The aim of this treatment is to maintain the vitality of the pulp in a deep carious lesion, when there is no direct pulpal involvement. All the carious dentine must be removed, and a thin layer of sound, non-carious dentine must remain. A lining of setting calcium hydroxide is placed, which stimulates the formation of secondary dentine. The tooth is restored over the dressing with a permanent restorative material.
It has been suggested that other medicaments may be used for indirect pulp caps, for example antibiotic pastes and anti-inflammatory drugs, but although some success has been reported, pulp necrosis and abscess formation often result without symptoms. As with the permanent dentition, research is presently focussing on the use of adhesive materials and bonding agents for indirect pulp capping. The long-term results of these long-term clinical trials are awaited.
It has been suggested that other medicaments may be used for indirect pulp caps, for example antibiotic pastes and anti-inflammatory drugs, but although some success has been reported, pulp necrosis and abscess formation often result without symptoms. As with the permanent dentition, research is presently focussing on the use of adhesive materials and bonding agents for indirect pulp capping. The long-term results of these long-term clinical trials are awaited.
It should be noted that one technique for indirect pulp capping, which was described in the past, is no longer recommended. This was where deep caries was carefully excavated, avoiding pulpal exposure, and the deeper layers of softened dentine dressed with a calcium hydroxidecontaining cement and a long-term temporary dressing. After a period of 6–8 weeks the tooth, which should have been symptomless, was reopened, and the arrested carious lesion examined. The success of this treatment was found to be less predictable and symptoms frequently developed. It is now recommended that all caries be removed, and if a pulpal exposure is found then either a direct pulp cap or a form of pulpotomy is used.