Indirect+Pulp+Cap+(Vital+Pulp+Therapy)

Vital Pulp Therapy Protocol for treating teeth with deep caries:

Obtain accurate pulpal diagnosis

 * 1) Cold test
 * 2) Percussion/palpation
 * 3) EPT

If the pulp tests **normal** or **reversible**, the goal is to **NOT** expose the pulp.
1) Obtain profound anesthesia (do NOT do a PDL injection). 2) Achieve good isolation (keeping area bacteria free very important). 3) Remove unsupported enamel. 4) With a large (#6) round bur on slow speed, remove ALL decay from DEJ. Establish an area approx. 2mm wide of solid, clean dentin at the DEJ. 5) Remove necrotic dentin with cotton pellets soaked in NaOCl. Remove only very soft dentin with a light touch and spoon excavator if necessary. 6) Place vitrebond or Fuji IX over pulpal floor. 7) Restore with either composite or amalgam. 8) Advise patient that in the event that they should feel any lingering, spontaneous, or cold pain they should return for reevaluation. Should also retest pulp vitality in 6-12 months.

Important Guidelines
The goal is to not go in for a second procedure (step wise excavation) as research indicates that this is unnecessary.

*Most important factor is to create a complete seal to prevent any further contamination of the dentin.


 * Do not place calcium hydroxide (dycal) between glass ionomer and dentin.**


 * The tooth should be retested at 6-12 months to ensure vitality has been maintained.**


 * Pt should be advised that if any symptoms arise (spontaneous pain, lingering pain to hot or cold, pain to biting) that they should return for reevaluation.**

*If pulp exposure occurs, recommended treatment is root canal therapy or extraction.(unless the root exposure happens during a procedure that did not involve decay initially, such as a crown preparation.)

courtesy of Dr. Thomason