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Two different types of pulp cap are distinguished. In direct pulp capping, the protective dressing is placed directly over an exposed pulp; and in indirect pulp capping, a thin layer of softened dentin, that if removed would expose the pulp, is left in place and the protective dressing is placed on top. [4]
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.
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]
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.
When there is adequate pulp recession, tubercle can be removed and tooth can be restored. [4] For teeth with normal pulp and immature apex, reduce the opposing occluding tooth. [4] Apply flowable composite to the tubercle. [4] Occlusion, restoration, pulp and periapex assessment should be done every 3–4 months until the apex matures. [4]
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.
An indirect restoration fabricated on model from Ips emax ceramic ready to be cemented on natural tooth structure. In this technique the restoration is fabricated outside of the mouth using the dental impressions of the prepared tooth. Common indirect restorations include inlays and onlays, crowns, bridges, and veneers.