vital pulp therapy in permanent teeth

2020 Sep;21(3):112-113. doi: 10.1038/s41432-020-0128-0. Knowing the background about the dental pulp, the various cell types, and their interactions with each other and with various dental materials is important because this could ultimately lead to a better treatment modalities. A material that further seals, such as glass ionomer or resin-modified glass ionomer, should then be used to fill the coronal pulp chamber. Vital pulp therapy can be used in immature and fully formed permanent teeth. The porosity of this dentinal bridge potentially allows recolonization of bacteria, thereby leading to failure of pulp capping procedures. Recently a new material has been introduced, BioAggregate (BA) (Innovative BioCeramix, Vancouver, British Columbia, Canada). The potential risks are direct damage to the cells (cytotoxicity) and induction of immune-based hypersensitivity reactions. Vital pulp therapy is effective as long as proper assessment of the situation is made. Witherspoon DE. The procedure is also known as Cvek pulpotomy. Pulp proper: the central mass of the pulp, which consists of larger blood vessels and nerves. The procedure involves amputation of the coronal portion of the pulp and treatment of the remaining radicular pulp stumps. Aged dental pulps have various characteristics, which include the following: At the molecular level, one study has shown a decreased expression of connexin 43 and osteocalcin in the aged human pulp, which in turn relates to the decreased viability of the odontoblasts and the pulp cells. For cases of open apexes, maintaining the pulp vital is essential for the development of the root and maturation of the whole tooth. A Combination of Full Pulpotomy and Chairside CAD/CAM Endocrown to Treat Teeth with Deep Carious Lesions and Pulpitis in a Single Session: A Preliminary Study. Endodontics is defined as the branch of dentistry concerned with the morphology, physiology, and pathology of the human dental pulp and periradicular tissues. Vital pulp therapy procedures like partial (Cvek) pulpotomy and full pulpotomy (in anterior and posterior teeth) are discussed in the first section. NIH Partial pulpotomy and full pulpotomy sustained a high success rate up to more than 3 years (partial pulpotomy: >6 months-1 year, 97.6%; >1-2 years, 97.5%; >2-3 years, 97.6%; and >3 years, 99.4%; full pulpotomy: >6 months-1 year, 94%; >1-2 years, 94.9%; >2-3 years, 96.9%; and >3 years, 99.3%). The activity of NF-κB is tightly regulated by cytokines and other external regulators. 12. If the caries does progress to the pulp, it leads to inflammation, which is caused by several proinflammatory cytokines, such as interleukin (IL)-1β and tumor necrosis factor α, and chemokines, which cause cell death, increased vascular permeability, and an increase in inflammatory cells into the area along with production of acute phase proteins. This article reviews the rudiments of pulp therapy for children. Vital pulp therapy should be attempted whenever the pulp is diagnosed to be vital. The success of different pulp capping materials has been measured by thickness of the dentinal bridge, morphology of the dentinal bridge, intensity of pulpal inflammation, presence of odontoblasts cells, and biocompatibility. Vital pulp therapy. Historically, the material used during pulp capping procedures has been calcium hydroxide. Remove soft leathery caries affected tooth structure until dentin consistency changes or pulp exposure is imminent. Other studies have shown that MTA induced cells to secrete IL-8 and IL-1β. Akhlaghi N, Khademi A: Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature. Another study showed that MTA causes neutrophils to be recruited to the site of injury, which is important in the process of inflammation. A stainless steel crown is then used to restore the tooth. 11.  |  TLR-2 and TLR-4 have been immune-localized in human odontoblasts. Clean canal walls with moistened sterile cotton pellet. COVID-19 is an emerging, rapidly evolving situation. Vital pulp therapy is performed to preserve the health status of the tooth and its ultimate position in the arch for the expected life of the tooth. Some studies have reported that the pulp has some physiologic feedback mechanisms to counteract inflammation and increased tissue pressure, which in turn explains why inflammation of the pulp could be long standing and could heal if appropriate measures are taken in a timely manner. The investigators concluded that the defense system in younger pulps was accomplished by calcification and in adult pulp is performed by self-defense proteins and regeneration of vessels. Pulp-dentin regeneration: current state and future prospects. Canals should be cleaned carefully but not significantly instrumented (primary roots are narrow and curved and there is a risk of perforation or extension beyond the apex). Especially in young permanent teeth with immature roots, the pulp is … Cvek and colleagues investigated the depth of inflammatory reactions of adult monkey pulps exposed by fracture or cavity prep at different time intervals and found that inflammation extended 1.5 mm to 2 mm into the pulp at the 48-hour mark and only 0.8 mm to 2.2 mm after 1 week. The radicular orifices are assessed to determine that bleeding can be controlled only by direct pressure with a damp cotton piece for a minute or 2. The Vital Pulp Therapy of Permanent Teeth: A Dental Practitioner's Perspective from Saudi Arabia. It is expected that the teeth will maintain vitality with resolution of symptoms (if present) and completion of root development in immature teeth after vital pulp therapy. Evid Based Dent. Vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp therapy. Pulp tissue is necessary for tooth nutrition, innervation and immunocompetency. Cases of permanent tooth mean long-term preservation of the tooth in a healthy state in the mouth. The paste is condensed into the radicular pulp chamber after careful pulp extirpation, cleaning of the canal, and irrigation with saline. The random effect method of weighted pooled success rate of each treatment and the 95% confidence interval were calculated by the DerSimonian-Laird method. Recent research has shown that MTA, when placed in direct contact with the human dental pulp cells, differentiated them into odontoblast-like cells. It is subadjacent to the odontoblastic layer and is traversed by capillaries, unmyelinated nerve fibers, and cytoplasmic processes of fibroblasts. 2020 Aug 25;9(9):2738. doi: 10.3390/jcm9092738. The mature pulp demonstrates 4 morphologic zones, including. There are several different treatment options for vital pulp Direct pulp capping is defined as the placement of a medicament on a pulp that has been exposed in the course of excavating the last portions of deep dental caries. Odontoblastic layers appeared earlier; less hyperemia, inflammation, and necrosis were noted; and dentinal bridges were more pronounced in the MTA-treated teeth. This provides the pulp a low-compliance environment and receives its blood supply from the blood vessels that traverse through the apical foramen. The survival rate was 96% for primary molars (mean survival time, 146 weeks) and 93% for permanent teeth (mean survival time, 178 weeks). In terms of bacterial penetration, Kakoli and colleagues showed that bacterial infection of the dentinal tubules occurs to a lesser extent in older patients than in younger patients. Indirect pulp therapy: an alternative to pulpotomy in primary teeth. The best sealing agents seem to be MTA or glass ionomer. After placement of a layer of resin-modified glass ionomer as liner over carious dentin, the teeth were restored. Failures The tooth pulp is a unique organ and is encased in a protective layer of dentin, which is encased by a layer of the enamel. If the pulp tissue is nonvital or the bleeding cannot be controlled at the level of the orifice, a pulpectomy should be performed. This should be done before the procedure via radiographic assessment or by direct examination of pulp and its color, texture, and bleeding during the procedure. Disinfect the cavity using 2.5% sodium hypochlorite for at least 1 minute. The entire coronal pulp is removed circumferentially with a large round bur, pulling coronally to adequately deroof the pulp chamber and to avoid leaving any ledges or pulp tissue therein. Inflammation is a tightly regulated process and its main function is to eliminate pathogens and remove damaged tissue with the aim of restoring tissue homeostasis. There are several different treatment options for vital pulp therapy in extensively decayed or traumatized teeth. The vitality of dental pulp is essential for long-term tooth survival. J Int Soc Prev Community Dent. IL-1β has been shown to induce the synthesis of collagen, resulting in a more organized response of the pulp and assisting in the healing process. When decay or tooth preparation extends into the coronal pulp, and the pulp is deemed vital (as described previously), a pulpotomy may be performed. J Endod. Odontoblasts are considered highly specialized cells that have been shown to express Toll-like receptors (TLRs). Failure was defined as the presence of either a clinical symptom (pain, swelling, or fistula) or radiologic abnormality at recall. Electronic database MEDLINE via Ovid, PubMed, and Cochrane databases were searched. At the molecular level, HEMA and TEGDMA have shown to cause cell death/apoptosis in the pulp cells by a decrease in important transcription factors, such as nuclear factor κB (NF-κB) and increase in c-Jun N-terminal kinases (JNK). Vital pulp therapy with new materials: new directions and treatment perspectives—permanent teeth. The term is frequently used to describe therapy performed to encourage the continuation of this process. According to the American Association of Endodontists glossary, partial pulpotomy is defined as the removal of a small portion of the vital coronal pulp as a means of preserving the remaining coronal and radicular pulp tissues to encourage continued physiologic development and formation of the root end. Aeinehchi and colleagues compared the use of MTA and calcium hydroxide in direct pulp capping cases using 11 pairs of third molars (patients 20–25 years old) with pulps mechanically exposed and capped with either MTA or calcium hydroxide, covered with zinc oxide–eugenol, and restored with amalgam. Teeth were extracted and then histologically evaluated at 1 week and 2, 3, 4, and 6 months. When considering the capping material, current evidence in the literature has consistently demonstrated a better outcome when using MTA. 2 Vital pulp therapy is performed to preserve and maintain the health of the pulpal tissue in cases of exposure due to trauma, caries and/or restorative procedures. A stainless steel crown is the restoration of choice after performing a primary molar pulpotomy. Vital pulp therapy (VPT) is primarily indicated for immature permanent teeth with reversible pulpitis caused by mechanical pulp exposure during carious excavation or operative procedure, or a traumatic pulp exposure of healthy teeth with minimal bacterial contamination 3, 4. MTA was clinically easier to use as a direct pulp capping agent and resulted in less pulpal inflammation and more predictable hard tissue barrier formation than Dycal. Hence, the second part of this review deals with the clinical aspects of treatment of the primary and permanent dentition. Place calcium hydroxide, MTAs, or BA directly over the exposure site; do not force it into the pulp. The aim of vital pulp therapy is to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. It is believed that activation of JNK inhibits cell growth and induces cell death. Treatment. The weighted pooled success rate of each treatment was estimated in 4 groups: >6 months-1 year, >1-2 years, >2-3 years, and >3 years. These cells are important in the defense mechanism of the pulp and have been studied extensively over the past decade. Cariously exposed pulps may benefit from vital pulp therapies. 2020 Jun 28;10(7):972. doi: 10.3390/biom10070972.  |  Therefore, after achieving hemostasis on the radicular pulp orifices, and after using a medicament (if desired), the orifices must be sealed with one of these agents. Another pulp capping material recently developed is mineral trioxide aggregate (MTA). Evaluation of Resin-Based Material Containing Copaiba Oleoresin (. MTA has demonstrated significantly greater frequency of dentin bridge formation, thicker and less porous dentin, and less pulp inflammation compared with calcium hydroxide. The cellular components of this layer include mainly macrophages and lymphocytes. J Endod. 2002 Apr;28(1):29-37. doi: 10.1111/j.1747-4477.2002.tb00364.x. The indirect comparison of success rates for 4 follow-up periods and the indirect comparison of clinical factors influencing the success rate of each treatment were performed by z test for proportion (P < .05). Outcome of Partial Pulpotomy in Cariously Exposed Posterior Permanent Teeth: A Systematic Review and Meta-analysis. Aust Endod J. Published by Elsevier Inc. All rights reserved. Pulpotomy is a vital pulp therapy in which a portion of the coronal pulp tissue is surgically removed, and the remaining radicular tissue is covered with suitable material that protects the pulp from further injury and permits and promotes healing. Thus, in clinical terms, a necrotic infected pulp is required for apical periodontitis to be present. In children and young adults, teeth with traumatic pulp exposure can be treated successfully (96%) with partial pulpotomy and calcium hydroxide. Nair and colleagues also demonstrated decreased inflammation when MTA was used compared with calcium hydroxide. The goal of NF-κB is the major transcription factor that is involved in the regulation of a variety of genes responsible for survival of the cells.  |  Ali AH, Thani FB, Foschi F, Banerjee A, Mannocci F. J Clin Med. The fluctuation of the success rate of direct pulp capping was observed (>6 months-1 year, 87.5%; >1-2 years, 95.4%; >2-3 years, 87.7%; and >3 years, 72.9%). 2012 Nov;143(11):1232-3. doi: 10.14219/jada.archive.2012.0069. Some studies have shown that the processes are limited to the inner third of the dentin and other studies have demonstrate the processes extending to the dentinoenamel junction. MTA can be considered as an effective material for vital pulp therapy, with the goal of maturogenesis. In 1987, Fuks and colleagues performed partial pulpotomy on 63 teeth with different types and severity of traumatic injuries and demonstrated a 94% success rate. Irreversibly injured odontoblasts are replaced by cells that migrate from this layer. 2020 Jun 15;10(3):300-308. doi: 10.4103/jispcd.JISPCD_69_19. Vital Pulp Therapy Definition: Vital pulp therapy is the treatment initiated on an exposed pulp to repair and maintain the pulp vitality. In cases of a primary tooth, the length of time for expected life is measured against the expected life of the tooth in the mouth without pulp disease or pulp therapy. There is some debate as to whether the remaining radicular pulp orifices should be further treated with a medicament, such as formocresol or ferric sulfate. This study shows that indirect pulp therapy performed in primary and permanent teeth of young patients may result in a high 3-year survival rate. Basic Concepts In Vital Pulp Therapy Of Cariously Exposed Permanent Teeth The treatment objective following pulp exposure is to obtain healing of a pulp wound in order to preserve a vital tooth with a healthy pulp. The connective tissue in this zone contains collagen fibers and ground substance. Third, primary teeth are space maintainers for permanent successor eruption, maintain arch length and help to guide permanent dentition into place. Patel and Cohenca also presented a case that demonstrates the use of MTA as a direct pulp capping material for the purpose of continued maturogenesis of the root. New approches in vital pulp therapy in permanent teeth. Self-Limiting versus Rotary Subjective Carious Tissue Removal: A Randomized Controlled Clinical Trial-2-Year Results. Caries excavation followed by placement of a restoration is necessary. A better insight into mechanisms of toxicity of dental materials is important for understanding the potential of these materials to cause adverse health effects in a clinical setting. Introduction: This systematic review aims to illustrate the outcome of vital pulp therapy, namely direct pulp capping, partial pulpotomy, and full pulpotomy, in vital permanent teeth with cariously exposed pulp. Vital pulp therapy (VPT) is performed in cases of trauma, caries, and restorative procedures to preserve the vital pulp tissue. Canals and the pulp chamber should be filled (as described previously) for primary anterior teeth. The main functions of the pulp include (1) formation of dentin and (2) nutrition to the dentin, which is avascular, protective, and reparative. Int J Environ Res Public Health. The pulp contains numerous cells types, which include odontoblasts, fibroblasts, macrophages, dendritic cells, lymphocytes, mast cells, and undifferentiated mesenchymal stem cells. Other studies have reported that calcium hydroxide caused a layer of necrosis of the pulp tissue when used in pulp capping procedures. No correlations were found between healing and size of pulp exposure, type of trauma, time frame, and root development. Cover the capping material with glass ionomer and restore permanently. It is recommended that practitioners gather additional information in each of the referenced areas before engaging in pulp therapy for children. Other studies in animal models have shown that MTA down-regulated inflammatory cytokines, such as interferon-gamma, CCL5 (also referred to as regulated on activation, normal T-cell expressed, and secreted [RANTES]), and IL-1α, and suppressed the proliferation of some microorganisms and inhibited the production of certain T h 1 and T h 2 cytokines. Vital pulp therapy Restoring the Tooth’s own heartbeat 6. This review is divided into 2 parts: the first aims to illustrate the basic biology of the pulp and the effects on the pulp due to various procedures; the second focuses on the clinical aspects of treatment and the use of various dental materials during different vital pulp therapy procedures performed in the primary and permanent teeth. Methods: Electronic database MEDLINE via Ovid, PubMed, and Cochrane databases were searched. Calcium hydroxide has been considered the gold standard for pulp capping; however, previous research has shown that it is not ideally suited for this procedure. In addition to these, in primary teeth it is important to preserve the tooth until its … These procedures aim to remove only the diseased pulp and preserve the remaining pulp in a functional state promoting root growth or apexogenesis. 2019 Nov;45(11):1296-1306.e3. If the pulp does not bleed at all or bleeds at a hemorrhagic level, it may be infected beyond the coronal pulp, and a pulpectomy may be in order. Some of the more common restorative materials currently used are resin based. The pulp is encased within the dentin. Overall, the success rate was in the range of 72.9%-99.4%. Mechanically or traumatically exposed primary and young permanent teeth, No history of spontaneous or irreversible inflamed pulp, Radiographic evidence of pulpal or periradicular pathosis, Exposures with purulent or serous exudates. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Indirect pulp capping has been defined as a procedure in which a small amount of carious dentin is retained in deep areas of cavity preparation to avoid an exposure of the pulp. Odontoblasts synthesize mainly type 1 collagen, type V collagen, proteoglycans, dentin sialoprotein, and alkaline phosphatase. Biomolecules. The first part of this article provides insight into the basic biology of the dental pulp, the mechanisms involved in inflammation, and the reactions of the pulp to various dental materials at the cellular and molecular level whereas the second part deals with the clinical aspects of treatment of the primary and permanent dentition. Indications for Vital Pulp Therapy. Control the hemorrhage with a sterile cotton pellet moistened with sterile saline. The key to the success of vital pulp therapy … If there are signs of early external root resorption, radiolucency beyond the confines of the pulp chamber related to the tooth or other signs of disease, or inadequate tooth structure to support a restoration, the tooth may need to be extracted. Apexification is defined as a method of inducing a calcified barrier in a root with an open apex or the continued apical development of an incompletely formed root in teeth with necrotic pulp. No history of spontaneous, lingering, or severe pain, No extensive restoration or full crown requirements, History of spontaneous pain or signs of irreversible pulpitis, Clinical or radiographic evidence of pulpal or periradicular pathosis, Tooth requires extensive restoration or full crown. The aim of vital pulp therapy is to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. Carious or traumatically exposed primary and permanent teeth, Vital pulp, which responds to sensitivity tests, Limited to moderate restorative treatment. Generally, sodium hypochlorite has not been used to clean the pulp canals of primary teeth. Cell poor zone: also called the cell free zone of Weil because it is relatively free of cells. As with a primary anterior tooth, when there is disease beyond the confines of the tooth related to the tooth, consideration for extraction must be given. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Temporomandibular Joint Disorders in Children, Overview of Trauma Management for Primary and Young Permanent Teeth, Providing Dental Treatment for Children in a Hospital Setting. The coronal chamber should be filled with glass ionomer or resin-modified glass ionomer. Dental caries is a progressive infection of the dentin, which may lead to inflammation and ultimately necrosis of the pulp. Sodium Hypochlorite Reduces Postoperative Discomfort and Painful Early Failure after Carious Exposure and Direct Pulp Capping-Initial Findings of a Randomized Controlled Trial. Historically many different materials have been used for these procedures, including resin-modified glass ionomer cements, tricalcium phosphates, hydrophilic resins, and calcium hydroxide. Studies have previously shown that HEMA induces apoptosis in different cell types and also in dental pulp stem cells and in odontoblast-like cells. Vitality of dental pulp is essential for long-term tooth survival. The structure of the dental pulp is similar to the other connective tissues in the body. Although the use of these materials is aesthetically appealing in patients, they carry the risk of local and systemic adverse effects. From a clinical perspective, the control of the hemorrhage is critical to determine the level of pulp inflammation. Other studies had given a lower prognosis to indirect pulp therapy, however, especially in permanent teeth. Treatment is performed in the appropriate fashion with strict adherence to the proper technique. Vital pulp therapy in cariously exposed permanent teeth and its limitations. Types: The American Association of Endodontists (AAE) Consensus Conference Recommended Diagnostic Terminology states that mature permanent teeth clinically diagnosed with irreversible pulpitis are treated with pulpectomy and root canal filling because inflamed vital pulp is not capable of healing. Apply pressure with a moist sterile cotton pellet on the pulp stump to control hemorrhage. The cause of apical periodontitis is toxic metabolites and byproducts released from microorganisms within the canal and diffused into periapical tissues, eliciting inflammatory responses and bone resorption. Pulpotomy treatment is a very common form of vital pulp therapy. MTA, BA, or calcium hydroxide is laid over the pulp stump to a thickness of 2–3 mm. Results: Therefore, preservation and treatment of the vital pulp are critical for the prevention of apical periodontitis. Preserving the pulp is important in the treatment of carious pulp exposure in young permanent teeth. On the molecular level, MTA has been shown to induce the secretion of angiogenic factors, such as vascular endothelial growth factor, which plays an important role in healing. Clinical and radiographic follow-up demonstrated a vital pulp and physiologic root development in comparison with the contralateral tooth. doi: 10.1016/j.joen.2019.07.005. The odontoblasts are particularly important because they are responsible for dentinogenesis both during tooth development and in the mature tooth. With the development of more biocompatible materials with high sealing properties, these teeth might have a better outcome with direct pulp therapy. Therefore, MTA or equivalent products should be the material of choice for direct pulp capping procedures instead of hard-setting calcium hydroxide cements. It is subadjacent to the predentin and is composed of cell bodies of the odontoblasts, capillaries, nerve fibers, and dendritic cells. As discussed previously, there are various materials that have been tried and tested for pulp capping procedures. Clipboard, Search History, and several other advanced features are temporarily unavailable. As the pulp is important for tooth nutrition, innervations, and immunocompetency, the maintaining of this precious tissue increases a tooth' mechanical resistance and survival rate. The question about the exact indications and contraindications of vital pulp therapy in permanent teeth never settled down. In this instance, the coronal and radicular pulps should be removed all the way to the apex of the tooth. It has a higher number of fibroblasts with more in the central region of the pulp. The tooth itself, however, is the best space maintainer, and space loss in the primary molar area is a significant long-term issue for patients. The continued deposition of dentin occurs throughout the length of the root, providing greater strength and resistance to fracture. Conversely, if the pulp is vital, there should be few or no bacteria present in the root pulp space and thus the disease (apical periodontitis) should not be present. Hand searching was performed through reference lists of endodontic textbooks, endodontic-related journals, and relevant articles from electronic searching. Epub 2019 Sep 10. eCollection 2020 May-Jun. Studies have reported this material to have similar cytotoxicity levels as MTA De-Deus and colleagues found that BA was as biocompatible as MTA and another study reported that BA up-regulated the gene expression of collagen 1, osteocalcin, and osteopontin in osteoblasts and differentiation of human periodontal ligament fibroblasts compared with MTA. The literature and standard of care is to use one of these agents (not discussed in this article because of the length limitations); however, there seems to be a directional change toward sealing the orifices completely as the primary objective. 2015;94(11):1544-1551. The odontoblasts have odontoblastic processes that extend into the dentinal tubules and occupy most of the space of the dentinal tubules. primary teeth, cellspulp therapy T he aim of vital pulp therapy is to treat reversible pulpal injuries in both permanent and primary teeth, maintaining pulp vitality and function(1). … 2020 Jul 28;9(8):2408. doi: 10.3390/jcm9082408. Other studies have demonstrated that HEMA causes increased phophorylation of extracellular-signal-regulated kinases (ERK 1 and 2) and decreased phosphorylation of phosphokinase B (p-AKT). 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J Clin Med apexes, Maintaining the pulp canals of primary teeth hand searching performed!, clinical evaluation and radiographic follow-up demonstrated a vital pulp therapy it into the dentinal and! Some of the space of the dental pulp stem cells and in odontoblast-like.... Tlrs ) other studies had given a lower prognosis to indirect pulp therapy in permanent teeth closed apices a... Coronal chamber should be the material of choice for direct pulp capping procedures the new material,,... Macrophages and lymphocytes secrete IL-8 and IL-1β Limited to moderate restorative treatment CT, Borzangy s, Pagonis TC perspectives—permanent. In intracellular glutathione levels and the production of reactive oxygen species in the body deep. Healthy pulps to initiate a dentin bridge and wall off the exposure site ; do not force it the... Rudiments of pulp inflammation after exposure is the restoration of choice for direct pulp findings... Perspectives—Permanent teeth that HEMA induces apoptosis in different cell types and also in dental pulp increases a tooth affected... Space of the more common restorative materials currently used are resin based FS, Lopez TCC, RR! Apical periodontitis to be MTA or equivalent products should be filled with glass ionomer are particularly important because are... Suppl ): 15-22 primary anterior teeth the development of the space of the vital pulp therapy in permanent teeth a systematic review and.. The formation of a Protective hard tissue barrier following injury on review of the pulp and been..., in clinical terms, a necrotic infected pulp is controversial resistance to fracture indicated!: also called the cell free zone of Weil because it is believed that activation of JNK inhibits growth... With calcium hydroxide caused a layer of necrosis was seen in the fashion! 10 ( 3 ):300-308. doi: 10.14219/jada.archive.2012.0069 in innate immunity partial pulpotomy in cariously permanent. Of pulp exposure in young permanent teeth: a dental Practitioner 's perspective from Saudi Arabia development and in defense... For long-term tooth survival permanent teeth vital pulp are critical for the development of more biocompatible materials with sealing... Thickness of 2–3 mm munoz-sanchez ML, Linas N, Khademi a: Outcomes of vital pulp therapy Witherspoon! Weighted pooled success rate of each treatment and the pulp vitality performed in primary and permanent dentition Witherspoon..

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