The scientific management of deep carious lesions in vital teeth using contemporary materials—a narrative review

Abstract

AimThe aim of this article is to review the scientific evidence for deep caries removal in permanent vital teeth and the choice of dentine replacement material and restoration of the teeth to maintain long term tooth vitality and function.MethodThe two position statements namely the European Society of Endodontology and the American Association of Endodontists position statements on vital pulp therapy will be scrutinized and compared with regards to the deep caries removal strategy and assessed for evidence of best practice. The properties of materials used to manage vital pulps and the best way to restore the teeth will be reviewed and guidance on the full management of vital teeth will be suggested.ConclusionsPromoting new treatment modalities for reversible and irreversible pulpitis allowing for pulp preservation should be considered. Although debatable, cases with deep caries should be managed by complete non-selective caries removal which will allow for pulpal management if needed and a more predictable outcome can be expected when using the new materials and treatment modalities of vital pulp therapy.

Diagnostic and Prognostic Predictors for the Success of Pulpotomy in Permanent Mature Posterior Teeth with Moderate to Severe Pulpitis: A Scoping Review

“…The development of a chairside diagnostic biomarker test with high specificity and sensitivity may assist in future clinical decision-making between VPT or RCT. Matrix Metalloproteinase-9 (MMP-9) has been of particular interest in recent studies as it is expressed in high concentrations in inflamed pulps as an indicator of tissue breakdown [93,94]. Mente et al [95] sampled pulpal blood after a partial pulpotomy in 44 teeth with deep caries and found that the MMP-9 levels were significantly higher in patients with moderate to severe pulpitis.…”

Potential factors affecting the success rate of indirect pulp therapy in primary molars with deep caries: a retrospective study

“…However, it is difficult to elicit accurate information on pulp symptoms in pediatric dentistry. Correctly diagnosing the pulp status of deep carious lesions in primary teeth is crucial for selecting the best vital pulp therapy [7,8]. Pulp sensibility and vitality tests measuring the nerve response rather than assessing the blood flow of the pulp have significant limitations [9].…”