Intro
Once the pulp gets exposed, the aim of the treatment is to promote pulp tissue healing and preserve pulp vitality
- Vital pulp therapy is to conserve,preserve and maintain healthy pulp tissue by sealing the surroundings as dentin do from oral microorganisms
- It have been compromised(settle a dispute by mutual concession) by anatomical anomalies, caries,trauma, or restorative procedures.
- The prime objective of the treatment strategy is to promote the formation of a reparative hard tissue barrier after pulpal injury, in order to retain the tooth as a functional unit.
So,Vital pulp therapy defined as
Nonvital pulp therapy, that is, apexification and pulpectomy are indicated if irreversible damage to pulp has occurred.
Pulp keeps the dentin moist which in turn ensures resilience and toughness of the dentin. Also, the vital pulp provides the protective resistance to mastication forces compared to endodontically treated tooth. So, it is always preferred to maintain the vitality of the pulp unless it is unavoidable.
prior to treatment, the histological condition of the pulp can be difficult to ascertain, based on the limitations of pulp testing methods, a limited knowledge of pulpal physiology, the subjectivity of the patient’s symptoms, and the presence of inflammatory mediators that cannot be assessed clinically
the impact and success of vital pulp therapy will depend largely on the patient’s age, size of the pulp, degree of microbial contamination, pulp capping material, and the seal of the final restoration.
“Teeth exhibiting provoked pain of short duration, that is relieved, upon the removal of the stimulus, with analgesics, or by brushing, without signs and symptoms of irreversible pulpitis, have a clinical diagnosis of reversible pulpitis and are candidates for vital pulp therapy.”
When the dental pulp is injured by carious exposure,or trauma, and competently treated, the mechanism of healing is similar to that observed in normal connective tissue.Since the vital pulp is, therefore, capable of demonstrating competent immune defense mechanisms, it is desirable to preserve the vitality of an exposed pulp and promote repair since its retention (longevity) is paramount to the tooth’s long-term survival.
The formation of a protective hard tissue barrier(reparative bridges) is the goal of vital pulp procedures.
TECHNIQUES FOR GENERATING REPARATIVE BRIDGES
VITAL THERAPY TECHNIQUES FOR GENERATING REPARATIVE BRIDGES according to their level of damage
1.indirect pulp capping 2.Direct pulp capping 3.partial pulpotomy 4.pulpotomy
Indirect pulp capping is defined as “a procedure in which a material is placed on a thin partition of remaining carious dentin that, if removed, might expose the pulp in immature permanent teeth.”
Direct pulp capping is defined as the “treatment of an exposed vital pulp by sealing the pulpal wound with a dental material placed directly on a mechanical or traumatic exposure to facilitate the formation of “reparative dentin” and maintenance of the vital pulp.”
Non-symptomatic teeth with no radiographic evidence of pathosis now show remarkable success using this technique.Caries removal is completed using various techniques,to a perimeter near the tissue, without directly exposing the pulp. Selected teeth with deep carious lesions that receive conservative caries excavation, where direct pulp exposures were avoided, have demonstrated strong potential for repair since the primary odontoblasts are preserved.
One or two-stage (step-wise) indirect pulp capping techniques are completed using either CH, zinc oxide-eugenol materials (ZOE) or CSCs.
Partial pulpotomy (Cvek pulpotomy) is described as “the removal of a small portion of the vital coronal pulp as a means of preserving the remaining coronal and radicular pulp tissues.”
Pulpotomy is a more invasive procedure defined as “the removal of the coronal portion of a vital pulp as a means of preserving the vitality of the remaining radicular portion. It may be performed as an emergency procedure for temporary relief of symptoms or therapeutic measure, as in the instance of a Cvek pulpotomy.”
The entire coronal pulp is removed to the level of the pulpal floor, or cementoenamel junction, and a capping material is placed over the canal orifices, or remaining radicular tissue.
Vital pulp therapy is indicated whenever the remaining pulp exhibits reversible pulpitis.thus why we don't remove all pulp,we conserve remaining pulp.
VITAL PULP THERAPY MATERIALS