Partial pulpotomy

Although the technique of pulpotomy is indicated for immature teeth with open apices, as described in Part 10, it cannot be recommended routinely in mature teeth. However, the technique of partial pulpotomy (a procedure between pulp capping and pulpotomy) was introduced by Cvek and has been shown to be very successful in the treatment of traumatically exposed pulps.

The exposed pulp and surrounding dentine is removed under rubber dam isolation with a high-speed diamond drill and copious irrigation using sterile saline, to a depth of about 2 mm. Haemostasis is achieved and the wound dressed with a non-setting calcium hydroxide paste, either powder and sterile saline or a proprietory paste. The cavity is sealed with a suitable lining,

Direct pulp capping

The aim of direct pulp capping is to protect the vital pulp which has been exposed during cavity preparation, either through caries or trauma.  The most important consideration in obtaining success is that the pulp tissue remains uncontaminated. In deep cavities, when an exposure may be anticipated, all caries should be removed before approaching the pulpal aspect of the cavity floor. If an exposure of the pulp occurs in a carious field the chances of successful pulp capping are severely compromised. A rubber dam should be applied as soon as pulp capping is proposed. The pulp should be symptom-free and uninfected, and the exposure should be small. Before commencing large restorations in suspicious teeth it may be prudent to test the vitality of the tooth with an electronic pulp tester, and also to expose a radiograph to ensure that there is no evidence of pulpal or periapical pathology. The radiograph may in fact be more valuable, as misleading results may occur when using an electric pulp tester on compromised multirooted teeth.