Pulp capping indirect

Alternatively the pulp may be saved by the process of pulp capping. This involves placing some sort of material over the pulp to protect it and maintain its viability so that more extreme treatment (extraction or endodontic therapy) can be avoided [1]. Two possible approaches are available, namely direct pulp capping, in which a bioactive material is placed directly over the exposed pulp, and indirect pulp capping, in which a cavity liner or sealant material is placed over a residual thin layer of dentine, which may be sound or carious. In the latter approach, the pulp has not been exposed, but it is at risk of becoming so either by the progress of the residual caries or by the process of tooth preparation. 

The removal of caries is essential when repairing a tooth damaged by decay. However, when caries is deep this may present a problem, as continued caries removal to prepare the cavity fully may lead to exposure of the pulp. Rather than exposing the pulp in this way, with the risks involved in such a procedure, an alternative approach is to leave the caries-affected demineralized dentine in the region directly adjacent to the pulp and to cover the whole of the affected zone with a cavity liner. This procedure is termed indirect pulp capping [1], and it has been shown to be as successful as restoring teeth conventionally with complete caries removal [26-28]. 

As well as being used for direct and indirect pulp capping, calcium hydroxide materials are recommended for nse in deep cavities. This is similar to their use in indirect pulp capping, but implies that all of the carious dentine has been removed, leaving behind a thin layer of sonnd caries-free dentine. Even in this circumstance, the high alkalinity of calcinm hydroxide materials is able to stimulate further dentine formation [41,43,44]. Their application where remaining sonnd dentine is thin will ensure that it does not remain thin. Instead, it will thicken in sitn nnder the influence of the calcium hydroxide to form an improved layer of dentine that is better able to protect the pulp from diffusion of monomers from repair materials or from the effects of bacterial penetration. This process takes time, with typically approximately 2 months time being need to form 0.1 mm of reparative dentine. 

Literature provided by the manufacturers suggests that Biodentine can be used for various applications, not only for pulp capping but also for other endodontic applications, such as repair of pulp chamber floor perforations and of lateral root perforations [95]. It can also be used for indirect pulp capping and to line deep carious lesions. However, to date systanatic smdies are lacking, and there is only limited evidence of clinical success of Biodentine in these applications. Early published results are promising, but more work is necessary before a definitive opinion on this material is possible [95]. 

Pulp capping may be either direct (covering a completely exposed pulp) or indirect (covering very thin dentine, either caries-free or caries-affected). 

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