Failures and successes of vital pulp therapy in an undergraduate dental clinic.

Abstract

Vital pulp therapy (VPT) has been the principal treatment option used to preserve pulp function during apical development of immature permanent teeth affected by caries and trauma. Advances in VPT protocols and bioactive materials have made this approach a possible treatment option for mature permanent teeth. This article presents a clinical VPT protocol for mature permanent teeth and compares 2 failed cases and 2 successful cases completed in the general dentistry clinic of a dental school. The objective is to allow general dentists to be more comfortable with providing VPT procedures as a treatment option. Four men underwent VPT in mature permanent teeth using established treatment protocols. In 2 treatments that failed, avascular pulp tissue removal was incomplete and/or inferior capping materials were used. In 2 treatments that were successful, all adversely affected pulp tissue was removed, and calcium silicate cements were used. The outcome differences in these cases support the application of advanced dental biomaterials and techniques to maintain pulpal vitality. Advanced VPT is more comprehensive than previous techniques, as it focuses on the removal of affected pulp tissue and the use of biomaterials to promote mineralized, hard tissue barriers. An accurate diagnosis, removal of inflamed necrotic/avascular pulp tissue, examination of the pulp tissue condition using magnification, and placement of calcium silicate cement directly on the exposed pulp tissue are critical to success.