ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title The Clinical Results Of Indirect Pulp Capping On Cariously Exposed Pulp
Clinical Question Does indirect pulp capping of a carious exposure lead to pulpal disease?
Clinical Bottom Line Indirect pulp capping is clinically successful and should be considered as an alternative pulp therapy procedure in deep carious lesions. (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) 18519994Thompson/2008Patients with partial versus complete removal of carious lesionsSystemic Review
Key resultsThe results of three randomized controlled trials, one of which followed up patients for 10 years, provide strong evidence for the advisability of leaving behind infected dentin, the removal of which would put the pulp at risk of exposure. Several additional studies have demonstrated that cariogenic bacteria, once isolated from their source of nutrition by a restoration of sufficient integrity, either die or remain dormant and thus pose no risk to the health of the dentition.
#2) 16856019Ricketts/2006Patients with either minimal or complete removal of decaySystemic Review
Key resultsPartial caries removal in symptomless, primary or permanent teeth reduces the risk of pulp exposure. We found no detriment to the patient in terms of pulpal symptoms in this procedure and no reported premature loss or deterioration of the restoration. The results of this systematic review reject the null hypothesis of no difference in the incidence of damage or disease of the nerve of the tooth (pulp) irrespective of whether the removal of decay had been minimal (ultraconservative) or complete and accept the null hypothesis of no difference in the progression of decay and longevity of restorations.
#3) 12627699Al-Zayer/2003132 patients with 187 primary posterior teeth treated with an IPTRetrospective Records Review
Key resultsThe success of IPT was 95% (178/187 teeth), with only 9 failures. The 1-year probability of survival of each tooth was estimated to be 96% using an exponential survival model. The use of a base over a calcium hydroxide liner significantly increased the success rate of IPT (P = .0095).
Evidence Search Limits: Systematic Reviews, Search dental pulp Limits: Systematic Reviews, Search dental therapy Limits: Systematic Reviews, Search dental caries Limits: Systematic Reviews
Comments on
The Evidence
The evidence is valid when it comes to the success rates of indirect pulp capping to prevent pulp exposure. The strength of the evidence is that both were systemic reviews using 5 databases that were narrowed down to the relevant topic of leaving partial caries near the pulp to see if there will be any pulpal damage. What also made these studies strong is that randomized controlled studies were involved. One in which followed patients up to 10 years and later tested to see if the partial caries left behind is still asymptomatic. That gives it strength to the evidence. Furthermore, the weakness of the studies is there is insufficient evidence to know whether it is necessary to re-enter and excavate the caries further.
Applicability From the gathered data, the evidence presented is applicable to a dentist when determining whether a procedure should be an indirect or direct pulp treatment of cariously involved tooth/teeth.
Specialty/Discipline (Endodontics) (General Dentistry) (Pediatric Dentistry)
Keywords Dental caries, dental pulp, dental therapy
ID# 565
Date of submission: 04/05/2010spacer
E-mail dinhn@livemail.uthscsa.edu
Author Nina Dinh
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author James B. Summit, DDS, MS
Faculty mentor/Co-author e-mail SUMMITT@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?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Daniel Eaddy, Maya Garcia, Azin Za (San Antonio, TX) on 01/07/2013
The evidence referenced in the original CAT remains the strongest published. A retrospective study published in 2010 (Gruythuysen PMID: 20728715 ) supports the finding in the CAT that indirect pulp capping is an effective therapy for maintaining pulpal vitality.
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