Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions

Publication Date: October 1, 2017
Last Updated: March 14, 2022

Recommendations

In vital primary teeth with deep caries lesions requiring pulp therapy, is one particular therapy (IPT, DPC, pulpotomy) more successful than others?

The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions.
611

Panel noted the high success rates among IPT, DPC, and pulpotomy and recommends that the choice of pulp therapy in vital primary teeth with deep caries lesions should be based on a biologic approach.

611

In vital primary teeth treated with indirect pulp treatment (IPT) due to deep caries lesions, does the choice of medicament affect success?

The panel found that the success of IPT in vital primary teeth with deep caries lesions is independent of the type of medicament used, and therefore conditionally recommends that clinicians choose the medicament based on individual preferences.
  • Follow-up duration: 24 months
(ModerateConditional (weak))
611
  • Follow-up duration: 48 months
(LowConditional (weak))
611

In vital primary teeth with deep caries lesions treated with DPC due to pulp exposure (one mm or less) encountered during carious dentin removal, does the choice of medicament affect success?

The panel found that in vital primary teeth with deep caries lesions treated with DPC due to pulp exposure (one mm or less) encountered during carious dentin removal, the success of DPC is independent of the type of medicament used, and therefore conditionally recommends that clinicians choose the medicament based on individual preferences.
Follow-up duration: 24 months
611

In vital primary teeth with deep caries lesions treated with pulpotomy due to pulp exposure during caries removal, does the choice of medicament or technique affect success?

The panel strongly recommends the use of MTA in vital primary teeth with deep caries lesions treated with pulpotomy due to pulp exposure during carious dentin removal. (ModerateStrong)
Follow-up duration: 24 months
611
The panel strongly recommends the use of formocresol in vital primary teeth with deep caries lesions treated with pulpotomy due to pulp exposure during carious dentin removal. (ModerateStrong)
Follow-up duration: 24 months
611
The panel conditionally recommends the use of ferric sulfate in vital primary teeth with deep caries lesions treated with pulpotomy due to pulp exposure during carious dentin removal. (LowConditional (weak))
Follow-up duration: 24 months
611
The panel conditionally recommends against the use of calcium hydroxide in vital primary teeth with deep caries lesions treated with pulpotomy due to pulp exposure during carious dentin removal. (LowConditional (weak))
Follow-up duration: 24 months
611
The panel conditionally recommends the use of lasers in vital primary teeth with deep caries lesions treated with pulpotomy due to pulp exposure during carious dentin removal. (LowConditional (weak))
Follow-up duration: 18 months
611
The panel conditionally recommends the use of sodium hypochlorite in vital primary teeth with deep caries lesions treated with pulpotomy due to pulp exposure during carious dentin removal. (Very LowConditional (weak))
Follow-up duration: 18 months
611
The panel conditionally recommends the use of tricalcium silicate in vital primary teeth with deep caries lesions treated with pulpotomy due to pulp exposure during carious denitn removal. (Very LowConditional (weak))
Follow-up duration: 12 months
611

Recommendation Grading

Overview

Title

Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions

Authoring Organization

American Academy of Pediatric Dentistry

Publication Month/Year

October 1, 2017

Last Updated Month/Year

January 17, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

For the purpose of this guideline, various interventions for vital pulp therapy were evaluated, including indirect pulp treatment using calcium hydroxide and alternates such as bonding agents/liners; direct pulp cap using calcium hydroxide and alternates such as bonding agents, mineral trioxide aggregate (MTA),or formocresol; and pulpotomies using formocresol, MTA, ferric sulfate (FS), sodium hypochlorite (NaOCl), lasers, calcium hydroxide, or tricalcium silicate. In addition to the reported adverse events, the evidence on outcome moderators such as type of final restorations and use of rubber dam was reviewed for this guideline.

Target Patient Population

Children with deep caries lesions

Inclusion Criteria

Female, Male, Adolescent, Child

Health Care Settings

Childcare center, Outpatient

Intended Users

Dentist, dental other, dentist pediatric dentistry, nurse, nurse practitioner, physician, physician assistant

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D010372 - Pediatrics, D005566 - Formocresols, D003782 - Dental Pulp, D003785 - Dental Pulp Capping, D003149 - Community Dentistry, D003813 - Dentistry, D010377 - Pediatric Dentistry

Keywords

dental procedure, pediatrics, pulp therapy

Source Citation

PEDIATRIC DENTISTRY V 39 / NO 5 SEP / OCT 17