Skip to main content
SpringerLink
Log in

Vital Pulp Therapy for Permanent Molars

  • Chapter
  • First Online:
Book cover The Guidebook to Molar Endodontics

Abstract

Guidelines for vital molar therapy are presented based on best available evidence. Often the cause for vital intervention is due to caries, but seldom the depth of the carious lesion is mentioned in literature, which may hamper the evaluation of prognosis following treatment. Moreover, the lack of devices for monitoring objectively the degree of pulp inflammation makes the topic a clinical challenge where proper tooth selection is important. In this chapter, the deep and extremely deep caries lesion is defined and linked to specific treatment protocols, which include both direct pulp as well as indirect pulp capping procedures. Particularly, a classification of the pulp capping procedure is described, which relates to two specific scenarios. In Class I the need for pulp capping arises by accident, while in Class II the capping procedure is expected and the set-up for the vital pulp therapy includes the use of the operating microscope.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Black GV. A work on operative dentistry in two volumes. Vol. II the technical procedures in filling teeth. 2nd ed. Chigaco: Medico-Dental Publishing; 1908.

    Google Scholar 

  2. Tomes J. A system of dental surgery. London: John Churchill; 1859. p. 336.

    Google Scholar 

  3. Dumsha T, Hovland E. Considerations and treatment of direct and indirect pulp-capping. Dent Clin North Am. 1985;29:251–9.

    PubMed  Google Scholar 

  4. Seale NS. Indirect pulp therapy: an alternative to pulpotomy in primary teeth. Tex Dent J. 2010;127:1175–83.

    PubMed  Google Scholar 

  5. Seal NS, Glickman GN. Contemporary perspective on vital pulp therapy: views from the endodontists and pediatric dentists. J Endod. 2008;34:S57–61.

    Article  Google Scholar 

  6. Mejáre IA, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Petersson A, Portenier I, Sandberg H, Tranæus S, Bergenholtz G. Diagnosis of the condition of the dental pulpa: a systematic review. Int Endod J. 2012;45:597–613.

    Article  PubMed  Google Scholar 

  7. Nadin G, Goel BR, Yeung CA, Glenny AM. Pulp treatment for extensive decay in primary teeth. Cochrane Database Syst Rev. 2003;(1):CD003220. doi: 10.1002/14651858. CD003220.

  8. Miyashita H, Worthington HV, Qualtrough A. Plasschaert A. Pulp management for caries in adults: maintaining pulp vitality. Cochrane Database Syst Rev. 2007;(2):CD004484. doi: 10.1002/14651858.CD004484.pub2.

  9. Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. J Endod. 2011;37:581–7.

    Article  PubMed  Google Scholar 

  10. MESH definition. Accessed 11 Feb 2016 from http://www.ncbi.nlm.nih.gov/mesh/?term=pulp+exposure.

  11. Webber RT. Apexogenesis versus apexification. Dent Clin North Am. 1984;28:669–97.

    PubMed  Google Scholar 

  12. Mjör IA. Human coronal dentine: structure and reactions. Oral Surg. 1972;33:810–23.

    Article  PubMed  Google Scholar 

  13. Trowbridge HO. Pathogenesis of pulpitis resulting from dental caries. J Endod. 1981;7:52–60.

    Article  PubMed  Google Scholar 

  14. Baume LJ. The biology of pulp and dentine. A historic, terminologic-taxonomic, histologic-biochemical, embryonic and clinical survey. Monogr Oral Sci. 1980;8:1–220.

    Article  PubMed  Google Scholar 

  15. Lesot H, Béque-Kirn C, Kubler MD, Meyer JM, Smith AJ, Cassidy N, Ruch JV. Experimental induction of odontoblast differentiation and stimulation during reparative processes. Cells Mat. 1993;33:201–17.

    Google Scholar 

  16. Smith AJ, Tobias RS, Plant CG, Browne RM, Lesot H. Odontoblast stimulation in ferrets by dentine matrix components. Arch Oral Biol. 1994;39:13–22.

    Article  PubMed  Google Scholar 

  17. Simon S, Smith AJ, Berdal A, Lumley PJ, Cooper PR. The MAP kinase pathway is involved in odontoblast stimulation via p38 phosphorylation. J Endod. 2010;36:256–9.

    Article  PubMed  Google Scholar 

  18. Simon SRJ, Berdal A, Cooper PR, Lumley PJ, Tomson PL, Smith AJ. Dentin-pulp complex regeneration: from lab to clinic. Adv Dent Res. 2011;23:340–5.

    Article  PubMed  Google Scholar 

  19. Couve E, Osorio R, Schmachtenberg O. The amazing odontoblast: activity, autophagy, and aging. J Dent Res. 2013;92(9):765–72.

    Article  PubMed  Google Scholar 

  20. Bjørndal L, Darvann T, Thylstrup A. A quantitative light microscopic study of the odontoblastic and subodontoblastic reactions to active and arrested enamel caries without cavitation. Caries Res. 1998;32:59–69.

    Article  PubMed  Google Scholar 

  21. Magloire H, Bouvier M, Joffre A. Odontoblast response under carious lesions. Proc Finn Dent Soc. 1992;88:257–74.

    PubMed  Google Scholar 

  22. Smith AJ, Scheven BA, Takahashi Y, Ferracane JL, Shelton RM, Cooper PR. Dentine as a bioactive extracellular matrix. Arch Oral Biol. 2012;57:109–21.

    Article  PubMed  Google Scholar 

  23. Bjørndal L, Darvann T. A light microscopic study of odontoblastic and non-odonotoblastic cells involved in the tertiary dentinogenesis in well-defined cavitated carious lesions. Caries Res. 1999;33:50–60.

    Article  PubMed  Google Scholar 

  24. Olsson H, Petersson K, Rohlin M. Formation of a hard tissue barrier after pulp capping in humans. A systematic review. Int Endod J. 2006;39:429–42.

    Article  PubMed  Google Scholar 

  25. Cooper PR, Takahashi Y, Graham LW, Simon S, Imazato S, Smith AJ. Inflammation-regeneration interplay in the dentine-pulp complex. J Dent. 2010;38:687–97.

    Article  PubMed  Google Scholar 

  26. Seltzer S, Bender IB, Ziontz M. The dynamics of pulp inflammation: correlations between diagnostic data and actual histologic findings in the pulp. Oral Surg Oral Med Oral Pathol. 1963;16:846–71.

    Article  PubMed  Google Scholar 

  27. Seltzer S, Bender IB, Ziontz M. The dynamics of pulp inflammation: correlations between diagnostic data and actual histologic findings in the pulp. Oral Surg Oral Med Oral Pathol. 1963;16:969–77.

    Article  PubMed  Google Scholar 

  28. Dummer PM, Hicks R, Huws D. Clinical signs and symptoms in pulp disease. Int Endod J. 1980;13:27–35.

    Article  PubMed  Google Scholar 

  29. Reit C. Värdering av information. Tandläkertidningen. 1995;87:67–77.

    Google Scholar 

  30. Bjørndal L, Reit C. The annual frequency of root fillings, tooth extractions and pulp-related procedures in Danish adults during 1977–2003. Int Endod J. 2004;37:782–8.

    Article  PubMed  Google Scholar 

  31. Bjørndal L, Demant S, Dabelsteen S. Depth and activity of carious lesions as indicators for the regenerative potential of dental pulp after intervention. J Endod. 2014;40:S76–81.

    Article  PubMed  Google Scholar 

  32. Bogen G, Kim JS, Bakland LK. Direct pulp capping with mineral trioxide aggregate: an observational study. J Am Dent Assoc. 2008;139:305–15.

    Article  PubMed  Google Scholar 

  33. Reeves R, Stanley HR. The relationship of bacteria penetration and pulpal pathosis in carious teeth. Oral Surg Oral Med Oral Pat. 1966;22:59–65.

    Article  Google Scholar 

  34. Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. J Endod. 1978;4:232–7.

    Article  PubMed  Google Scholar 

  35. Mejáre I, Cvek M. Partial pulpotomy in young permanent teeth with deep carious lesions. Endod Dent Traumatol. 1993;9:238–42.

    Article  PubMed  Google Scholar 

  36. Mass E, Zilberman U. Clinical and radiographic evaluation of partial pulpotomy in carious exposure of permanent molars. Pediatr Dent. 1993;15:257–9.

    PubMed  Google Scholar 

  37. Barrieshi-Nusair KM, Qudeimat MA. A prospective clinical study of mineral trioxide aggregate for partial pulpotomy in cariously exposed permanent teeth. J Endod. 2006;32:731–5.

    Article  PubMed  Google Scholar 

  38. Witherspoon DE, Small JC, Haris GZ. Mineral trioxide aggregate pulpotomies: a case series outcome assessment. J Am Dent Assoc. 2006;137:610–8.

    Article  PubMed  Google Scholar 

  39. Eghbal MJ, Asgary S, Baglue RA, Parirokh M, Ghoddusi J. MTA pulpotomy of human permanent molars with irreversible pulpitis. Aust Endod J. 2009;35:4–8.

    Article  PubMed  Google Scholar 

  40. Hasselgren G, Reit C. Emergency pulpotomy: pain relieving effect with and without the use of sedative dressings. J Endod. 1989;15:254–6.

    Article  PubMed  Google Scholar 

  41. Chailertvanitkul P, Paphangkorakit J, Sooksantisakoonchai N, Pumas N, Pairojamornyoot W, Leela-Apiradee N, Abbott PV. Randomized control trial comparing calcium hydroxide and mineral trioxide aggregate for partial pulpotomies in cariously exposed pulps of permanent molars. Int Endod J. 2014;47:835–42.

    Article  PubMed  Google Scholar 

  42. Bjørndal L, Mjör IA. Dental caries: characteristics of lesions and pulpal reactions. In: Mjör IA, editor. Pulp-dentin biology in restorative dentistry. Chicago: Quintessence; 2002. p. 55–75.

    Google Scholar 

  43. Kerkhove Jr BC, Herman SC, Klein AI, McDonald RE. A clinical and television densitometric evaluation of the indirect pulp capping technique. J Dent Child. 1967;34:192–201.

    PubMed  Google Scholar 

  44. Maltz M, de Oliveira EF, Fontanella V, Bianchi R. A clinical microbiological, and radiographic study of deep caries lesions after incomplete caries removal. Quint Int. 2002;33:151–9.

    Google Scholar 

  45. Gruythuysen R, van Strijp G, Wu M-K. Long-term survival of indirect pulp treatment performed in primary and permanent teeth with clinically diagnosed deep carious lesions. J Endod. 2010;36:1490–3.

    Article  PubMed  Google Scholar 

  46. Maltz M, Garcia R, Jardim JJ, et al. Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. J Dent Res. 2012;91:1026–31.

    Article  PubMed  Google Scholar 

  47. Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database Syst Rev. 2013;(3):CD003808. doi: 10.1002/14651858. CD003808.pub3. Review.

  48. Schwendicke F, Meyer-Lueckel H, Dörfer C, Paris S. Failure of incompletely excavated teeth – a systematic review. J Dent. 2013;41:569–80.

    Article  PubMed  Google Scholar 

  49. Bjørndal L, Larsen T, Thylstrup A. A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res. 1997;31:411–7.

    Article  PubMed  Google Scholar 

  50. Orhan AI, Oz FT, Ozcelik B, Orhan K. A clinical and microbial comparative study of deep carious lesion treatment in deciduous and young permanent molars. Clin Oral Invest. 2008;12:369–78.

    Article  Google Scholar 

  51. Orhan AI, Firdevs TO, Orhan K. Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars. Pediatric Dent. 2010;32:347–55.

    Google Scholar 

  52. Bjørndal L, Reit C, Bruun G, et al. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci. 2010;118:290–7.

    Article  PubMed  Google Scholar 

  53. Bjørndal L, Thylstrup A. A practice-based study on stepwise excavation of deep carious lesions in permanent teeth: a 1-year follow-up study. Community Dent Oral Epidemiol. 1998;26:122–8.

    Article  PubMed  Google Scholar 

  54. Miles JP, Gluskin AH, Chambers D, Peters OA. Pulp capping with mineral trioxide aggregate (MTA): a retrospective analysis of carious pulp exposures treated by undergraduate dental students. Oper Dent. 2010;35:20–8.

    Article  PubMed  Google Scholar 

  55. Hørsted P, Søndergaard B, Thylstrup A, EL Attar K, Fejerskov O. A retrospective study of direct pulp capping with calcium hydroxide compounds. Endod Dent Traumatol. 1985;1:29–34.

    Article  PubMed  Google Scholar 

  56. Marthaler TM. Changes in dental caries 1953–2003. Caries Res. 2004;38:173–81.

    Article  PubMed  Google Scholar 

  57. Simon S, Perard M, Zanini M, Smith AJ, Charpinter E, Djole SX, Lumley PJ. Should pulp champer pulpotomy be seen as a permanent treatment? Some preliminary thoughts. Int Endod J. 2013;46:79–87.

    Article  PubMed  Google Scholar 

  58. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004;30:196–200.

    Article  PubMed  Google Scholar 

  59. Lovelace TW, Henry MA, Hargreaves KM, Diogenes A. Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod. 2011;37:133–8.

    Article  PubMed  Google Scholar 

  60. Petrino JA, Boda KK, Shambarger S, Bowles WR, McClanahan SB. Challenges in regenerative endodontics: a case series. J Endod. 2010;36:536–41.

    Article  PubMed  Google Scholar 

  61. Torabinejad M, Turman M. Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: a case report. J Endod. 2011;37:265–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, 2200, Copenhagen, Denmark

    Lars Bjørndal PhD

Authors
  1. Lars Bjørndal PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lars Bjørndal PhD .

Editor information

Editors and Affiliations

  1. Department of Endodontics, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, California, USA

    Ove A. Peters

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Bjørndal, L. (2017). Vital Pulp Therapy for Permanent Molars. In: Peters, O. (eds) The Guidebook to Molar Endodontics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52901-0_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-52901-0_4

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-52899-0

  • Online ISBN: 978-3-662-52901-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation