The efficacy of pulp capping materials. A comparative trial

Vital Pulp Therapy in Vital Permanent Teeth with Cariously Exposed Pulp: A Systematic Review

“…Data from selected studies showed that 70% of direct pulp capping (17,(29)(30)(31)(32)(33)(34)(35) and partial pulpotomy (18,26,(36)(37)(38) studies included only teeth with caries exposure with either short duration pain or asymptomatic, normal response to percussion test and normal radiographic appearance apically. Several studies included teeth with signs and symptoms of irreversible pulpitis such as teeth with spontaneous pain (17,18,20) and teeth that were positive to percussion (17,18).…”

“…A profuse bleeding that is difficult to stop indicates severe pulpal inflammation. The literature suggested several methods to control pulpal hemorrhage including rinsing the surgical wound with sodium hypochlorite solution (17,30,36,43), physiologic saline solution (18,26,29,37,38), or hydrogen peroxide (17,44) or pressing with a cotton pellet (19, 31, 33-35, 39, 43, 45). There are no available data as to which method provides the best outcome.…”

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“…Although pain associated with a pulp exposure is associated with a poorer prognosis (9,25,28), pain alone is not a definite measure of the state of the pulp and some painful teeth may be only reversibly damaged (23) and amenable to pulp capping. According to James et al (83) the ability of the exposed pulp to heal is inversely proportional to the amount of inflammation present.…”

“…According to James et al (83) the ability of the exposed pulp to heal is inversely proportional to the amount of inflammation present. Some authors (28,(84)(85)(86) therefore have advocated pretreatment of the painful tooth with a corticosteroid antibiotic paste to reduce inflammation before pulp capping in order to improve the prognosis compared to immediate pulp capping with calcium hydroxide. The time the pulp is in contact with the corticosteroid antibiotic paste seems to be critical, as prolonged exposure will retard or even prevent healing of the pulp (81,(84)(85)(86) because the corticosteroid depresses connective tissue activity, which interferes with healing (87).…”

“…However, when there are no pre-existing signs and symptoms, studies show that carious exposures can be successfully pulp capped (26)(27)(28), and when the exposure occurs during removal of the last remaining carious dentine, the prognosis is no worse than for mechanical exposures (15), although animal studies indicate that healing may be delayed (29). When the carious exposure occurs in a painful tooth, then the prognosis for pulp capping is usually worse (8,16,25,28).…”