CDA Oasis Resource: What is the goal of vital pulp therapy?

The goal of vital pulp therapy is to preserve or regenerate tissues of the pulp-dentine complex of affected teeth and includes: direct and indirect pulp-capping, pulpotomy and more recently, regenerative pulp therapy. Pulp tissue may become compromised due to caries, loss of tooth structure/surface, traumatic injury or operatively as a result of cavity preparation. However, before treating the pulp-dentine complex, practitioners must be able to predict the extent of injury to the pulp tissues and treat it with the most suitable approach for the situation and seal it with a restoration that will prevent microleakage.

After a vital pulp therapy has been performed, the tooth should be re-evaluated between 6-12 weeks and then at 6 and 12 months. The assessment appointment should consist of a history, palpation of soft tissue, percussion tests as well as pulp tests. Radiographs may show pulpal and/or periapical changes. Pulp capped and pulpotomized teeth should be checked for the presence of a calcific bridge, radiographically. These teeth should also be probed directly after removing the dressing – if the bridge formation is incomplete, the treatment is deemed a failure and root canal therapy should be considered.

The outcome of vital pulp therapy is dependent upon:

• Health of the pulp
• Maturity and formation of the apical portion of the root
• Sufficient removal of any infected hard/soft tissues
• Damage to the pulp tissue during operative procedures
• Microleakage of the final restoration

Source: Endodontics, Elsevier 2014