Pulp capping is a key minimally invasive procedure used to preserve the vitality of the dental pulp after exposure or near exposure due to caries or trauma.
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✅ What Is Pulp Capping?
Pulp capping is a conservative dental procedure in which a biocompatible and bioactive material is placed over the pulp or affected dentin to stimulate healing, reduce inflammation, and promote reparative dentin formation. It is indicated in cases of:
▪️ Deep caries approaching the pulp
▪️ Mechanical exposure during cavity preparation
▪️ Traumatic exposure in young teeth with open apices
▪️ Reversible pulpitis
Two main types exist:
▪️ Direct pulp capping – placed directly over an exposed pulp.
▪️ Indirect pulp capping – placed over deep dentin close to the pulp but without exposure.
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Modern pulp-capping materials protect the pulp through several biological processes:
▪️ Antibacterial activity (e.g., calcium hydroxide has high pH).
▪️ Sealing ability that prevents microleakage.
▪️ Bioactivity, stimulating odontoblast-like cell differentiation.
▪️ Release of calcium ions, promoting mineralization and dentin bridge formation.
▪️ Reduction of pulpal inflammation and support of tissue regeneration.
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Dental Article 🔽 Pulp Therapy in Pediatric Dentistry: Complete and Updated Guide ... Pulp therapy in pediatric dentistry includes a wide range of procedures aimed at preserving pulp health and tooth function in both primary and immature permanent teeth.✅ Common Materials and Commercial Names
1. Calcium Hydroxide (Ca(OH)₂)
Commercial names: Dycal®, Life®, Calcimol®
Key actions: High pH antibacterial effect; stimulates mineralized bridge formation.
2. Mineral Trioxide Aggregate (MTA)
Commercial names: ProRoot® MTA, MTA Angelus®
Key actions: Excellent sealing, biocompatibility, promotes strong dentin bridge formation.
3. Biodentine® (Tricalcium Silicate Cement)
Commercial name: Biodentine® (Septodont)
Key actions: Bioactivity, fast setting time, high mechanical strength, pulp regeneration support.
4. Resin-Modified Calcium Silicate Materials
Commercial names: TheraCal LC®, BioCal®
Key actions: Light-cured convenience, calcium release, improved handling properties.
📊 Comparative Table: Pulp Capping Materials
| Aspect | Advantages | Limitations |
|---|---|---|
| Calcium Hydroxide | Antibacterial; inexpensive; widely available | Poor long-term seal; tunnel defects in dentin bridge |
| MTA | Excellent sealing; high biocompatibility; strong dentin bridge | Long setting time; higher cost; potential discoloration |
💬 Discussion
Advances in bioceramic materials have transformed pulp protection, offering predictable outcomes with high long-term vitality rates. MTA and Biodentine outperform traditional calcium hydroxide in sealing ability and dentin bridge quality, although calcium hydroxide remains widely used due to affordability and ease of application. Material selection depends on exposure type, tooth vitality, patient age, and clinical resources.
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Modern pulp capping techniques effectively protect the dental pulp, arrest inflammation, and promote natural dentin regeneration. Evidence consistently supports bioactive materials—particularly MTA and Biodentine—as the gold standard for vital pulp therapy. Appropriate case selection and strict isolation significantly increase long-term success.
🔎 Recommendations
▪️ Use rubber dam isolation to prevent contamination during pulp capping.
▪️ Prefer MTA or Biodentine for direct exposures in young permanent teeth.
▪️ Use indirect pulp capping when possible to avoid unnecessary pulpal exposure.
▪️ Follow up clinically and radiographically at 6 and 12 months.
▪️ Educate patients about symptoms of pulpal complications (persistent pain, swelling).
📚 References
✔ Bjørndal, L., & Ludwig, S. (2022). Management of deep caries and pulpal protection strategies. International Endodontic Journal, 55(Suppl. 1), 59–73. https://doi.org/10.1111/iej.13743
✔ Celik, E. U., & Unever, S. (2020). Success rates of pulp capping materials in vital pulp therapy. Journal of Endodontics, 46(8), 1061–1067. https://doi.org/10.1016/j.joen.2020.04.008
✔ Cox, C. F., Subay, R. K., Suzuki, S., & Suzuki, S. H. (2017). Pulp capping materials: A review of the literature. Dental Materials, 33(7), 745–758. https://doi.org/10.1016/j.dental.2017.03.006
✔ Torabinejad, M., & Parirokh, M. (2010). Mineral trioxide aggregate: A comprehensive literature review. Part II: Clinical applications. Journal of Endodontics, 36(2), 190–202. https://doi.org/10.1016/j.joen.2009.09.010
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