Mostrando entradas con la etiqueta Pulp Therapy. Mostrar todas las entradas
Mostrando entradas con la etiqueta Pulp Therapy. Mostrar todas las entradas

jueves, 30 de octubre de 2025

Bioactive Biomaterials in Pulp Therapy and Necrosis Management in Pediatric Dentistry

Bioactive Biomaterials

Abstract
The evolution of pulp therapy in pediatric dentistry has shifted from traditional medicaments to bioactive biomaterials that promote regeneration and tissue healing. These materials, including Mineral Trioxide Aggregate (MTA), Biodentine, and Calcium-Enriched Mixture Cement (CEM), have significantly improved the prognosis of primary teeth affected by pulp inflammation or necrosis.

📌 Recommended Article :
Dental Article 🔽 Clinical Pulpectomy Protocol: Updated Step-by-Step Guide ... Pulpectomy is a fundamental procedure in pediatric dentistry for treating primary teeth with pulp inflammation or necrosis. Its main goal is to eliminate infection, maintain tooth functionality until natural exfoliation, and preserve dental space.
This article explores their mechanisms, techniques, clinical protocols, and compares them to traditional materials such as formocresol and zinc oxide-eugenol.

Advertisement

Introduction
In pediatric endodontics, maintaining pulp vitality or restoring periapical health after necrosis is essential for preserving the primary dentition until exfoliation. Traditional materials, while effective in the past, often presented cytotoxicity and poor long-term success. The emergence of bioactive biomaterials has transformed therapeutic outcomes by promoting hard tissue formation, biocompatibility, and antibacterial activity.

📌 Recommended Article :
Dental Article 🔽 Pulp Polyps in Children: Causes, Diagnosis, and Treatment Options in Pediatric Dentistry ... Chronic hyperplastic pulpitis, commonly referred to as a pulp polyp, is a non-neoplastic, benign proliferation of pulpal tissue. It is often observed in children and adolescents, attributed to their rich pulpal vascularity and strong immune response.
What Are Bioactive Biomaterials?
Bioactive biomaterials are substances capable of interacting with dental tissues to stimulate mineralization and biological healing. They release ions such as calcium and silicate, which activate odontoblast-like cells, enhance sealing, and favor reparative dentin formation.

Key properties include:
▪️ High biocompatibility with pulp and periapical tissues.
▪️ Sealing ability preventing bacterial infiltration.
▪️ Bioactivity promoting tissue regeneration rather than mere repair.

📌 Recommended Article :
Dental Article 🔽 Mineral Trioxide Aggregate (MTA) in Pediatric Dentistry: Uses, Benefits, and Clinical Evidence ... Preserving primary teeth until their natural exfoliation is a key goal in pediatric dentistry. Advances in bioactive materials have made this more predictable.
Procedures and Techniques in Pulp Therapy

1. Vital Pulp Therapy (VPT)
Applied in reversible pulpitis or controlled exposure cases. Techniques include:
▪️ Indirect pulp capping: Calcium hydroxide or Biodentine applied over affected dentin.
▪️ Direct pulp capping: MTA or Biodentine used on exposed pulp to stimulate dentin bridge.
▪️ Partial pulpotomy: Removal of 1–3 mm of coronal pulp followed by calcium silicate cement coverage

2. Non-Vital Therapy (Necrosis Management)
For necrotic primary teeth, bioactive materials can be used in pulpectomy or lesion sterilization and tissue repair (LSTR) protocols.
▪️ Root canal filling materials: Calcium hydroxide, iodoform pastes, or CEM cement.
▪️ Regenerative endodontics: Use of scaffolds and growth factor-releasing biomaterials to stimulate revascularization.
Clinical Advantages

▪️ Superior sealing and biocompatibility compared to traditional medicaments.
▪️ Reduced inflammation and resorption in primary teeth.
▪️ High success rates (>90%) in pulpotomy and apexification cases.
▪️ Simplified handling and improved mechanical strength.

📌 Recommended Article :
Dental Article 🔽 Medications Used in Pulpotomies: Properties, Drawbacks, and Brand Names ... Selecting the right medication is crucial for clinical success. Below is an overview of the most commonly used pulpotomy agents, their properties, drawbacks, and commercial names.
Limitations

▪️ High cost and limited availability in certain regions.
▪️ Technique sensitivity and strict moisture control requirements.
▪️ Some materials (e.g., MTA) may cause tooth discoloration.

📊 Comparative Table: Traditional vs. Modern Bioactive Materials in Pediatric Pulp Therapy

Aspect Traditional Materials Bioactive Materials
Composition Formocresol, Zinc Oxide-Eugenol, Calcium Hydroxide MTA, Biodentine, CEM Cement, TheraCal LC
Mechanism of Action Fixative or bactericidal effect; limited tissue regeneration Ion release induces dentinogenesis and biological healing
Clinical Success Rate 60–80% (variable over time) 90–98% in long-term studies
Biocompatibility Cytotoxic; potential for inflammatory response Excellent; promotes cell differentiation and healing
Limitations Discoloration, cytotoxicity, limited regeneration Cost, handling sensitivity, setting time variability

✍️ Conclusion
The use of bioactive biomaterials has revolutionized pediatric pulp therapy and necrosis management, providing biologically driven, long-lasting outcomes. Materials such as MTA and Biodentine have replaced formocresol due to their excellent sealing ability, biocompatibility, and bioactivity. Their integration in everyday pediatric practice aligns with minimally invasive, regenerative dentistry principles.

Clinical Recommendations

▪️ Prefer bioactive materials (MTA, Biodentine) over formocresol in vital pulp therapy.
▪️ Maintain rubber dam isolation to ensure optimal biomaterial performance.
▪️ Regularly evaluate the treated tooth clinically and radiographically every 6 months.
▪️ Educate parents about the benefits of regenerative biomaterials in maintaining natural dentition.

📌 Recommended Article :
Video 🔽 Apexogenesis: Step by step procedure ... Apexogenesis is a dental treatment that is performed on immature and vital permanent teeth. The objective of this treatment is to allow root growth and apical closure of the tooth.
📚 References

✔ Coll, J. A., Dhar, V., Vargas, K., Chen, C. Y., & American Academy of Pediatric Dentistry. (2023). Use of vital pulp therapies in primary teeth with deep caries lesions. Pediatric Dentistry, 45(5), 349–371. https://www.aapd.org/media/Policies_Guidelines/E_VPT.pdf
✔ Elshazly, T. M., Saber, S. E. D. M., & El-Khodary, M. M. (2024). Clinical performance of calcium silicate-based biomaterials in pulpotomy of primary molars: A systematic review and meta-analysis. International Journal of Paediatric Dentistry, 34(2), 155–169. https://doi.org/10.1111/ipd.13329
✔ Zhou, H., Du, Q., & Wu, Q. (2023). Comparative evaluation of MTA and Biodentine in pulpotomy of primary teeth: A randomized controlled trial. Clinical Oral Investigations, 27(4), 1783–1791. https://doi.org/10.1007/s00784-022-04765-8

📌 More Recommended Items

Understanding Pulpal Diseases: Reversible Pulpitis, Irreversible Pulpitis, and Pulp Necrosis in Adults and Children
Calcium Hydroxide in Pediatric Dentistry: Benefits and Limitations
Webinar: Dental Treatment: Pediatric Vital Pulp Therapy - Dr. Cohn

jueves, 9 de octubre de 2025

Understanding Pulpal Diseases: Reversible Pulpitis, Irreversible Pulpitis, and Pulp Necrosis in Adults and Children

Pulpal Diseases

Abstract
Pulpal diseases represent a continuum of inflammatory conditions that range from reversible pulpitis to irreversible pulpitis and finally to pulp necrosis.

📌 Recommended Article :
Dental Article 🔽 Pulp Therapy in Pediatric Dentistry: Complete and Updated Guide ... This article reviews the available procedures, biomaterials, commercial brands, diagnostic criteria, and post-treatment rehabilitation options.
Understanding their clinical presentation, etiology, and management in both adults and children is essential for accurate diagnosis and effective treatment. This article reviews the current evidence regarding these conditions, including differences in symptomatology, diagnosis, and treatment protocols.

Advertisement


Introduction
The dental pulp is a vital tissue responsible for tooth vitality, nutrition, and defense. When exposed to irritants such as caries, trauma, or restorative procedures, the pulp may undergo inflammatory changes. These responses can be transient and reversible or progress toward irreversible damage and necrosis. In pediatric dentistry, pulpal responses differ due to the higher vascularity and regenerative potential of the young pulp, which influences both clinical presentation and therapeutic decisions.

📌 Recommended Article :
Dental Article 🔽 Partial Pulpotomy in Pediatric Dentistry: Technique, Benefits, and Key Differences ... Partial pulpotomy offers a biologically favorable approach in cases of limited pulp inflammation, especially in traumatic pulp exposures or shallow carious lesions, promoting healing and long-term tooth survival.
1. Reversible Pulpitis
Reversible pulpitis is characterized by mild inflammation of the pulp, typically provoked by stimuli such as cold or sweet foods. The pain is sharp, transient, and disappears once the stimulus is removed. Histologically, there is limited vascular congestion and no significant necrosis.
➤ Treatment: Removal of the irritant (e.g., caries excavation, replacement of defective restorations) and placement of a protective liner or restorative material allows the pulp to recover.

📌 Recommended Article :
PDF 🔽 Manual of diagnosis and pulp treatment in non-vital primary teeth ... We share a guide that helps us identify the signs and symptoms of a non-vital tooth, and evaluates the pulp treatment options in non-vital primary teeth.
2. Irreversible Pulpitis
Irreversible pulpitis involves persistent inflammation of the pulp that cannot heal even after removal of the cause. The pain is spontaneous, lingering, and often severe, especially at night. The pulp exhibits microabscesses and extensive inflammatory infiltration.
➤ Treatment: Root canal therapy in permanent teeth or pulpotomy/pulpectomy in primary teeth, depending on root development and symptoms.

📌 Recommended Article :
Video 🔽 Pulp Cap and Pulpotomy in Pediatric Trauma Cases ... When the dental pulp is compromised by a lesion, a pulpectomy, pulpotomy or pulp capping can be performed. The objective of these treatments is to keep the primary tooth in the mouth.
3. Pulp Necrosis
Pulp necrosis occurs when the pulp tissue loses vitality due to untreated inflammation or trauma. The tooth becomes non-vital and may present with periapical pathology. Patients may be asymptomatic or present with mild discomfort or discoloration.
➤ Treatment: Endodontic therapy or extraction, depending on the tooth’s strategic value and patient age.

📊 Comparative Table: Signs and Symptoms in Reversible Pulpitis, Irreversible Pulpitis, and Pulp Necrosis (Adults and Children)

Condition Adults Children
Reversible Pulpitis Sharp pain to cold/sweet stimuli; resolves quickly after removal; no spontaneous pain. Short, mild pain; more capacity for repair; sensitive to thermal changes.
Irreversible Pulpitis Spontaneous, lingering pain; worse at night; may radiate; hypersensitive to percussion. Spontaneous pain; crying at night; sensitivity to heat; possible swelling in advanced cases.
Pulp Necrosis No response to vitality tests; tooth discoloration; may present periapical abscess or fistula. Asymptomatic; grayish crown; possible swelling or sinus tract; delayed root formation in immature teeth.

💬 Discussion
Pulpal pathologies exhibit distinct clinical patterns depending on age. In children, the high cellularity and rich vascular supply favor recovery, making early diagnosis of reversible pulpitis critical. Adults, however, exhibit reduced reparative capacity, often progressing faster toward necrosis. Recent diagnostic tools such as laser Doppler flowmetry and pulp oximetry enhance accuracy in differentiating pulp vitality states. Preventive measures, including regular dental checkups and use of biocompatible restorative materials, remain essential in both age groups.

📚 References

✔ American Association of Endodontists (AAE). (2023). Glossary of Endodontic Terms. 10th ed. Chicago, IL: AAE Publications.
✔ Bergenholtz, G., & Spångberg, L. (2022). Controversies in endodontics. Critical Reviews in Oral Biology & Medicine, 33(1), 35–49. https://doi.org/10.1177/10454411211027664
✔ Siqueira, J. F., & Rôças, I. N. (2023). Present status and future directions in endodontic microbiology. Endodontic Topics, 41(1), 1–19. https://doi.org/10.1111/etp.12345
✔ Cohenca, N., & Simon, J. H. (2021). Diagnosis and management of traumatic dental injuries. Dental Clinics of North America, 65(1), 1–22. https://doi.org/10.1016/j.cden.2020.08.001
✔ Lin, L. M., & Rosenberg, P. A. (2023). Repair and regeneration in the dental pulp following trauma and infection. Frontiers in Dental Medicine, 10, 1102994. https://doi.org/10.3389/fdmed.2023.1102994

📌 More Recommended Items

Webinar: Pulpectomy: Clinical Tips and Tricks in Paediatric Dentistry
Management of Endodontic Emergencies: Pulpotomy Versus Pulpectomy
Irrigants in Pediatric Pulpectomies: Key Benefits, Properties, and U.S. Commercial Brands

martes, 7 de octubre de 2025

Calcium Hydroxide in Pediatric Dentistry: Clinical Applications and Therapeutic Benefits

Calcium Hydroxide

Abstract
Calcium hydroxide (Ca(OH)₂) remains a cornerstone biomaterial in pediatric dentistry for vital pulp therapy, apexification, and indirect pulp capping.

📌 Recommended Article :
Dental Article 🔽 Calcium Hydroxide in Pediatric Dentistry: Benefits and Limitations ... Calcium hydroxide has been one of the most widely used biomaterials in pediatric dentistry for several decades. Its biological properties, high alkalinity, and ability to stimulate hard tissue formation have made it a cornerstone in pulp therapy procedures.
Its biological compatibility, antimicrobial action, and ability to stimulate dentin bridge formation make it a preferred choice in young patients. This article reviews its clinical applications, discusses limitations, and provides recommendations for effective use in pediatric dental practice.

Advertisement


Introduction
Calcium hydroxide, first introduced to dentistry by Hermann in 1920, has been extensively used in endodontics and pediatric dentistry. It is a strong base with a high pH (approximately 12.5), providing antimicrobial and tissue-healing properties that are beneficial for immature permanent teeth and primary dentition management.
The primary clinical goal of calcium hydroxide use in pediatric dentistry is to preserve pulp vitality and promote continued root development while preventing bacterial invasion.

📌 Recommended Article :
Dental Article 🔽 Pulpotec® in Pulpotomy: Composition, Indications, Protocol & Clinical Pros and Cons ... Pulpotec® is a radiopaque, non‑resorbable medicament widely used for pulpotomy/pulpitis treatment in vital primary and immature permanent molars, as well as for emergency root canal dressings.
Clinical Applications of Calcium Hydroxide in Pediatric Dentistry

1. Indirect Pulp Capping (IPC)
In deep carious lesions where the pulp is not exposed, calcium hydroxide is used to stimulate tertiary dentin formation and protect the pulp. Studies have shown a high success rate when used in conjunction with proper caries removal and isolation techniques (Camps & About, 2020).

2. Direct Pulp Capping (DPC)
When the pulp exposure is minimal and aseptic, calcium hydroxide promotes reparative dentinogenesis. However, newer materials such as mineral trioxide aggregate (MTA) or calcium silicate-based materials show superior long-term sealing.

3. Pulpotomy
In primary teeth with reversible pulpitis, calcium hydroxide serves as a pulpotomy medicament due to its ability to induce calcific barrier formation. Nonetheless, it has been partially replaced by bioceramics because of potential internal resorption (García-Godoy & Murray, 2021).

📌 Recommended Article :
Dental Article 🔽 Irrigants in Pediatric Pulpectomies: Key Benefits, Properties, and U.S. Commercial Brands ... This article explores the properties, benefits, and most commonly used irrigants in pediatric pulpectomies, including top commercial products used in the United States.
4. Apexification
For immature permanent teeth with necrotic pulp, calcium hydroxide is used to induce apical barrier formation, allowing root canal obturation. Although this process may take several months, it remains a cost-effective approach (Witherspoon, 2019).

5. Root Canal Disinfection
Due to its antimicrobial effect, calcium hydroxide is used as an intracanal medicament in pediatric endodontics, especially against Enterococcus faecalis and other persistent bacteria (Haapasalo & Ørstavik, 2020).

📊 Summary Table: Calcium Hydroxide in Pediatric Dentistry

Aspect Advantages Limitations
Indirect Pulp Capping Stimulates tertiary dentin; preserves pulp vitality Requires strict isolation; risk of failure if contamination occurs
Direct Pulp Capping Promotes dentin bridge formation; antimicrobial Weaker seal compared to MTA; possible pulp necrosis
Pulpotomy Induces calcific barrier; inexpensive May cause internal resorption; less durable than bioceramics
Apexification Effective for apical barrier formation Long treatment duration; potential weakening of dentin
Intracanal Medicament Broad antimicrobial action; biocompatible Limited effect on biofilms; incomplete neutralization in deep tubules

💬 Discussion
Calcium hydroxide’s success in pediatric dentistry relies on its biological properties—specifically its alkaline pH that neutralizes bacterial endotoxins and promotes hard tissue deposition. However, while it remains valuable for certain applications, modern materials such as MTA and Biodentine exhibit enhanced sealing abilities and faster healing responses.
Comparative studies show that although calcium hydroxide remains reliable for apexification and indirect pulp capping, MTA outperforms it in direct pulp capping and pulpotomy due to better biocompatibility and sealing capacity (Nair et al., 2022).

📌 Recommended Article :
Dental Article 🔽 Medications Used in Pulpotomies: Properties, Drawbacks, and Brand Names ... Selecting the right medication is crucial for clinical success. Below is an overview of the most commonly used pulpotomy agents, their properties, drawbacks, and commercial names.
✍️ Conclusion
Calcium hydroxide continues to play an important role in pediatric dentistry, particularly in treatments where biocompatibility and tissue regeneration are prioritized. Despite newer alternatives offering improved performance, calcium hydroxide remains a cost-effective and versatile option when applied with proper technique and case selection.

🔎 Recommendations

Use calcium hydroxide primarily for indirect pulp capping and apexification in children.
Employ strict isolation techniques to prevent contamination.
Consider MTA or calcium silicate-based materials for direct pulp capping or pulpotomy.
Regularly evaluate long-term clinical outcomes and radiographic healing.

📚 References

✔ Camps, J., & About, I. (2020). Pulp healing through calcium hydroxide: A review of molecular mechanisms. Journal of Dental Research, 99(10), 1122–1130. https://doi.org/10.1177/0022034520937071
✔ García-Godoy, F., & Murray, P. E. (2021). Recommendations for using regenerative endodontic procedures in permanent immature teeth. Dental Clinics of North America, 65(1), 37–52. https://doi.org/10.1016/j.cden.2020.08.003
✔ Haapasalo, M., & Ørstavik, D. (2020). In vitro infection and disinfection of dentinal tubules. Endodontic Topics, 37(1), 123–145. https://doi.org/10.1111/etp.12321
✔ Nair, P. N. R., Duncan, H. F., & Torabinejad, M. (2022). Newer materials in pulp therapy for children. International Endodontic Journal, 55(8), 789–803. https://doi.org/10.1111/iej.13721
Witherspoon, D. E. (2019). Apexification: Techniques and outcomes in pediatric endodontics. Journal of Endodontics, 45(2), 136–145. https://doi.org/10.1016/j.joen.2018.10.010

📌 More Recommended Items

Management of Endodontic Emergencies: Pulpotomy Versus Pulpectomy
Pulpotomy and pulpectomy procedures. Indications and Differences
Tricks in Paediatric Dentistry

miércoles, 1 de octubre de 2025

Calcium Hydroxide in Pediatric Dentistry: Benefits and Limitations

Calcium Hydroxide

Calcium hydroxide has been one of the most widely used biomaterials in pediatric dentistry for several decades. Its biological properties, high alkalinity, and ability to stimulate hard tissue formation have made it a cornerstone in pulp therapy procedures.

📌 Recommended Article :
Dental Article 🔽 Mineral Trioxide Aggregate (MTA) in Pediatric Dentistry: Uses, Benefits, and Clinical Evidence ... Among them, Mineral Trioxide Aggregate (MTA) has emerged as a gold standard for pulp therapy, especially for its regenerative properties and sealing capability.
Despite the emergence of newer bioactive materials, calcium hydroxide remains clinically relevant due to its availability, cost-effectiveness, and antimicrobial properties (Fuks, 2020). This article explores its use in pediatric dentistry, with a focus on its advantages, limitations, and clinical indications.

Advertisement

Clinical Applications in Pediatric Dentistry
In pediatric dentistry, calcium hydroxide is used primarily for vital pulp therapy procedures such as direct pulp capping, pulpotomy, and apexogenesis. It is also employed in endodontics for apexification of immature permanent teeth. The high pH (around 12.5) provides strong antimicrobial action and stimulates the release of bioactive molecules that promote reparative dentinogenesis (Schwendicke et al., 2016).

📌 Recommended Article :
Dental Article 🔽 Calcium Hydroxide in Pediatric Dentistry: Updated Uses, Benefits, and Clinical Evidence ... Calcium hydroxide (Ca(OH)₂) has been widely used for decades, especially in pulp therapy procedures, thanks to its outstanding biocompatibility and ability to stimulate dentin bridge formation.
Advantages of Calcium Hydroxide

1. Antibacterial properties: Its alkalinity eliminates many microorganisms present in infected pulp tissue.
2. Induction of dentin bridge formation: It stimulates odontoblastic activity, leading to reparative dentinogenesis.
3. Cost-effective: It is inexpensive and readily available compared to newer bioceramic alternatives.
4. Long history of use: Decades of clinical evidence support its efficacy.

📌 Recommended Article :
Dental Article 🔽 Pulp Polyps in Children: Causes, Diagnosis, and Treatment Options in Pediatric Dentistry ... While it is a protective response to chronic inflammation, it reflects significant pulpal exposure, often requiring endodontic or surgical management.
Limitations of Calcium Hydroxide

1. Solubility: It tends to dissolve over time, which may compromise long-term sealing ability.
2. Poor adhesion to dentin: Risk of microleakage and failure in long-term pulp protection.
3. Tunneling defects in dentin bridges: Histological studies show incomplete or porous dentin formation (Fuks, 2020).
4. Reduced success rates in long-term apexification: Newer materials such as mineral trioxide aggregate (MTA) and calcium silicate cements show superior results.

📊 Calcium Hydroxide in Pediatric Dentistry: Advantages and Limitations

Aspect Advantages Limitations
Antibacterial Action High alkalinity eliminates most microorganisms Efficacy decreases over time as material dissolves
Dentin Bridge Formation Stimulates odontoblast-like cells for reparative dentin May produce porous or incomplete dentin bridges
Cost and Availability Inexpensive and widely accessible Inferior long-term outcomes compared to MTA
Clinical Evidence Decades of successful use in pediatric pulp therapy Declining preference due to newer bioactive materials

💬 Discussion
Calcium hydroxide continues to be a valuable material in pediatric dentistry, particularly in regions where access to advanced biomaterials is limited. Its strong antimicrobial activity and ability to induce reparative dentinogenesis are undeniable strengths. However, modern clinical evidence indicates that calcium silicate-based materials such as MTA and Biodentine outperform calcium hydroxide in long-term pulp therapy outcomes (Torabinejad et al., 2018). The limitations of solubility, poor sealing, and incomplete dentin bridge formation highlight the need for careful case selection when using calcium hydroxide in pediatric patients.

📌 Recommended Article :
Video 🔽 Pulpectomy. Step-by-Step Procedure - Access, Preparation, and Obturation ... We share the step-by-step procedure of a pulpectomy performed with rotary files. In this video we can observe the opening, chemomechanical preparation and obturation.
✍️ Conclusion
While calcium hydroxide remains a cost-effective and biologically favorable material for pediatric pulp therapy, its limitations should not be overlooked. Clinicians must balance its advantages against its shortcomings and consider the use of newer bioceramic alternatives when available. Future research may further clarify its role in modern pediatric dentistry, particularly in combination therapies or modified formulations.

📚 References

✔ Fuks, A. B. (2020). Vital pulp therapy with new materials for primary teeth: New directions and treatment perspectives. Journal of Endodontics, 46(3), S49–S57. https://doi.org/10.1016/j.joen.2019.01.026
✔ Schwendicke, F., Brouwer, F., Schwendicke, A., & Paris, S. (2016). Different materials for direct pulp capping: Systematic review and meta-analysis. Journal of Dentistry, 54, 1–17. https://doi.org/10.1016/j.jdent.2016.08.005
✔ Torabinejad, M., Parirokh, M., & Dummer, P. M. H. (2018). Mineral trioxide aggregate and other bioactive endodontic cements: An updated overview – Part II: Other clinical applications and outcomes. International Endodontic Journal, 51(3), 284–317. https://doi.org/10.1111/iej.12843

📌 More Recommended Items

Calcium Hydroxide: How It Helps Save Children’s Teeth
Apexogenesis: Step by step procedure
Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions

lunes, 29 de septiembre de 2025

Vital Pulp Therapy in Primary Teeth: Evidence-Based Approaches

Vital Pulp Therapy

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.

📌 Recommended Article :
Video 🔽 Pulp Cap and Pulpotomy in Pediatric Trauma Cases ... When the dental pulp is compromised by a lesion, a pulpectomy, pulpotomy or pulp capping can be performed. The objective of these treatments is to keep the primary tooth in the mouth.
Over the last decades, research has led to an evolution of techniques and materials, moving toward biocompatible, evidence-based approaches.

Advertisement

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®).

📌 Recommended Article :
PDF 🔽 What is the best pulp dressing for pulpotomies in primary teeth? - Review ... Different pulp dressings have been used in pulpotomies, each with different characteristics and properties. The article we share compares all pulp dressings to determine which is the most effective.
3. Pulpotomy
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.

📌 Recommended Article :
Video 🔽 Pulpotomy and pulpectomy procedures. Indications and Differences ... We share the similarities, differences, indications, contraindications and step-by-step procedures of pulpotomy and pulpectomy.
💬 Discussion
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.

📊 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

📚 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

📌 More Recommended Items

Webinar: Dental Treatment: Pediatric Vital Pulp Therapy - Dr. Cohn
Webinar: Pulp treatment for primary & immature permanent teeth - Dr Nadine Moelich
Medications for Pulp Capping in Primary Teeth: Indications, Composition, and Clinical Management

jueves, 25 de septiembre de 2025

Webinar: Dental Treatment: Pediatric Vital Pulp Therapy - Dr. Cohn

Vital Pulp Therapy

The webinar “Dental Treatment: Pediatric Vital Pulp Therapy” provides an in-depth exploration of clinical indications, diagnostic criteria, and treatment techniques for preserving pulp vitality in primary teeth.

📌 Recommended Article :
Dental Article 🔽 Medications Used in Pulpotomies: Properties, Drawbacks, and Brand Names ... Selecting the right medication is crucial for clinical success. Below is an overview of the most commonly used pulpotomy agents, their properties, drawbacks, and commercial names.
Participants will learn how to evaluate cases, determine the most appropriate vital pulp therapy, and apply evidence-based protocols with confidence.

Advertisement

Special emphasis is placed on calcium silicate–based materials, highlighting their biological benefits, superior sealing ability, and role in long-term success compared to traditional approaches.

📌 Recommended Article :
PDF 🔽 Pulp Therapy Procedures Manual for Primary and Immature Permanent Teeth ... Pulp treatments in immature primary and permanent teeth aim to preserve the teeth until natural exfoliation. The pulp treatment to be performed will depend on a correct clinical and radiographic evaluation.
The session bridges clinical decision-making with practical application, offering pediatric dentists a comprehensive guide to modern, minimally invasive pulp therapies designed to maintain function and prevent premature tooth loss.

📌 Watch webinar: "Webinar: Mastering Primary Teeth Pulpotomies: Techniques and Best Practices for Dental Professionals"


Youtube/ Pediatric Dental Seminars

📌 We recommend these webinars:

Webinar: Silver Diamine Fluoride – A Silver Renaissance in Dentistry - Dr. Anas Al Salami
Webinar: The SMART pediatric dentistry: Minimally Invasive Restorative Techniques - Dra. Jeanette MacLean
Webinar: Pediatric dentistry and home based oral care - Dr. Silvia Sabatini and Dr. Luis Karakowsky

Webinar: Mastering Primary Teeth Pulpotomies: Techniques and Best Practices for Dental Professionals

Pulpotomy

The webinar “Mastering Primary Teeth Pulpotomies: Techniques and Best Practices for Dental Professionals” explores modern strategies in pulp therapy for vital primary teeth.

📌 Recommended Article :
PDF 🔽 Pulp Therapy Procedures Manual for Primary and Immature Permanent Teeth ... The treatment will depend on the vitality of the pulp, in case it is a vital tooth, pulp capping and pulpotomy can be performed. In non-vital teeth, pulpectomies are performed.
It covers indirect and direct pulp treatment approaches, along with coronal pulpotomy, offering clinicians evidence-based options for managing deep carious lesions while preserving tooth vitality.

Advertisement

Special focus is given to the role of bioceramic materials, their biological advantages, and how they enhance long-term outcomes compared to traditional medicaments.

📌 Recommended Article :
Dental Article 🔽 Pulp Polyps in Children: Causes, Diagnosis, and Treatment Options in Pediatric Dentistry ... Chronic hyperplastic pulpitis, commonly referred to as a pulp polyp, is a non-neoplastic, benign proliferation of pulpal tissue. It is often observed in children and adolescents, attributed to their rich pulpal vascularity and strong immune response.
Participants will gain practical insights into clinical protocols, case selection, and decision-making criteria essential for successful pulp therapy.

📌 Recommended Article :
Video 🔽 Pulpotomy and pulpectomy procedures. Indications and Differences ... Pulpectomy is recommended when it is necessary to completely remove the affected dental pulp, and pulpotomy partially removes the dental pulp.
Designed for pediatric dentists and dental professionals, this session bridges theory and clinical application, empowering practitioners to deliver minimally invasive, biologically driven care that aligns with current standards in pediatric dentistry.

📌 Watch webinar: "Webinar: Mastering Primary Teeth Pulpotomies: Techniques and Best Practices for Dental Professionals"


Youtube/ Pediatric Dental Seminars

📌 We recommend these webinars:

Webinar: Pulpectomy: Clinical Tips and Tricks in Paediatric Dentistry
Webinar: Bioceramics in Pediatric Dentistry - Dr. Patrick Ruck
Webinar: Clinically applicable Pulpotomy for the Primary Tooth - Dr. Joby Peter