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Caries 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 non-selective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has 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 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. This article is protected by copyright. All rights reserved.
This article was published in the following journal.
Name: International endodontic journal
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Application of a protective agent to an exposed pulp (direct capping) or the remaining thin layer of dentin over a nearly exposed pulp (indirect capping) in order to allow the pulp to recover and maintain its normal vitality and function.
Inflammation of the DENTAL PULP, usually due to bacterial infection in dental caries, tooth fracture, or other conditions causing exposure of the pulp to bacterial invasion. Chemical irritants, thermal factors, hyperemic changes, and other factors may also cause pulpitis.
A dental specialty concerned with the maintenance of the dental pulp in a state of health and the treatment of the pulp cavity (pulp chamber and pulp canal).
Death of pulp tissue with or without bacterial invasion. When the necrosis is due to ischemia with superimposed bacterial infection, it is referred to as pulp gangrene. When the necrosis is non-bacterial in origin, it is called pulp mummification.
Deep grooves or clefts in the surface of teeth equivalent to class 1 cavities in Black's classification of dental caries.
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A biomaterial is defined as a substance that has been engineered to take a form which, alone or as part of a complex system, is used to direct, by control of interactions with components of living systems, the course of any therapeutic or diagnostic proc...