Pulp Horn Capping with MTA

[Jlm50]

If a PT has an exposed pulp horn exposed during a prep and its capped with MTA, a sealant placed over it, and a composite restoration - is it normal for the PT to have a general toothache the day of the procedure? Or is this indication that the MTA will not be successful and a root canal is needed? Or how much time should it take for the PT to be ache free?

 

[cooliyak]

Completely depends on the situation. What was the pulpal status prior to the procedure? Was it purely mechanical or did caries extend into the pulp? How big was the exposure? Were you able to control the bleeding?
Generally speaking (but not ideally), sensitivity or aches following a restoration, even without a pulpal exposure, is normal up to a point. With an exposure, you usually have to be more cautious with symptoms and follow up vitality testing will be needed periodically. You probably won’t be able to tell for sure how successful the pulp capping is for a few more days or a week to two. Even then, it can take a turn for the worst at any point and need a RCT.

 

[TanMan]

If a PT has an exposed pulp horn exposed during a prep and its capped with MTA, a sealant placed over it, and a composite restoration - is it normal for the PT to have a general toothache the day of the procedure? Or is this indication that the MTA will not be successful and a root canal is needed? Or how much time should it take for the PT to be ache free?

Post-op sensitivity depends a lot on pre-op status. It's usually prudent to tell the patient what they MAY experience. Either nothing, all the way to severe, spontaneous lingering pain. The most important part is not the procedure, but setting up patient expectations before performing the procedure (especially IF the patient is asymptomatic). If the patient has increasing levels of pain as the days go by, more likely a root canal will be needed. If the pain is decreasing, either your pulp is healing or becoming necrotic.

If your bonding protocols are pretty solid, then there should be no pain to biting. Most common symptom is pain to cold after the procedure. Although MTA is the ideal material for a DPC, it's ridiculously expensive and technique sensitive. I'd rather use durelon as the pulp cap.

Everyone reacts differently, but the main factor depends on whether the pulp was hyperemic upon exposure. If it's hyperemic, just do the endo. Second is age . Open apices/young patients tolerate direct pulp caps better than closed apices/adults.