Dr. Nitin Mirdha Bhawana Dhariwal Dr. Bobbin Gill Preksha Bohara Dr. Nirmala Bishnoi

GUIDED BY:- PRESENTED BY:-
Dr. NITIN MIRDHA BHAWANA DHARIWAL

Dr. BOBBIN GILL PREKSHA BOHARA
Dr. NIRMALA BISHNOI
CONTENTS
Introduction
Objective
Goals
Procedure :- Indirect pulp capping
Direct pulp capping
Pulpotomy
Apexogenesis
Reference
INTRODUCTION
Pulp vital therapy is a treatment initiated to
preserve and maintain pulp tissue in a healthy
state that has been compromised by caries,
trauma or restorative procedure
OBJECTIVE
To stimulate the
formation of reparative
dentin to retain the tooth
as a functional unit
GOALS
Dentin bridge formation
Continuation of rest development
INDIRECT PULP CAPPING
It is defined as a procedure wherein small amount of
carious dentin is retained in deep areas of cavity to avoid
exposure of pulp, followed by placement of a suitable
medication and restorative material that seals off the
carious dentin and encourage pulp recovery
BY INGLE
RATIONALE:- Carious dentin consist of two layers
1. Outer layer –irreversibly denatured,
infected, not remineralizable
2. Inner layer – reversibly denatured, not
infected, remineralizable
INDICATION
Deep carious lesion near the pulp tissue but not
involving it
No mobility
No history of spontaneous toothache
No top
No radiographic evidence of pulp pathology
No root resorption or radicular disease should be
present radiographically
CONTRAINDICATION
Presence of pulp exposure
Radiographic evidence of pulp pathology
History of spontaneous toothache
Tooth sensitive to percussion
Mobility of tooth
PROCEDURE
Band the tooth if tooth is grossly decayed
Apply rubber dam
Remove soft caries either with spoon excavator or round
bur
Use fissure bur and extend it to sound tooth structure
A thin layer of dentin and some amount of caries is left
to avoid exposure
Place CaOH with ZnPO4 base
Tooth should be evaluated after 6-8weeks
DIRECT PULP CAPPING-
WHAT IS DIRECT PULP CAPPING ?
 Placement of a protective dressing directly over the
exposed pulp
DIRECT PULP CAPPING-
 DEFINITION:-
Direct pulp capping is defined as a
procedure in which the exposed vital pulp is covered
with a protective dressing or a base placed directly over
the site of exposure in an attempt to preserve pulpal
vitality.
 RATIONALE:-
To encourage young and healthy pulp
to initiate a dentin bridge and form a wall over the
exposure site
OBJECTIVES :-
 To seal the pulp against bacterial leakage.
 The vitality of pulp should be maintained.
 Protect pulp from thermal stimulus.
 No prolonged post-treatment signs or symptoms
of sensitivity,pain or swelling should be evident.
FACTORS AFFECTING
PROGNOSIS OF DPC:-
Area of Size of exposure Bacterial
exposure contamination
DPC
Duration of
Carious v/s exposure before
Microleakage mechanical treatment
exposure
INDICATIONS:-
 Asymptomatic (no spontaneous pain,normal
response to thermal testing,and pulp is vital before
the operative procedure).
 Small exposure,less than 0.5mm in diameter.
 Hemorrhage from the exposure site is easily
controlled (within 10 minutes).
 The exposure occur is cleaned and
uncontaminated.
 Atraumatic exposure and little desiccation of the
tooth with no evidence of aspiration of blood into
the dentin (dentin blushing).
CONTRAINDICATIONS:-
 Carious or wide pulp exposure.
 Spontaneous and nocturnal toothache.
 Uncontrolled bleeding at the exposure site.
 Radiographic evidence of pulp pathology.
 Excessive tooth mobility.
 Purulent or serous exudates from exposure site.
CLINICAL PROCEDURE:-
TECHNIQUE OF DPC:-
 Two techniques have demonstrated success with
DPC : Calcium hydroxide technique and MTA
technique.
 Caries removal is accomplished with the #2
carbide bur and spoon excavators.
 The flowchart for the clinical protocol for DPC is :-
MEDICATION AND MATERIAL USE
FOR DPC ARE:-
 Calcium hydroxide
 Zinc oxide eugenol
 Antibiotics
 Calcitonin
 Collagen
 Corticosteroids
 Formocresol
 Resorbable tricalcium phosphate
PULPOTOMY:-
DEFINITION:-
 Pulpotomy is defined as a procedure in which a
portion of the exposed coronal vital pulp is surgically
removed as a means of preserving the vitality and
functions of the remaining radicular portion.
• Objectives:-
1) Preservation of vitality of the
radicular pulp,through the surgical excision of
the coronal pulp,the infected and inflamed area
is removed,leaving vital,uninfected pulpal tissue
in the root canal.
2)Relief of pain in patients with acute pulpalgia
and inflammatory changes in the tissue.
3) Ensuring the continuation of normal
apexogenesis in immature permanent teeth by
retaining the vitality of the radicular pulp.
RATIONALE:-
 Maintain integrity of radicular pulp tissue to allow
continued root growth.
 Pulp of immature teeth has significant reparative
potential.
 Dressing is placed over the pulp stump to protect it
and to promote healing
 The two most commonly used dressing contain
either Ca(OH)2 and MTA.
INDICATIONS:-
 Traumatized or pulpally involved vital permanent
tooth with open apex.
 Clinical and radiograph pulp vitality.
 Pain, if present, is neither spontaneous nor
persists after removal of the stimulus.
 No or easy to control hemorrhage from
amputation site.
 No abscess or fistule
CONTRAINDICATION:-
 Patient with irreversible pulpitis.
 Abnormal sensitivity to heat and cold.
 Tenderness to percussion or palpation because of
pulpal disease.
 Marked constriction of the pulp chamber or root
canals (calcification).
 Mobility.
 Presence of purulent discharge.
PROGNOSIS:-
 The success of this procedure depends upon the
following:-
 Vitality of the majority of the radicular pulp.
 No radiographic evidence of internal root
resorption.
 No radiographic sign of periradicular
periodontitis.
 No breakdown of periradicular supporting tissues.
 No harm to succedaneous teeth.
CLASSIFICATION:-
The pulpotomy procedure can be
classified on the basis of following:-
I. Amount of pulpal tissue removed :-
a.) Partial pulpotomy (Cvek’s pulpotomy)
b.)Complete pulpotomy(cervical
pulpotomy)
II.Type of medicament employed:-

a) Calcium hydroxide pulpotomy
b) MTA pulpotomy
c) Formocresol pulpotomy
Based on the amount of pulpal tissue
removed:-
 A. Partial pulpotomy(Cvek’s
pulpotomy):-
A kind of pulpotomy in which only a portion
of the coronal pulp is removed or removal of tissues until
normal tissue that is free of inflammation is reached
before placing a medicament.
PROCEDURE-
 Anesthetize and isolate the tooth
 Remove carious lesion with slow speed round bur
Remove the coronal pulp and control hemorrhage
using sodium hypochlorite and moistened cotton
pellets with slight pressure.
Place calcium hydroxide or MTA over the
amputation site.
If calcium hydroxide is placed,recall the
patient,check dentin bridge formation,and place
permanent restoration.
 B. Complete pulpotomy(cervical
pulpotomy):-
It involves the complete removal of the
coronal portion of the dental pulp,followed by
placement of a suitable dressing or medicament that will
promote healing and preserbe the vitality of the tooth.
PROCEDURE- The technique is same as that of the

partial pulpotomy except that it is upto root orifice.
BASED ON THE TYPE OF MEDICAMENT
EMPLOYED:-
 A: Calcium hydroxide pulpotomy:- Is presently
recommended as one of medicament for vital pulp
therapy in permanent dentition,but not indicated
as agent for pulpotomy in primary dentition.
 It is applied on the amputated pulp with a sterile
pledget of cotton.
 It should be filled till depth of atleast 1-2mm on
which base of RMGIC or flowable componer is
applied.
 B: MTA pulpotomy (mineral trioxide
aggregates):- It is mixed as per the
manufactured instructions to get a wet sand
consistency
 It has been proved that MTA is better material
than Ca(OH)2 in terms of healing,quality of seal
provider and superior biocompatibility.
 MTA mix is placed upon amputated site with the
help of MTA carrier gun or an amalgam carrier.it
should be placed in pulp chamber and condensed
lightly with moist cotton pellet.
 Minimum thickness of 2mm material should be
placed.
 C: Formocresol pulpotomy:- Introduced in
1904 by buckley.
 It is preferred in primary teeth due to
high(98%)clinical and radiographic success rate.
 Buckley’s formocresol consists of –

Formaldehyde 19%
Tricresol 35%
Glycerin 15%
Water 31%
Procedure of formocresol pulpotomy-
Follow up :-
 The tooth should be checked with radiographs and
vitality tests every 3months
 In the event of pain or death of pulp,the root canal
should be removed as soon as possible,and
endodontic therapy should be started if thye apex
is mature.
 If the apex is immature then apexification should
be initiated.
APEXOGENESIS
It is defined as the treatment of a vital pulp by capping or
pulpotomy in order to permit continue growth of the
root and closure of the open apex
It maintain the vitaity of the tooth
RATIONALE :-Maintenance of integrity of the
radicular pulp tissue to allow for continued root growth
INDICATION
Indicated for traumatized or pulpally involve vital
permanent tooth when root apex is incompletely
formed
No history of spontaneous pain
No sensitivity on percussion
No hemorrhage
Normal radiographic apperance
CONTRAINDICATION
Evidence that radicular pup has undergone
degeneration changes
Purulent drainage
History of prolonged pain
Necrotic debris in canal
Periapical radiolucency
PROCEDURE
REFERNCE
TEXTBOOK OF ENDODONTICS
[4th EDITION] BY Nisha garg
TEXTBOOK OF PEDIATRIC
DENTISTRY [4TH EDITION]
BY Nikhil marwah
TEXTBOOK OF ENDODONTICS
BY Grossman

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GUIDED BY:- PRESENTED BY:-

Dr. NITIN MIRDHA BHAWANA DHARIWAL

II.Type of medicament employed:-

PROCEDURE- The technique is same as that of the

 Buckley’s formocresol consists of –

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