Introduction to Dental Materials by Richard Van Noort

Author:Richard Van Noort [Van Noort, Richard]
Language: eng
Format: azw3
ISBN: 9780723437819
Publisher: Elsevier Health Sciences UK
Published: 2014-04-23T16:00:00+00:00

Figure 2.6.2 Transmission electron micrograph showing the extent of acid penetration into dentine

Clinical significance

The important points to appreciate are that many dental materials:

are biologically compatible with the pulp for indirect pulp capping, as long as there are no bacteria present and coronal micro-leakage is prevented

will stimulate the formation of reparative dentine.

Direct pulp capping

Direct pulp capping can be described as the dressing of an exposed pulp with the objective of maintaining pulp vitality. If a pulpal exposure occurs as a consequence of tooth preparation or trauma, it is important that steps are taken to avoid bacterial contamination. If one can be sure that this is the case, then the procedure of direct pulp capping carries a good prognosis for saving the pulp; although views vary, the general consensus is that calcium hydroxide cement is the choice of pulp-capping material in such situations. However, this view is now being challenged, with some clinicians promoting the merits of mineral trioxide aggregate.

Nevertheless, many clinicians believe that the long-term success rate with root-canal therapy does not warrant the treatment of traumatic pulp exposures with the more unpredictable pulp-capping procedures, especially as unsuccessful pulp capping may lead to resorption, calcification, pulpitis, pulp necrosis or periapical involvement. However, the advantages of a successful pulp-capping procedure are that young vital teeth have an opportunity to continue to develop and the tooth-weakening effects of root-canal treatment are avoided.

If direct pulp capping as a clinical procedure is controversial, then so is the choice of materials for pulp capping. A pulp-capping material can be considered to behave as a wound dressing for the exposed pulp. Such a material can passively wall off the pulp from the outside environment so as to prevent bacterial invasion and/or can induce some change in the pulp.

There is evidence to suggest that the pulp has the capacity to wall itself off by forming a connective tissue barrier that eventually changes into hard tissue. The induction of hard tissue formation needs to be preceded by a low-grade irritation that results in superficial coagulation necrosis. On this basis, a pulp-capping material must:

• have a superficial effect on the pulp tissue, thereby inducing a biological encapsulation process that results in hard tissue formation

• cause no adverse effects, whether systemically or locally, such that the pulp is kept alive

• protect the pulp from the coronal ingress of bacteria.

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