Management of deep caries and the exposed pulp

International Endodontic Journal - Tập 52 Số 7 - Trang 949-973 - 2019
Lars Bjørndal1, Stéphane Simon2,2,3, Phillip Tomson4, Henry F. Duncan5
1Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
2Laboratoire IN SERM UMR 1138 Paris France
3Paris Diderot University, Paris, France
4School of Dentistry, Institute of Clinical Sciences, Birmingham, UK
5Division of Restorative Dentistry & Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland

Tóm tắt

AbstractCaries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one‐visit as indirect pulp treatment or two‐visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re‐emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp–dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence‐based management strategies and education in management of the exposed pulp are critical in the future.

Từ khóa


Tài liệu tham khảo

10.1016/j.joen.2010.12.004

10.1007/s10266-010-0127-2

Asgary S, 2017, Long‐term outcomes of pulpotomy in permanent teeth with irreversible pulpitis: a multi‐center randomized controlled trial, American Journal of Dentistry, 30, 151

10.1590/0103-6440201302168

10.1038/sj.bdj.2017.672

10.1097/00004770-200009000-00010

10.1159/000403169

Bègue‐Kirn C, 1992, Effects of dentine proteins, transforming growth factor beta 1 (TGF beta 1) and bone morphogenetic protein 2 (BMP2) on the differentiation of odontoblast in vitro, International Journal of Developmental Biology, 36, 491

10.1177/10454411000110040501

10.1111/j.1600-0714.1982.tb00188.x

10.2105/AJPH.2014.301869

Bjørndal L, 2018, Textbook of Endodontology, 61

10.1016/j.joen.2014.01.016

10.1111/j.1365-2591.2004.00904.x

Bjørndal L, 2016, The Dental Pulp ‐ Biology, Pathology and Regenerative Therapies, 125

10.1111/j.1600-0528.1998.tb01938.x

10.1159/000262431

10.1159/000016431

10.1111/j.1365-2591.2006.01149.x

10.1111/j.1600-0722.2010.00731.x

10.1177/0022034517702620

10.14219/jada.archive.2008.0160

10.1177/00220345650440050701

10.1016/j.joen.2017.06.031

10.1002/cne.901910307

10.1038/sj.bdj.2018.864

Casagrande L, 2010, Indirect pulp treatment in primary teeth: 4‐year results, American Journal of Dentistry, 23, 34

10.1016/S0003-9969(96)00115-X

10.1128/JCM.43.2.843-849.2005

Cooper PR, 2016, The Dental Pulp‐ Biology, Pathology and Regeneration, 97

10.1016/j.jdent.2010.05.016

10.1177/0022034513495874

10.1111/j.1600-0714.1985.tb00479.x

Cox CF, 1996, Tunnel defects in dentine bridges: their formation following direct pulp capping, Operative Dentistry, 21, 4

Cox CF, 1998, Biocompatibility of primer, adhesive and resin composite systems on non‐exposed and exposed pulps of non‐human primate teeth, American Journal of Dentistry, 11, S55

10.1016/S0099-2399(83)80005-3

10.1111/j.1365-2591.1980.tb00834.x

10.1016/j.yexcr.2013.02.022

10.1111/iej.12588

10.1159/000262119

Elderton RJ, 1993, Overtreatment with restorative dentistry: when to intervene?, International Dental Journal, 43, 17

10.1111/iej.12030

10.1111/j.1365-2591.2006.01180.x

10.1002/jez.b.21259

10.1155/2015/230251

10.1016/j.joen.2017.03.012

10.1073/pnas.1015449108

Ferracane JL, 2013, Dentin matrix component solubilization by solutions of pH relevant to self‐etching dental adhesives, Journal of Adhesive Dentistry, 15, 407

10.1002/jbmr.5650050708

10.1016/0003-9969(90)90093-P

10.1159/000357628

10.1016/j.joen.2012.05.016

Fuks AB, 1982, Clinical and radiographic assessment of direct pulp capping and pulpotomy in young permanent teeth, Pediatric Dentistry, 4, 240

10.1016/j.joen.2014.11.021

10.1111/iej.12492

10.1111/iej.12606

10.1016/0030-4220(73)90101-1

10.1089/scd.2014.0117

10.1177/00220345490280021101

10.1093/aje/kwj069

10.1177/154411130401500103

10.1016/j.biomaterials.2005.12.020

10.1016/j.joen.2007.01.003

10.1177/154405910208100806

10.1016/j.joen.2006.11.008

10.1177/0022034515571415

10.4103/0972-0707.212243

Hewlett ER, 2003, Clinical considerations in adhesive restorative dentistry‐influence of adjunctive procedures, Journal of the California Dental Association, 31, 477, 10.1080/19424396.2003.12224192

10.1177/0022034513484336

10.3109/03008207.2014.923855

10.1177/00220345940730031301

10.1177/0022034516639276

10.1038/sj.bdj.2017.273

10.1016/j.joen.2015.03.015

10.1016/j.joen.2017.06.007

10.1046/j.1365-2591.2001.00341.x

10.1111/odi.12348

10.1016/j.joen.2007.10.022

10.1177/0022034515573272

Kerkhove BC, 1967, A clinical and television densitometric evaluation of the indirect pulp capping technique, Journal of Dentistry for Children, 34, 192

10.1067/moe.2001.113831

10.1177/154405910408301s07

10.4012/dmj.2016-283

10.1155/2015/385127

10.1016/j.tripleo.2009.12.034

10.1111/iej.12719

10.1016/j.jdent.2015.06.010

10.1111/j.1365-2591.2011.01995.x

Lesot H, 1994, Biologically active molecules and dental tissue repair: a comparative review of reactionary and reparative dentinogenesis with the induction of odontoblast differentiation in vitro, Cell Materials, 4, 199

10.1016/j.jdent.2014.07.007

10.1177/0022034515602879

10.1290/0502014.1

10.1128/MMBR.50.4.353-380.1986

10.1111/iej.12511

10.1177/0022034512460403

10.1080/00016357.2018.1447684

10.1089/ten.tea.2015.0311

10.1016/j.joen.2015.02.024

10.1177/08959374940080022001

10.1099/mic.0.26082-0

10.1038/sj.bdj.2012.524

10.1016/j.joen.2013.07.026

Massler M, 1978, Treatment of profound caries to prevent pulpal damage, Journal of Pedodontics, 2, 99

10.1177/0022034514562833

10.1016/S0003-9969(03)00003-7

10.1111/j.1365-2591.2012.02016.x

10.1016/j.joen.2010.02.024

10.1016/0030-4220(72)90278-2

10.1016/0030-4220(74)90322-3

10.1046/j.0143-2885.2003.00609.x

10.1128/JCM.42.11.5238-5244.2004

10.1111/j.1365-2591.2007.01329.x

10.1097/01.don.0000143414.22112.57

Nyborg H, 1955, Healing processes in the pulp on capping; a morphologic study; experiments on surgical lesions of the pulp in dog and man, Acta Odontologica Scandinavica, 13, 1

10.1159/000261281

10.1159/000345367

Oen KT, 2007, Attitudes and expectations of treating deep caries: a PEARL Network survey, General Dentistry, 55, 197

10.1038/s41598-018-29112-3

Pameijer CH, 1998, The disastrous effects of the “total etch” technique in vital pulp capping in primates, American Journal of Dentistry, 11, S45

10.1016/S0003-9969(97)00090-3

10.1016/j.joen.2017.10.012

10.1111/iej.12841

10.1177/10454411960070020101

10.1111/j.1875-595X.2008.tb00185.x

10.1016/0030-4220(91)90311-Y

10.14219/jada.archive.1996.0058

10.1259/dmfr.25.1.9084279

10.1111/iej.12614

10.3109/00016358609004733

10.1016/j.cyto.2014.05.014

10.1371/journal.pone.0167289

10.1016/0030-4220(66)90143-5

10.1177/0022034515612086

Ricketts D, 2013, Operative caries management in adults and children, Cochrane Database Systematic Reviews, CD003808

10.1016/j.jdent.2014.06.012

10.1016/j.joen.2014.08.010

10.1016/S0003-9969(00)00075-3

10.1177/00220345000790021201

10.1016/j.jdent.2008.12.002

Schröder U, 1972, Evaluation of healing following experimental pulpotomy of intact human teeth and capping with calcium hydroxide, Odontologisk Revy, 23, 329

Schröder U, 1973, Effect of an extra‐pulpal blood clot on healing following an experimental pulpotomy and capping with calcium hydroxide, Odontologisk Revy, 24, 257

10.1177/002203458506400407

Schröder U, 1972, Scanning electron microscopy of hard tissue barrier following experimental pulpotomy of intact human teeth and capping with calcium hydroxide, Odontologisk Revy, 23, 211

10.1016/j.joen.2014.07.028

10.1007/s00784-016-1802-7

10.1177/0022034516639271

10.1007/s00784-016-1776-5

10.1016/0030-4220(63)90323-2

10.1016/0030-4220(63)90201-9

10.1111/cdoe.12310

10.1016/j.tripleo.2011.04.026

10.1038/sj.bdj.2014.243

10.1016/j.bone.2009.06.018

10.1111/j.1365-2591.2012.02113.x

10.1046/j.1365-2591.2002.00564.x

10.1159/000063930

10.1002/j.0022-0337.2003.67.6.tb03668.x

10.1016/0003-9969(94)90029-9

Smith AJ, 1995, Reactionary dentinogenesis, International Journal of Developmental Biology, 39, 273

10.1016/j.yexcr.2012.07.008

10.1016/j.joen.2015.10.019

10.1177/0022034509341946

10.1159/000016628

10.1016/j.joen.2014.09.005

10.3109/00016357.2013.775338

10.1007/s00784-016-2023-9

10.1016/0030-4220(89)90252-1

10.1016/0030-4220(72)90300-3

10.14219/jada.archive.1975.0455

Swedish Council on Health Technology Assessment(2010)Methods of diagnosis and treatment in endodontics: a systematic review. Assessment No. 203. [WWW document] URLhttps://www.sbu.se/contentassets/eafcce68f3aa438cb932c76702cde403/methods-of-diagnosis-and-treatment-in-endodontics_full.pdf

10.1016/j.joen.2017.03.033

10.1111/iej.12605

10.1016/j.jdent.2013.11.026

10.1016/j.jdent.2007.04.008

10.1016/j.cyto.2012.11.009

10.1111/iej.12624

10.1016/0030-4220(74)90348-X

Tuzuner T, 2012, Clinical and radiographic outcomes of direct pulp capping therapy in primary molar teeth following haemostasis with various antiseptics: a randomised controlled trial, European Journal of Paediatric Dentistry, 13, 289

10.1111/j.1600-9657.1986.tb00158.x

WheltonH CrowleyE O'MullaneDet al. (2007)Oral health of Irish adults 2000 – 2002. Irish Department of Health and Children [WWW document]https://health.gov.ie/wp-content/uploads/2014/03/oral_health02.pdf

10.1111/j.1365-2591.2005.00962.x

10.1007/s00784-016-1824-1

10.14219/jada.archive.1977.0194

10.1111/iej.12793

World Health Organization, 2017, Sugars and Decay

10.1111/iej.12940

10.1016/j.joen.2012.04.018

10.1016/j.joen.2017.02.009

10.1016/j.joen.2010.10.003

10.1016/j.joen.2010.08.042

Thông tin
Thông tin xuất bản

International Endodontic Journal

Tập 52 Số 7

949-973

Thông tin tác giả