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Title Direct versus indirect pulp capping in maintaining pulp vitality
Clinical Question In an asymptomatic, permanent vital tooth with extensive caries, is performing a direct or indirect pulp cap more effective at maintaining tooth vitality?
Clinical Bottom Line Because there is no evidence proving that direct is better than indirect, or vice versa, currently accepted conventional practice should be employed. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17443547Miyashita/2007979 patients with asymptomatic vital permanent teeth with extensive caries.Systematic Review
Key resultsThe findings from this review do not suggest that there should be any significant change from accepted conventional practice procedures when the pulp of the carious tooth is considered. Materials used in capping treatment includes: Ledermix, glycerrhetinic acid/antibiotic mix, zinc oxide eugenol, calcium hydroxide, Cavitec, Life, Dycal, potassium nitrate, dimethyl isosorbide, and polycarboxylate cement.
Evidence Search "Dental Pulp"[Mesh] AND "Dental Caries"[Mesh] ...view in PubMed
Comments on
The Evidence
There were limited articles that compared direct to indirect pulp capping. I also searched under the Mesh term “Dental Pulp Capping” and could not find any articles that compared these two treatments. The Cochrane review in this CAT only included four RCTs and recognized the small number of studies as a limitation to its conclusion. This study did not consider stepwise excavation treatment.
Applicability Vital permanent teeth with extensive caries.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords Direct pulp capping, indirect pulp capping, pulp vitality, dental caries, dental pulp
ID# 553
Date of submission: 03/30/2010spacer
E-mail riggsc@livemail.uthscsa.edu
Author Chad Riggs
Co-author(s) e-mail
Faculty mentor/Co-author Joseph Bartoloni, DDS
Faculty mentor/Co-author e-mail Bartoloni@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
Comments and Evidence-Based Updates on the CAT
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by Rachel Lowery (San Antonio, TX) on 04/19/2012
I completed a PubMed search on this topic on April 19, 2012. The publication listed in this CAT is still current, the most recent, and the highest level of evidence available at this time.

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