pulp capping and dentin regeneration

Started by eyeballfanatic
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eyeballfanatic

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when a cavity is drilled and a medicated substance is placed, then a filling, can the dentin regenerate if the decay did not reach the pulp yet?
 
A dentin bridge, or reparative dentin, can form. This dentin encroaches on the pulp chamber and thus reduces the pulp chambers size. Which can make future RCT difficult if the restoration fails.
 
SoulPower said:
A dentin bridge, or reparative dentin, can form. This dentin encroaches on the pulp chamber and thus reduces the pulp chambers size. Which can make future RCT difficult if the restoration fails.
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what are the factors or chances that a pulp cap would fail and a RCT is needed? how long would one wait after a pulp cap to determine this?
 
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eyeballfanatic said:
what are the factors or chances that a pulp cap would fail and a RCT is needed? how long would one wait after a pulp cap to determine this?
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did you pulp your 1st tooth?

kidding....anyway, answer...depends. if you had rubber dam on, pinpoint exposure, little to no decay in area of exposure and a good restoration was done then that tooth will likely do just fine.

if you were doing a 2nd molar, deep decay, no rubber dam, and burried a spoon or explorer in pulp chamber (rookie mistake haha) ... well, place your pulp cap, restore and make sure your margins are well sealed. follow your patient and see if they report any pain soon shortly after filling.

now, the only caveat to this situation is if you did not test vitality before restoration was started and just "treated" a non-vital tooth, well, good luck explaining that to your pt.

but to your original question... wait a couple of weeks. if pt reports no symptoms then there is a good chance you're in the clear. but...again, refer to previous paragraph.
 
First of all, dont worry. No one is perfect. You want to think of this from a biological perspective. The repair response depends on the type of injury and the guestimated number of microbes introduced into the wound. You didnt mentiin whether there was a pulpal exposure or not. But you dont necessarily need one for odontoblast injury or death. Assuming it is a reversible injury, you want to initiate tirtiary (sp?) dentin apposition. MTA or Ca(OH)2 works best. But the key is the seal. You dont want any more microbes getting in. A RMGI works ok but there really isnt anything thats perfect. The tooth will tell you how to proceed from there. Trust your instincts...so long as theyre buttressed with a solid dose of the literature. In other words, wait 2 weeks for progressive symptoms. If no symptoms, then you might be ok. If not, then you have your first endo case. Either way youre doing a service for your patient. Good luck.
 
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