Pulp therapy is a cornerstone of both pediatric and adult restorative dentistry. However, despite advances in materials and techniques, treatment failure remains a relevant clinical challenge.
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✅ Biological Risk Factors for Pulp Therapy Failure
Biological factors often determine the baseline prognosis before treatment begins.Key contributors include:
▪️ Incorrect pulp diagnosis (reversible vs. irreversible pulpitis)
▪️ Advanced bacterial contamination
▪️ Undetected pulpal necrosis
▪️ Compromised immune response
Accurate case selection is one of the most critical determinants of pulp therapy success.
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Many failures are directly related to operator-dependent factors.
Common errors include:
▪️ Inadequate isolation, leading to salivary and bacterial contamination
▪️ Incomplete caries removal, leaving infected dentin
▪️ Over-instrumentation or pulp tissue trauma
▪️ Improper placement of pulp capping or pulpotomy materials
Studies consistently show that lack of rubber dam isolation significantly increases failure rates.
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The choice and handling of materials play a decisive role.
Frequent issues include:
▪️ Incorrect manipulation of calcium-based materials
▪️ Use of outdated or low-biocompatibility agents
▪️ Poor sealing ability of restorative materials
Modern bioactive materials such as mineral trioxide aggregate (MTA) and calcium silicate cements demonstrate superior outcomes due to their biocompatibility, sealing ability, and bioinductive properties.
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Even a technically correct pulp therapy can fail if the final restoration is inadequate.
Critical aspects:
▪️ Coronal microleakage
▪️ Delayed placement of definitive restoration
▪️ Poor marginal adaptation
▪️ Occlusal overload
A hermetic coronal seal is as important as the pulpal procedure itself.
馃搳 Comparative Table: Factors Influencing Pulp Therapy Outcomes
| Aspect | Advantages | Limitations |
|---|---|---|
| Accurate Pulp Diagnosis | Improves case selection and prognosis | Requires clinical experience and diagnostic tools |
| Use of Bioactive Materials | Promotes dentin bridge formation and healing | Higher cost and technique sensitivity |
| Rubber Dam Isolation | Reduces bacterial contamination | May be challenging in uncooperative patients |
| Definitive Coronal Seal | Prevents microleakage and reinfection | Failure if restoration is delayed or poorly adapted |
Current evidence confirms that pulp therapy failure is rarely due to a single factor. Instead, it is the result of an interaction between biological status, clinical technique, material selection, and restorative quality. Advances in bioactive materials have improved success rates, but they cannot compensate for poor diagnosis or inadequate isolation. Long-term success depends on strict adherence to evidence-based protocols.
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▪️ Perform thorough pulp vitality and radiographic assessment
▪️ Always use rubber dam isolation
▪️ Select bioactive materials with proven clinical evidence
▪️ Ensure immediate and well-sealed definitive restorations
▪️ Schedule follow-up evaluations to detect early signs of failure
✍️ Conclusion
Pulp therapy fails primarily due to diagnostic errors, inadequate isolation, material misuse, and poor coronal sealing. When evidence-based principles are respected, pulp therapy remains a highly predictable and conservative treatment option. Continuous education and protocol standardization are key to improving clinical outcomes.
馃摎 References
✔ American Academy of Pediatric Dentistry. (2023). Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry, 384–392.
✔ Aguilar, P., & Linsuwanont, P. (2011). Vital pulp therapy in vital permanent teeth with cariously exposed pulp: A systematic review. Journal of Endodontics, 37(5), 581–587. https://doi.org/10.1016/j.joen.2010.12.004
✔ Bogen, G., Kim, J. S., & Bakland, L. K. (2008). Direct pulp capping with mineral trioxide aggregate: An observational study. Journal of the American Dental Association, 139(3), 305–315. https://doi.org/10.14219/jada.archive.2008.0150
✔ Hilton, T. J. (2009). Keys to clinical success with pulp capping: A review of the literature. Operative Dentistry, 34(5), 615–625.
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