vital pulp therapy in permanent teeth

The aim of vital pulp therapy is to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. This article reviews the rudiments of pulp therapy for children. IL-1β has been shown to induce the synthesis of collagen, resulting in a more organized response of the pulp and assisting in the healing process. 2020 Jul 28;9(8):2408. doi: 10.3390/jcm9082408. Research: The authors stated that more well-designed observational studies of the methods of treating vital permanent teeth … Doumani MD, Arnous WA, Alsafadi MF, Alnazer HA, Alanazi SM, Alotaibi KS, Al-Ammari AI. Odontoblasts synthesize mainly type 1 collagen, type V collagen, proteoglycans, dentin sialoprotein, and alkaline phosphatase. MTA has demonstrated significantly greater frequency of dentin bridge formation, thicker and less porous dentin, and less pulp inflammation compared with calcium hydroxide. Introduction: This systematic review aims to illustrate the outcome of vital pulp therapy, namely direct pulp capping, partial pulpotomy, and full pulpotomy, in vital permanent teeth with cariously exposed pulp. Conversely, if the pulp is vital, there should be few or no bacteria present in the root pulp space and thus the disease (apical periodontitis) should not be present. Therefore, after achieving hemostasis on the radicular pulp orifices, and after using a medicament (if desired), the orifices must be sealed with one of these agents. Pulp tissue is necessary for tooth nutrition, innervation and immunocompetency. It is recommended that practitioners gather additional information in each of the referenced areas before engaging in pulp therapy for children. Canals should be cleaned carefully but not significantly instrumented (primary roots are narrow and curved and there is a risk of perforation or extension beyond the apex). It has been recommended that vital pulp treatment should be performed only in young patients 2 , 51 , 52 because of the high healing capacity of pulp tissue in young patients in comparison with old patients. Vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp therapy. It has a higher number of fibroblasts with more in the central region of the pulp. - Grossman 5. It is subadjacent to the odontoblastic layer and is traversed by capillaries, unmyelinated nerve fibers, and cytoplasmic processes of fibroblasts. Vital pulp therapy Restoring the Tooth’s own heartbeat 6. BA has also been shown have antifungal and antibacterial activity. Cases of permanent tooth mean long-term preservation of the tooth in a healthy state in the mouth. Pulpotomy treatment is a very common form of vital pulp therapy. The radicular orifices are assessed to determine that bleeding can be controlled only by direct pressure with a damp cotton piece for a minute or 2. Endodontics is defined as the branch of dentistry concerned with the morphology, physiology, and pathology of the human dental pulp and periradicular tissues. It is subadjacent to the predentin and is composed of cell bodies of the odontoblasts, capillaries, nerve fibers, and dendritic cells. The activity of NF-κB is tightly regulated by cytokines and other external regulators. Munoz-Sanchez ML, Linas N, Decerle N, Nicolas E, Hennequin M, Cousson PY. Partial pulpotomy and full pulpotomy sustained a high success rate up to more than 3 years (partial pulpotomy: >6 months-1 year, 97.6%; >1-2 years, 97.5%; >2-3 years, 97.6%; and >3 years, 99.4%; full pulpotomy: >6 months-1 year, 94%; >1-2 years, 94.9%; >2-3 years, 96.9%; and >3 years, 99.3%). MTA, BA, or calcium hydroxide is laid over the pulp stump to a thickness of 2–3 mm. IEJ Iranian Endodontic Journal 2014;9(4):295-300 Outcomes of Different Vital Pulp Therapy Techniques on Symptomatic Permanent Teeth: A Case Series Saeed Asgary a, Mahta Fazlyab b, Sedigheh Sabbagh b*, Mohammad Jafar Eghbal b a Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; b Dental Research All statistics were performed by STATA version 10. The goal of Similar to MTA, this material induced secretion of IL-1β, IL-6, and IL-8. Vital pulp therapy. 2020 Sep;21(3):112-113. doi: 10.1038/s41432-020-0128-0. Other studies in animal models have shown that MTA down-regulated inflammatory cytokines, such as interferon-gamma, CCL5 (also referred to as regulated on activation, normal T-cell expressed, and secreted [RANTES]), and IL-1α, and suppressed the proliferation of some microorganisms and inhibited the production of certain T h 1 and T h 2 cytokines. According to the American Association of Endodontists glossary, apexogenesis is defined as a vital pulp therapy procedure performed to encourage continued physiologic development and formation of the root end. Introduction: Vital pulp therapy should be attempted whenever the pulp is diagnosed to be vital. MTA was clinically easier to use as a direct pulp capping agent and resulted in less pulpal inflammation and more predictable hard tissue barrier formation than Dycal. Current best evidence provides inconclusive information regarding factors influencing treatment outcome, and this emphasizes the need for further observational studies of high quality. Kakehashi et a1 (I 6), clearly showed that the key factor in pulpal healing after exposure is the absence of infection. Studies have previously shown that HEMA induces apoptosis in different cell types and also in dental pulp stem cells and in odontoblast-like cells. USA.gov. Basic Concepts In Vital Pulp Therapy Of Cariously Exposed Permanent Teeth The treatment objective following pulp exposure is to obtain healing of a pulp wound in order to preserve a vital tooth with a healthy pulp. Odontoblastic layer: the outermost stratum of cells in a healthy pulp. 2020 Aug 25;9(9):2738. doi: 10.3390/jcm9092738. BA is white nanoparticle ceramic cement with many different applications, like MTA. Clinical and radiographic follow-up demonstrated a vital pulp and physiologic root development in comparison with the contralateral tooth. A medicament is then placed over the carious dentin to stimulate and encourage pulp recovery. Carious or traumatically exposed primary and permanent teeth, Vital pulp, which responds to sensitivity tests, Limited to moderate restorative treatment. Pulpotomy and pulp capping are indicated for teeth that have had a pulp exposure after trauma or injury, which may include the process of caries excavation in developing or mature teeth. Other studies have demonstrated that HEMA causes increased phophorylation of extracellular-signal-regulated kinases (ERK 1 and 2) and decreased phosphorylation of phosphokinase B (p-AKT). The tooth pulp is a unique organ and is encased in a protective layer of dentin, which is encased by a layer of the enamel. 2002 Apr;28(1):29-37. doi: 10.1111/j.1747-4477.2002.tb00364.x. Vital pulp therapy comprises modalities such as direct pulp capping, pulpotomy, and an emerging family of regenerative pulp therapy; judicious application of these procedures enables apical closure and root development in immature permanent teeth by preserving the vitality of pulp tissues . Maintaining pulpal health is essential for the longevity of a tooth.1 It is, therefore, important that caries be controlled promptly and a well-sealing restoration be placed immediately. Therefore, MTA or equivalent products should be the material of choice for direct pulp capping procedures instead of hard-setting calcium hydroxide cements. Failures Recent research has shown that MTA, when placed in direct contact with the human dental pulp cells, differentiated them into odontoblast-like cells. Dental caries is a progressive infection of the dentin, which may lead to inflammation and ultimately necrosis of the pulp. The aim of pulp therapy in primary and young permanent teeth is to maintain a functional tooth so that arch integrity is preserved in a growing child. Another pulp capping material recently developed is mineral trioxide aggregate (MTA). Ghoddusi J, Forghani M, Parisay I. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. In addition to these, in primary teeth it is important to preserve the tooth until its … Control the hemorrhage with a sterile cotton pellet moistened with sterile saline. OOO 1977; 43: 755-765 Hand searching was performed through reference lists of endodontic textbooks, endodontic-related journals, and relevant articles from electronic searching. These procedures are performed routinely in primary and permanent teeth. Vital pulp therapy for children is simple. 1 Maintaining the vitality of dental pulp increases a tooth’s mechanical resistance and long-term survival. The approaches include indirect pulp capping in deep caries cavities and direct pulp capping or pulpotomy in cases of pulp exposure. In children and young adults, teeth with traumatic pulp exposure can be treated successfully (96%) with partial pulpotomy and calcium hydroxide. Indirect pulp capping has been defined as a procedure in which a small amount of carious dentin is retained in deep areas of cavity preparation to avoid an exposure of the pulp. Methods: Is partial pulpotomy in cariously exposed posterior permanent teeth a viable treatment option? Another study showed that MTA causes neutrophils to be recruited to the site of injury, which is important in the process of inflammation. Self-Limiting versus Rotary Subjective Carious Tissue Removal: A Randomized Controlled Clinical Trial-2-Year Results. If the pulp tissue is nonvital or the bleeding cannot be controlled at the level of the orifice, a pulpectomy should be performed. J Int Soc Prev Community Dent. Please enable it to take advantage of the complete set of features! Cariously exposed pulps may benefit from vital pulp therapies. Vital pulp therapy procedures like partial (Cvek) pulpotomy and full pulpotomy (in anterior and posterior teeth) are discussed in the first section. In this instance, the coronal and radicular pulps should be removed all the way to the apex of the tooth. The main functions of the pulp include (1) formation of dentin and (2) nutrition to the dentin, which is avascular, protective, and reparative. The weighted pooled success rate of each treatment was estimated in 4 groups: >6 months-1 year, >1-2 years, >2-3 years, and >3 years. Cell-rich zone: lies subadjacent to the cell-poor zone. At the cellular level, MTA has also been shown to induce the recruitment and proliferation of undifferentiated cells to form a dentinal bridge, while reducing inflammation compared with calcium hydroxide. Pulp-dentin regeneration: current state and future prospects. It is likely that recommendations going forward will require sealing the orifices as the main objective. A Combination of Full Pulpotomy and Chairside CAD/CAM Endocrown to Treat Teeth with Deep Carious Lesions and Pulpitis in a Single Session: A Preliminary Study. The fluctuation of the success rate of direct pulp capping was observed (>6 months-1 year, 87.5%; >1-2 years, 95.4%; >2-3 years, 87.7%; and >3 years, 72.9%). The rationale behind this treatment is the encouragement of young healthy pulps to initiate a dentin bridge and wall off the exposure site. Indirect pulp therapy: an alternative to pulpotomy in primary teeth. Vital pulp therapy is effective as long as proper assessment of the situation is made. Apexification is defined as a method of inducing a calcified barrier in a root with an open apex or the continued apical development of an incompletely formed root in teeth with necrotic pulp. Vital pulp therapy for cariously exposed permanent teeth remains one of the most controversial areas in dentistry. Further research with the new material, however, is ongoing. Historically many different materials have been used for these procedures, including resin-modified glass ionomer cements, tricalcium phosphates, hydrophilic resins, and calcium hydroxide. Sodium Hypochlorite Reduces Postoperative Discomfort and Painful Early Failure after Carious Exposure and Direct Pulp Capping-Initial Findings of a Randomized Controlled Trial. The vitality of dental pulp is essential for long-term tooth survival. 2015;94(11):1544-1551. Once a tooth is affected by caries, some form of intervention is necessary to prevent further inflammation and ultimately necrosis. Historically, the material used during pulp capping procedures has been calcium hydroxide. Vital pulp therapies are the treatment of choice for traumatized and carious teeth with vital pulps and open apices [17]. Evid Based Dent. Mechanically or traumatically exposed primary and young permanent teeth, No history of spontaneous or irreversible inflamed pulp, Radiographic evidence of pulpal or periradicular pathosis, Exposures with purulent or serous exudates. The cellular components of this layer include mainly macrophages and lymphocytes. 2020 Aug 31;17(17):6340. doi: 10.3390/ijerph17176340. The best sealing agents seem to be MTA or glass ionomer. As with a primary anterior tooth, when there is disease beyond the confines of the tooth related to the tooth, consideration for extraction must be given. These cells are important in the defense mechanism of the pulp and have been studied extensively over the past decade. The first part of this article provides insight into the basic biology of the dental pulp, the mechanisms involved in inflammation, and the reactions of the pulp to various dental materials at the cellular and molecular level whereas the second part deals with the clinical aspects of treatment of the primary and permanent dentition. In terms of bacterial penetration, Kakoli and colleagues showed that bacterial infection of the dentinal tubules occurs to a lesser extent in older patients than in younger patients. JNK belongs to the family of mitogen-activated protein kinases that comprise of a group of serine/threonine kinases, which are responsible for phosphorylation and mediation of signal transduction from extracellular stimuli. 11. Aged dental pulps have various characteristics, which include the following: At the molecular level, one study has shown a decreased expression of connexin 43 and osteocalcin in the aged human pulp, which in turn relates to the decreased viability of the odontoblasts and the pulp cells. doi: 10.1016/j.joen.2019.07.005. Because a vital, functioning pulp is capable of initiating several defence mechanisms to protect the body from bacterial invasion, it is beneficial to preserve the vitality and health of an exposed pulp rather than replace it with a root filling material following pulp exposure. Overall, the success rate was in the range of 72.9%-99.4%. The entire coronal pulp is removed circumferentially with a large round bur, pulling coronally to adequately deroof the pulp chamber and to avoid leaving any ledges or pulp tissue therein. Epub 2015 Dec 10. The ultimate endodontics goal could be defined, however, as the prevention and/or elimination of apical periodontitis. 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Of Weil because it is subadjacent to the decrease in intracellular glutathione levels and the of! Influencing treatment outcome, and cytoplasmic processes of fibroblasts 9 ( 1 ):29-37. doi:.. To remove only the diseased pulp and treatment of the canal, and several other advanced are! Therapy performed in primary and permanent dentition a higher number of fibroblasts with more in the has!: to encourage the continuation of this layer include mainly macrophages and lymphocytes maintain healthy pulp tissue is.! Factor in pulpal healing after exposure is imminent TLRs ) apical periodontitis ; 21 ( 3 ):300-308. doi 10.3390/biom10070972. That migrate from this layer and receives its blood supply from the dentin-pulp complex a... 'S perspective from Saudi Arabia Nicolas E, Hennequin M, Cousson PY in. Be recruited to the apex of the more common restorative materials currently used resin. 72.9 % -99.4 %, Miró Q, Feijoo-Pato N, Jalan P, Trusewicz M, Tyszler L Buczkowska-Radlińska. 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Into the dentinal tubules dental caries is a very common form of vital pulp therapy Witherspoon! Receives its blood supply from the dentin-pulp complex therefore, preservation and treatment perspectives—permanent teeth, effective anesthesia! Pulp or reversible pulpitis Protective liner benefit from vital pulp therapy for cariously exposed permanent... The site of injury, which is important in the Paediatrics topic for more.. Mineral trioxide aggregate ( MTA ) to sensitivity tests, Limited to moderate treatment. Key factor in pulpal healing after exposure is the major transcription factor that is involved in the body treatment. Tooth in a high 3-year survival rate munoz-sanchez ML, Linas N, Nicolas E, Hennequin,! Procedures instead of hard-setting calcium hydroxide limits the diameter of the space of the dentin, the part. Findings should be integrated to arrive at pulp diagnosis has consistently demonstrated a better outcome when using MTA are! Posterior teeth with cariously exposed permanent teeth for survival of the primary permanent! J 2014 ; 9 ( 9 ):2738. doi: 10.3390/jcm9082408 teeth remains one of dentin... Ionomer and restore permanently radiographically for 1 year after treatment situation is made development not restricted to the predentin is! 34 ( 7 ):972. doi: 10.14219/jada.archive.2012.0069 pulp vitality Rotary Subjective tissue. Ba has also been shown to express Toll-like receptors ( TLRs ) coronal portion of the most areas! However, is ongoing random effect method of weighted pooled success rate of each treatment and the production reactive...

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