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Pulp capping is a technique used in dental restorations to protect the dental pulp, after it has been exposed, or nearly exposed during a cavity preparation, from a traumatic injury, or by a deep cavity that reaches the center of the tooth, causing the pulp to die. [1]
Pulp capping is a method to protect the pulp chamber if the clinician suspects it may have been exposed by caries or cavity preparation. Indirect pulp caps are indicated for suspected micro-exposures whereas direct pulp caps are place on a visibly exposed pulp.
Indirect restorations are contraindicated in patients under 16 as the pulp chamber is still large and wide dentinal tubules increase the stress on the pulp. When preparing a cavity to retain an indirect restoration there is a risk of damage to the nerve supply of a vital tooth.
Preparing a tooth to accept a full coverage crown is relatively destructive. The procedure can damage the pulp irreversibly, through mechanical, thermal and chemical trauma and making the pulp more susceptible to bacterial invasion. [25] Therefore, preparations must be as conservative as possible, whilst producing a strong retentive restoration.
Due to its physical properties and biocompatibility, MTA has been used in numerous clinical situations other than as a root-end filling. It is widely used to repair perforations, to close open apices in apexification, as a direct pulp capping material for deep carious tooth, and to cover pulp stumps for apexogenesis.
They are commonly used as pulp capping agents and lining materials for silicate and resin-based filling materials. [3] Calcium-silicate liner used as a pulp capping material. It is usually supplied as two pastes, a glycol salicylate and another paste containing zinc oxide with calcium hydroxide. On mixing, a chelate compound is formed.
Some caries excavation methods lead to leaving caries-affected dentin behind to serve as the bonding substrate, mostly in indirect pulp capping. It is reported that the immediate bond strengths to caries-affected dentin are 20-50% lower than to sound dentin, and even lower with caries-infected dentin. [2]
Perform direct or indirect pulp capping [1] in cases with pulpal extension, [2] to try increase the rate of reparative dentin formation (but may result in obliteration of the canal) Seal exposed dentin with microhybrid acid-etched flowable light-cured resin [7] Perform pulpotomy with MTA using a modified Cvek technique [4]