Wednesday, September 10, 2014

Direct pulp capping

Fig, 5  A deciduous molar with a deep carious lesion has been isolated prior to commencing endodontic therapy.
This treatment is only recommended when a small traumatic exposure occurs, during cavity preparation of a vital non-infected pulp.
A calcium hydroxide dressing is placed directly over the pulp, followed by a lining and restoration, and the whole technique is carried out using local anaesthesia and with adequate isolation from salivary contamination. It has been suggested that the high cellular content of primary pulp tissue may be responsible for the failure of direct pulp capping in primary teeth.

Undifferentiated mesenchymal cells may differentiate into osteoclastic cells in response to either the caries or direct pulp capping which leads to internal resorption. It is also suggested that exposures on axial walls have a poor prognosis as the pulp coronal to the exposure may be deprived of its blood supply and undergo necrosis.