Delivered by:
Dr. Rajeev Kumar Singh
Direct Pulp Capping
Indications
Small pinpoint
mechanical
exposure of < 1
mm diameter
Recent traumatic
(<24 h) pulp exposure
contra-Indications
Spontaneous pain/
Nocturnal pain
X
Thickening of PDL
Uncontrollable hemorrhage
at the time of exposure
X
Excessive tooth mobility
Purulent or serous exudate
from the exposure
X
Furcation/periapical
radiolucency
objectives of dpc
Seal the pulp against
bacterial leakage
Maintain the vitality
of the underlying
pulp tissue
Encourage the pulp to wall
off the exposure site by
initiating a dentin bridge
success of dpc
Non inflamed pulp
Nice sealing of
capping material
& restoration
HIGH
SUCCESS
RATE
Application of a non toxic
capping material
Hemorrhage
properly
controlled
Procedure of dpc
Once an exposure is encountered,
further manipulation of pulp is
avoided
Cavity should be irrigated with saline
or distilled water or chlorhexidine
Hemorrhage is arrested with light
pressure from sterile cotton pellets
Place the pulp capping material,
on the exposed pulp with
application of minimal pressure so
as to avoid forcing the material
into pulp chamber
Place temporary restoration
Final restoration is done after determining the
success pulp of capping which is done by
determination of dentinal bridge, maintenance
of pulp vitality and lack of pain.
Procedure in brief
A radiopaque capping material is placed directly onto the surface of vital
pulp tissue at the site of the pulp exposure followed by a base
The final restoration is placed over the base
The status of the pulp and peri-radicular tissues should be assessed through
periodic recall examinations.
silent feature of clinically successful dpc
Maintenance of pulp vitality
Absence of sensitivity or pain
Minimal pulp inflammatory responses
Absence of radiographic signs of dystrophic changes
Teeth with immature roots should show continued root
development and apexogenesis
Decision of doing DPC
Enzymes & matrix components
Zinc Oxide Eugenol
Calcium Hydroxide
Collagen
Growth Factors
Glass ionomers cement
Isobutyl cyanoacrylate
Bio dentine
Resin Bonding agents
Laser
Bone morphogenic
protein
Alpha-Tricalcium
Phosphate
Bio aggregates
Theracal
Corticosteroids & antibiotics
Mineral Trioxide Aggregate (MTA)
Various materials used for DPC
Calcium hydroxide Ca(OH)2
Originally introduced by Herman in 1930 as a pulp-capping agent
It is the most commonly used dressing for treatment of the vital pulp
Mechanism of action of Ca(OH)2
A calcified barrier may be induced when calcium hydroxide is
used as a pulp-capping agent or placed in the root canal in
contact with healthy pulpal or periodontal tissue.
Because of the high pH of the material, up to 12.5, a
superficial layer of necrosis occurs in the pulp to a depth of up
to 2 mm.
Beyond this layer only a mild inflammatory response is seen,
and providing the operating field was kept free of bacteria when
the material was placed, a hard tissue barrier may be formed.
The hydroxyl group is considered to be the most
important component of calcium hydroxide as it provides
an alkaline environment which encourages repair and active
calcification.
The alkaline pH induced not only neutralizes lactic acid
from the osteoclasts, thus preventing a dissolution of the
mineral components of dentine, but could also activate
alkaline phosphatases which play an important role in
hard tissue formation.
The calcified material which is produced appears to be the
product of both odontoblasts and connective tissue cells and
may be termed osteodentine. The barrier, which is composed
of osteodentine, is not always complete and is porous.
Mineral Trioxide Aggregate or MTA
MTA) was developed for use as a dental root repair material
by Dr. Mahmoud Torabinejad
MTA is used for creating an apical plug during apexification,
repairing root perforations during root canal therapy and
treating internal root resorption and can be used as both a
root-end filling material and pulp-capping material.
Composition
• Tricalcium
silicate
• Tricalcium aluminate
• Tricalcium oxide
• Silicate oxide
Mixed with sterile water in a 3:1
powder-to-liquid ratio,
MTA sets in 5 minutes
Properties
•Low or no solubility
•PH value10.2 after mixing and rises to 12.5 after 3
hours
•Antibacterial effect
•Induces pulpal cell proliferation
•Stimulation of mineralized tissue formation
Bio dentine
Bio dentine was developed by Septodent.
It is a calcium-silicate based formulation which is suitable as
a dentin replacement material whenever origin dentin is
damaged.
TheraCal LC
TheraCal Lc is a light cured, resin
modified calcium silicate filled liner.
It performs as an insulator/barrier
and protectant of the dental pulp
complex.
Bioaggregate
Bioaggregate is a root canal repair material which is composed of
ceramic nano particles.
It promotes cementogenesis and forms a hermetic seal inside the root
canal.
DPC in Primary teeth ????
Reasons of failure
High cellular content of pulp tissue
Undifferentiated mesenchymal cells may give rise to
odontoclasts, which may cause internal resorption
Faster inflammatory response
Poor localization of infection
Indirect pulp capping
Direct pulp capping
Indication
Indication
 Ideally, used when pulpal
inflammation has been judged to be
minimal and complete removal of
caries would cause a pulp exposure
 Small mechanical exposure less than
1mm which is surrounded by sound
dentin
 Light red bleeding from the exposure site
that can be controlled by cotton pellet
 Traumatic exposure in a dry, clean field,
which report to the dental office within 24
hrs
Contraindication
 Any signs of pulpal or periapical
pathology
 Soft leathery dentin covering a very
large area of the cavity, in a non
restorable tooth
Contraindication







Pain at night
Spontaneous pain
Tooth mobility
Thickening of PDL
Intra radicular radiolucency
Excess bleeding at the exposure site
Purulent or serious exudate
Summery
Calcium hydroxide remains the “gold standard” for direct pulp
capping. It has the longest track record of clinical success and is
the most cost-effective of all materials.
MTA demonstrates comparable results to calcium hydroxide as
a direct pulp capping agent in short-term data.
Zinc oxide and eugenol formulations, glass ionomers, resinmodified glass ionomers and adhesives are poor direct pulp
capping agents and should be avoided for this use.
Summery
DPC has been found to be less successful in primary teeth than
IPC or coronal pulpotomy.
DPC tends to be more successful in young permanent teeth.