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Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping
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- This retrospective study evaluated the reaction of pulp tissue to direct and indirect pulp capping after 10 years of follow-up. The preservation of pulp vitality was significantly higher after indirect pulp capping procedures (93.8%) than after direct pulp capping procedures (23.8%). The pulp capping material should be carefully considered when performing a direct pulp capping procedure. Vitality preservation was significantly higher in individuals younger than 25 years and when the width of the pulp exposure area before direct pulp capping was less than 1 mm.
- The effectiveness of pulp vitality preservation after indirect pulp capping treatments depends on the adhesive system used, with the total-etch system outperforming the self-etch system.
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Journal of Clinical Medicine
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Long-Term Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping: A Retrospective Clinical Study
J Clin Med 2024 Jul 06;13(13)3962, M Alovisi, A Baldi, A Comba, R Gamerro, G Paolone, M Mandurino, M Dioguardi, A Roggia, N ScottiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Vital pulp therapy relates to the preservation and maintenance of the vitality of pulp tissue, controlling the progression of cariogenic bacteria and establishing a seal with bioactive materials.
In a recent retrospective clinical study by Alovisi et al in 2024, 140 patients (84 females and 56 males) were evaluated for the 10-year long-term outcomes of direct and indirect pulp capping with different materials. The patient profile of this study consisted of 12 (aged <18 years), 20 (19–25 years), 32 (26–40 years), 60 (41–60 years), and 16 patients (>60 years) with 276 permanent teeth who were divided into five groups according to the treatment/material/adhesive system used: direct pulp capping with mineral trioxide aggregate/resin-based glass ionomer/TheraCal and indirect pulp capping with a 3-step total-etch or a 2-step self-etch adhesive system.
The results of this study showed an overall success rate of 72.5% (200 successes and 76 failures). The success rate for direct pulp capping was 23.8%, with an association between pulpal necrosis and material used. Interestingly, the exposure area was associated with pulp necrosis, and bleeding did not affect pulp necrosis. Pulp calcification was directly related to the type of material used. On the other hand, the success rate of indirect pulp capping was up to 93.8%, with a significant relationship between pulp necrosis and the type of adhesive system used. Additionally, the failure rate increased in patients older than 40 years. Pulp calcification was noted in only 33% of cases treated with indirect pulp capping.
Overall, the study demonstrated that pulp vitality preservation depends on the patient's age and area of exposure. Furthermore, the type of adhesive system used plays a role in preserving pulp vitality during indirect pulp capping procedures. Therefore, clinicians should carefully select bioactive materials and adhesive systems as they play a critical role in the preservation of pulp vitality.