• Vital pulp stump capped with Ca(OH)2 • Temporary restoration • Follow-up
– Asymptomatic: permanent restoration – Symptomatic: endodontic treatment
Zinc oxide-eugenol cement (ZOE)
•Only for indirect pulp capping •Bactericidal effect and hermetic marginal seal •Cytotoxicity: use of ZOE as a liner in deep carious
2. Temporary restoration placed over Ca(OH)2 or MTA 3. Follow-up 4. Permanent restoration 5. Pulpotomy or endodontic treatment for symptomatic
tooth
1.2 Indirect pulp capping
Indications: • Accidental or mechanical pulp exposure
(normal pulp) – Cavity preparation – Placement of pins – Trauma • Mainly for immature permanent teeth with recent (<24 hr) traumatic pulp exposure or mechanical exposure during cavity preparation
Pulp Capping Materials
Calcium hydroxide 氢氧化钙
• The most commonly-used (direct) pulp-capping material – Water-based calcium hydroxide – Resin-based calcium hydroxide e.g. Dycal, Timeline
lesions is still controversial
Procedures
1. Remove all softened, mushy or leathery dentine 2. Either ZOE or Ca(OH)2 placed on the remaining
dentin to kill or suppress bacteria 3. Base 4. Temporary or permanent restoration
• Calcium hydroxide • Mineral trioxide aggregates (MTA)
矿化三氧化聚合物
MTA
• Excellent biocompatibility and hydrophilicity • Induce hard tissue regeneartion • Indicated for apical barrier, perforation repair,
retrofilling and vital pulpal therapy • Setting time: 4~5 hrs
Procedures
1. Ca(OH)2 or MTA applied to the exposure to stimulate differentiation of new odontoblast-like cells and formation of secondary dentin
Indications
– Deep carious lesions – No history of pulpalgia 牙髓痛 – No signs of irreversible pulpitis – No pulp exposure after
excavation of carious dentine
Should mature teeth be pulp capped?
•Size of exposure limited to o.5mm •Contraindicated for carious tooth with pulp invacture with pulpal involvement
Direct pulp capping
Hemostatic reagents 止血剂
• Saline 盐水 • Hydrogen peroxide 双氧水 • Diluted sodium hypochlorite 次氯酸钠 • Chlorhexidine 洗必泰
Pulp capping materials
2. Pulpotomy
Indicated for immature permanent teeth • Traumatic pulp exposure • Mechanical pulp exposure • Carious pulp exposure
Procedures
• Removal of all carious dentin and pulp tissue to the level of the radicular pulp
• Direct pulp capping 直接盖髓术 • Indirect pulp capping 间接盖髓术 • Pulpotomy 牙髓切断术
“Principles and practice of endodontics”
1. Pulp capping
1.1 Direct pulp capping
Chapter 18 Vital Pulp Therapy and Apexification
学习要点
掌握：直接盖髓术、间接盖髓术、牙髓切断术的原理及适应 证
根尖诱导成形术的修复机制和愈合类型 熟悉：直接盖髓术、间接盖髓术、根尖诱导成形术操作步骤
了解：根尖屏障术的原理和操作步骤
Vital Pulp Therapy 活髓保存治疗