AVA Conference Perth 2019

Direct pulp capping following partial pulpotomy has been an accepted practice for preserving the vitality of the pulp in complicated fractures of immature permanent teeth (under 11-18 months of age) and in the treatment of malocclusion. It is also the first aid procedure in post-traumatic situation which allows to postpone the definite treatment after releasing of acute problems. The objective of vital pulp therapy is to create a bacteria-tight seal over non-inflamed, healthy pulp that provides long term protection. There should be production of a tertiary dentinal bridge made of randomly oriented dentin covering the pulpal exposure. However, this dentin bridge formation is now known to be generally insufficient to protect the pulp for the life of the patient as tunnels penetrate the reparative dentin, therefore coronal seal is critical. The tooth should also continue to produce secondary dentin. As vital pulp therapy is often performed on immature teeth with incomplete apices, normal apex formation (apexogenesis) should continue if this procedure is successful. Regardless of the presentation, lifelong monitoring of the tooth should be performed to ensure continuous pulpal protection and tooth vitality. At present, the most common medicant used for vital pulp therapy is mineral trioxide aggregate (MTA)