Vital pulp therapy (VPT) in primary teeth aims to preserve the vitality and function of the dental pulp after carious or traumatic exposure. Its ultimate goal is to maintain primary teeth until their natural exfoliation, ensuring arch integrity, mastication, and normal development of permanent successors.
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✅ Definition of Vital Pulp Therapy Techniques
1. Indirect Pulp Treatment (IPT)
Indirect pulp treatment involves leaving a thin layer of affected but not infected dentin to avoid pulp exposure. A biocompatible liner is placed to encourage dentin remineralization and pulp healing.
➤ Current materials: calcium hydroxide, resin-modified glass ionomer, mineral trioxide aggregate (MTA), and calcium silicate-based cements.
2. Direct Pulp Capping (DPC)
Direct pulp capping is performed when a small mechanical or traumatic pulp exposure occurs. A bioactive material is applied directly over the pulp to stimulate reparative dentin formation.
➤ Current materials: MTA, calcium hydroxide, and newer bioceramics (Biodentine®).
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Pulpotomy is the most widely used VPT technique in primary teeth. It involves removal of the coronal pulp tissue, preserving radicular pulp vitality.
➤ Current medicaments: formocresol (historically used but controversial), ferric sulfate, MTA, Biodentine®, and sodium hypochlorite as hemostatic agents.
4. Pulpectomy (Non-Vital Alternative)
Although technically not a vital pulp therapy, pulpectomy is often considered in the treatment plan when pulp vitality cannot be preserved. It involves complete removal of pulp tissue and obturation of root canals with resorbable materials.
➤ Current medicaments: iodoform-based pastes (Vitapex®), calcium hydroxide-iodoform combinations.
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Current evidence strongly favors biocompatible and bioactive materials such as MTA and calcium silicate-based cements over traditional agents like formocresol, due to their improved outcomes in terms of pulp healing, dentin bridge formation, and biocompatibility (Farsi et al., 2023). The choice of technique depends on pulp status, extent of caries, and presence of symptoms. While IPT and DPC are conservative, pulpotomy remains the gold standard for cariously exposed but vital pulp.
Long-term clinical trials indicate that MTA and Biodentine® outperform traditional materials in terms of success rates and reduced adverse effects (Gomes et al., 2022). Nonetheless, cost and handling characteristics remain barriers in some clinical settings.
✍️ Conclusion
Vital pulp therapy in primary teeth is essential to maintain function and arch stability until natural exfoliation. Evidence-based protocols support the use of bioactive cements such as MTA and Biodentine®, which demonstrate superior clinical and histological outcomes compared to traditional agents. The clinician’s decision should integrate pulp vitality assessment, child cooperation, and material availability.
馃搳 Vital Pulp Therapy Techniques in Primary Teeth
| Technique | Advantages | Limitations |
|---|---|---|
| Indirect Pulp Treatment (IPT) | Preserves pulp vitality; high success rate; conservative | Risk of residual caries; requires good sealing |
| Direct Pulp Capping (DPC) | Promotes reparative dentin formation; maintains pulp vitality | Lower success in carious exposures; best for mechanical exposures |
| Pulpotomy | Effective in symptomatic exposures; long-standing clinical success | Technique sensitive; controversy over medicaments |
| Pulpectomy | Option for non-vital teeth; preserves tooth until exfoliation | Not a true VPT; complex procedure; risk of failure in resorption |
馃摎 References
✔ Farsi, N., Bawazir, O., & Al-Shahrani, A. (2023). Clinical and radiographic success of pulpotomy in primary teeth using mineral trioxide aggregate and Biodentine: A systematic review and meta-analysis. International Journal of Paediatric Dentistry, 33(1), 35–45. https://doi.org/10.1111/ipd.13013
✔ Gomes, A. C., Lima, T. F., Soares, D. G., & Hebling, J. (2022). Vital pulp therapy in primary teeth with calcium silicate-based materials: A systematic review. Journal of Dentistry, 120, 104102. https://doi.org/10.1016/j.jdent.2022.104102
✔ American Academy of Pediatric Dentistry (AAPD). (2022). Guideline on pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry, 403–412. https://www.aapd.org/research/oral-health-policies--recommendations
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