Materials used in VPT
Among the materials described for use in pulp therapy procedures, calcium hydroxide-based cements and bioceramics10 have been mentioned. The latter are biocompatible materials that are divided into three basic groups:
- high-resistance bio-inert cements;
- bioactive cements that create chemical bonds with mineralised tissue; and
- biodegradable materials that are actively involved in metabolic processes of the organism.13
There are many materials that can be used for VPT procedures, the best known being mineral trioxide aggregate (MTA) and the latest-generation calcium silicate-based cements, such as EndoSequence BC RRM, Biodentine and CeraPutty. All these materials belong to the bioactive cements group.
The new generation of calcium silicate-based materials with a putty consistency share the following properties with MTA: creation of alkaline pH in the area where they are placed, biocompatibility, antibacterial capacity, release of calcium and hydroxyl ions, good margin sealing properties and insolubility in oral fluids. One of the most appreciated advantages of these materials, such as the one used in this case, is that they do not alter the colour of the tooth structure.14–18 This last property makes them the materials of choice when it is necessary to perform treatments that involve the coronal and cervical zones, such as performing pulp capping, especially in anterior teeth.
Prognosis
Establishing the right diagnosis is essential for the success of VPT. An ideal scenario is one in which the tooth to be treated is diagnosed with reversible pulpitis.6 It is generally accepted that a history of spontaneous pain or nocturnal pain is associated with irreversible pulp inflammation.19, 20 In such cases, the success of direct pulp capping is in doubt,21 although some studies indicate that VPT can even be successful in such a situation.1, 22–24
For long-term success in VPT procedures, it is extremely important to give the tooth a definitive restoration that guarantees suitable margin sealing, because this factor, together with the absence of bacterial contamination during the procedure, is among the most important aspects to be taken into account to avoid pulp inflammation developing later.25, 26 The reported success rate for VPT using bioactive cements after a follow-up of up to ten years is higher than 85%,3, 27 a good percentage for a dental procedure over that length of time.
Conclusion
From a completely optimistic standpoint, the ultimate aim of any dentist when carrying out a restorative or endodontic procedure should be to maintain pulp vitality and functionality of the tooth with an absence of symptoms.28 Based on the results reported in a number of clinical research studies,1–5, 17, 18, 25, 29–31 we can conclude that VPT of teeth with reversible pulpitis is a highly effective treatment option for maintaining pulp vitality.
To post a reply please login or register