Vital Pulp Therapy with New Materials: New Directions and Treatment Perspectives - Permanent Teeth

Resident: Roberts

Date: 10/20/10

Article title: Vital Pulp Therapy with New Materials: New Directions and Treatment Perspectives - Permanent Teeth

Author: Witherspoon, David

Journal: Pediatric Dentistry

Volume: 30:3 pages: 220 - 224

Discussion:

The basic principle of vital pulpal treatment an be broken down in to two phases. The initial phase involves removing the diseased and bacterially contaminated tissue. The second phase involves establishing an environment that will prevent any further and future bacterial contamination. Calcium Hydroxide has been advocated as the material of choice for various forms of vital pulp therapy, but recently MTA has received a lot of attention as a potential replacement because of its ability to kill bacteria, induce mineralization and establish a tight bacterial seal.

MTA is composed of tricalicum silicate, bismuth oxide, dicalcium silicate, tricalcium aluminate, calcium sulfate and may contain other trace particles. It has a compressive strength equal to that of IRM and has been shown to have antibacterial effects on facultative but not anaerobic bacteria. Its ability to prevent long term leakage appears to be high and better than amalgam or IRM.

Compared with Calcium hydroxide, in animal studies, MTA consistently induces the dentin at a greater rate with superior structural integrity. There seems to be a greater effect of dentinal bridging, minimal effect on pulpal inflammation, and nominal hyperemia. The process by which this happens is not fully understood but it has been suggested that the tricalcium oxide reacts with the tissue fluids to form calcium hydroxide and works in a similar way as does strait calcium oxide.

Various studies have shown that the potential for success is higher than that of Ca. hydroxide. In one such study, MTA was assessed as a medicament for direct pulp cap therapy and proved to have a 98% success rate. In another study, where pulpotomies were assessed using MTA as its choice of medicament, it showed a lower percentage of failures than other techniques being applied. In short MTA is a good substitute for calcium hydroxide and would be an acceptable choice for replacement and may be desired where teeth are immature and root development is dependent and pulpal vitality.

Assessment: Good article, resonated with other studies that we have all read and heard about.