pulp has been inadvertently exposed during an operative procedure. The tooth must be asymptomatic, the pulp exposure is minimal (<1mm), and good isolation is essential. Exposure due to decay is a contraindication. This technique is based on the application of an agent directly onto the pulp. Failure manifests as an abscess or internal resorption. Materials commonly used are Calcium Hydroxide ($\text{CaOH}_2$) or root canal repair material (calcium hydroxide powder).

Pulpotomy

Amputation of Coronal Pulp

Amputation of the coronal portion of the affected pulp is performed. The pulp tissue at the root canal levels is capable of healing, in the absence of inflammation, once the affected portion of the pulp is removed.

Indications

• Temporary dentition where only the coronal pulp is affected, even with irreversible pulpitis, while the radicular pulp is vital with no clinical or radiological signs of inflammation.
• Teeth susceptible to be restored.
• Two-thirds of radicular canals must be healthy.

Contraindications

• Spontaneous pain or percussion-provoked pain.
• Abnormal mobility.
• Presence of a fistula.
• Internal or external resorption.
• Pulpal calcifications.
• Presence of periapical areas at the interradicular level.
• Excessive bleeding during pulpal treatment.

Materials Used

Materials used in this technique must accomplish certain requirements:

• Bactericidal.
• Innocuous to pulp tissue.
• Promote healing of radicular pulp.
• Do not interfere in the radicular resorption process of temporary teeth.

Materials include: Formocresol, glutaraldehyde, ferric sulphate, MTA, and 3% $\text{NaOCl}$.

Comparison of Fixatives

Formocresol is used during 3 minutes, yielding 70–79% radiological and clinical success. Glutaraldehyde offers better fixating properties with less diffusion, but shows a lower clinical and radiological response.