Vital Pulp Therapy: Indirect Pulp Capping
An indirect pulp cap should be used to avoid mechanical exposures during caries excavation. Before performing an indirect 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 an indirect pulp cap during caries excavation.
- Place rubber dam isolation (if not already placed).
- Remove unsupported enamel.
- With large round bur on slowspeed handpiece, remove all caries from DEJ.
- Establish an area approximately 2mm wide of solid, clean dentin at DEJ.
- Remove necrotic dentin from the pulpal floor using a cotton pellet soaked in Sodium Hypochlorite or Chlorhexidine (if necessary, a spoon excavator can be used very lightly).
- Seal with Vitrebond -- be sure to avoid placing Vitrebond near the cavosurface margin(s).
- 1 scoop powder for 1 drop of liquid, mix on mixing pad
- Available on cart
- Restore with permanent restoration.
- Inform patient of situation and advise patient to return if any symptoms arise.
- Reevaluate in 6-12 months.
- Document history of symptoms
- Perform vitality testing
- Take new PA radiograph to monitor for periapical changes