Are you facing root canal therapy? There may be a help afterwards….
It is important to evaluate carefully the tooth symptoms and history of previous treatments.
The consequences of pulp exposure from caries, trauma or tooth preparation misadventure can be severe, with pain and infection the result. The morbidity associated with treating pulp exposures is consequential, often requiring either extraction or root canal therapy. Both the loss of the tooth and its replacement, or endodontic treatment and tooth restoration, involve multiple appointments and considerable expense. An alternative procedure to extraction or endodontic therapy is pulp capping, in which a medicament is placed directly over the exposed pulp (direct pulp cap), or a cavity liner or sealer is placed over very small amount of residual caries (indirect pulp cap) in an attempt to maintain pulp vitality and avoid the more extensive treatment dictated by extraction or endodontic therapy.
The direct pulp cap, in which a material (Calcium hydroxide) is placed directly over the exposed pulp tissue, has been suggested as a way to promote pulp healing and generate reparative dentin. If successful, this procedure precludes the need for more invasive, more extensive and more expensive treatment. A number of factors have been shown to have an impact on direct pulp cap success, such as impeccable area isolation, gentle use of instrument, disinfection of the tooth cavity. A very careful approach removing tooth decay with minimizing tooth trauma during the procedure to minimum leads to successful tooth vitality preservation and perhaps never needing additional therapies.
Calcium Hydroxide
Calcium hydroxide was introduced to the dental profession in 1921 and has been considered the “gold standard” of direct pulp capping materials for several decades.There are a number of well-known advantages to calcium hydroxide that have caused it to receive this recognition. Calcium hydroxide has excellent antibacterial properties. One study found a 100% reduction in microorganisms associated with pulp infections after one-hour contact with calcium hydroxide. Most importantly, calcium hydroxide has a longterm track record of clinical success as a direct pulp-capping agent in periods of up to 10 years.
Calcium hydroxide is believed to effect pulp repair by one or more of several mechanisms of action. Calcium hydroxide possesses antibacterial properties, and this can minimize or eliminate bacterial penetration to the pulp. Traditionally, it has been believed that calcium hydroxide’s high pH causes irritation of the pulp tissue, which stimulates repair via some unknown mechanism. In recent years, this “unknown mechanism” may have been explained by the release of bioactive molecules. It is known that a variety of proteins are incorporated into the dentin matrix during dentinogenesis. Of particular importance to the topic of pulp capping is that at least two of these proteins, Bone Morphogenic Protein (BMP) and Transforming Growth Factor-Beta One (TBF-β1), have demonstrated the ability to stimulate pulp repair. Furthermore, calcium hydroxide is known to solubilize these proteins from dentin, lending credence to the release of these bioactive molecules as a significant mediator in pulp repair following pulp capping.
Success rate of the above procedures is highly dependent on many factors such as patient age, history of the symptoms and operator’s skills and isolation techniques performing this procedure. Close follow up with periodic pulp testing and radiographic evaluation is necessary to maintain success of this procedure.
Read more on How to preserve tooth vitality and prevent root canal therapy: “Vital pulp capping: a worthwhile procedure” , “Keys to Clinical Success with Pulp Capping: A Review of the Literature”
