Vital Pulp Therapy: Direct Pulp Capping
A direct pulp cap should be used to treat small (1mm or less) mechanical exposures during caries excavation. Before performing a direct pulp cap, it is important that the pulp vitality is established. The tooth should:
- not have a history of spontaneous pain
- should test vital to cold test and/or EPT
- the PA should not show any periapical pathology
- the tooth should be restorable
If the tooth fits the criteria listed above, you can proceed with performing a direct pulp cap.
- Place rubber dam isolation (if not already placed).
- Control hemorrhage by applying pressure to exposure with cotton pellet.
- If bleeding does not stop with pressure alone, soak cotton pellet with saline or dilute sodium hypochlorite (found on cart or on endo cart).
- Place MTA.
- Seal with Vitrebond.
- Restore with permanent restoration.
- Inform patient of situation and advise patient to return if any symptoms of irreversible pulpitis arise.
- Reevaluate in 6 months.
- Document history of symptoms
- Perform vitality testing
- Take new PA radiograph to monitor for periapical changes