Dr. Gordon Christensen answers a reader's question about pulp capping. Two reviewers (D.P. With one-stage indirect pulp capping techniques typically all or most of the caries is removed at the initial appointment, some type of indirect pulp capping material is placed in close approximation to but not in direct contact with the pulp, and the final restoration is placed, all in the same appointment. Pediatr Dent 22:278–286 PubMed, Zurück zum Zitat Coll JA (2008) Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date? Indirect pulp capping in the primary dentition: a four year follow-up study. indication • Large carious lesion • asymptomatic Troth or mild transient symptoms. Pediatr Dent 38:280–288, Zurück zum Zitat Hilton TJ, Summitt JB (2006) Pulpal considerations. 15 Other studies have shown success when glass ionomer … Oper Dent 42:470–477. Int Endod J 45:571–579. Evidenced-based review of clinical studies on indirect pulp … Thus, ferric sulphate can still be a valid and inexpensive solution for pulpotomies in primary teeth. Schwendicke F, Dorfer C, Paris S. Incomplete caries re- pulpotomy medicaments in primary teeth. https://doi.org/10.1007/s00784-007-0152-x PubMedCrossRef, https://doi.org/10.1007/s00784-007-0152-x, Zurück zum Zitat Modena KC, Casas-Apayco LC, Atta MT, Costa CA, Hebling J, Sipert CR, Navarro MF, Santos CF (2009) Cytotoxicity and biocompatibility of direct and indirect pulp capping materials. https://doi.org/10.1177/0022034516639919 PubMedCrossRef, https://doi.org/10.1177/0022034516639919, Zurück zum Zitat Monea M, Stoica A, Monea A (2014) Histological evaluation of indirect pulp capping procedures with calcium hydroxide and mineral trioxide aggregate. • Remove superficial caries. Purpose: Evaluate clinical and radiographic changes in primary teeth submitted to indirect pulp capping (IPC) over a 48-month-period. Romanian J Morphol Embryol 54:1081–1086, Zurück zum Zitat Choung HW, Lee DS, Lee JH, Shon WJ, Lee JH, Ku Y, Park JC (2016) Tertiary dentin formation after indirect pulp capping using protein CPNE7. In patients with uncontrolled caries or extensive loss of coronal structure, in which full coverage is … There is evidence of vital tissue e.g. graphic success of CH capping in primary teeth and reported a. • The most important factor that affects the success of VPT is the vitality of the pulp, and the vascularization which is necessary for the function of odontoblasts. All contra-indications as for the indirect pulp cap. There is no history of spontaneous pain. 230-236(7), Publisher: American Academy of Pediatric Dentistry, Keywords: Therefore, the aim of this study was to evaluate and compare the clinical and radiographical success of calcium sulfate and calcium hydroxide used as a direct pulp-capping material in primary teeth. PULPOTOMY. https://doi.org/10.1016/j.joen.2014.08.010 PubMedCrossRef, https://doi.org/10.1016/j.joen.2014.08.010, Zurück zum Zitat Ricucci D, Loghin S, Niu LN, Tay FR (2018) Changes in the radicular pulp-dentine complex in healthy intact teeth and in response to deep caries or restorations: a histological and histobacteriological study. 2016) reported successful clinical (no pain, absence of sinus tract) and radiographic (no sign of external and internal resorption, presence of calcified bridge) outcomes following the use of MTA and TheraCal LC when used for indirect pulp capping in primary teeth. When dental caries is removed from a tooth, all or most of the infected and softened enamel and dentin are removed. The study included a total of 109 patients aged 5–9 years who had primary teeth with deep carious lesions and symptoms of reversible pulpitis. Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date? Aktuelle, verlässliche Information und Fortbildung für Ärzte im Berufsalltag. J Endod. *. The carious peripheral dentin was removed at the enamel-dentin junction using a high-speed tungsten-carbide bur and the infected and necrotic soft dentin layer in the center was carefully removed to prevent pulp exposure. https://doi.org/10.7860/JCDR/2014/7719.3980 PubMedPubMedCentralCrossRef, https://doi.org/10.7860/JCDR/2014/7719.3980, Zurück zum Zitat Gandolfi MG, Siboni F, Prati C (2012) Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. Marchi JJ, de Araujo FB, Froner AM, et al. (1) a calcium … Defined as a procedure wherein the deepest layer of the remaining affected carious dentin is covered with a layer of biocompatible material in order to prevent pulp exposure and further trauma to the pulp. https://doi.org/10.1016/j.joen.2008.02.033 PubMedCrossRef, https://doi.org/10.1016/j.joen.2008.02.033, Zurück zum Zitat Franzon R, Opdam N, Guimarães L, Demarco F, Casagrande L, Haas A, Araujo F (2015) Randomized controlled clinical trial of the 24-months survival of composite resin restorations after one-step incomplete and complete excavation on primary teeth. In this review, new concepts in preservation of the healthy pulp tissue in deciduous teeth and induction of the reparative dentin … But with the introduction of new biomaterials, there have been numerous reports of improved success rates. If the pulp is too close to becoming exposed, instead of removing all of the tissue, our dentists may instead seal off the decayed material. pulpotomy out of date? An indirect pulp cap procedure is used when bacterial decay has reached near to the pulpal chamber, causing inflammation and threatening the survival of the tooth. Am J Dent 26:196–200 PubMed, Zurück zum Zitat Trairatvorakul C, Sastararuji T (2014) Indirect pulp treatment vs antibiotic sterilization of deep caries in mandibular primary molars. 18-month results. Materials and methods This clinical study was conducted with 40 primary . Depending on the proximity to the dental pulp or nerve, there are two pulp-capping procedure types: 1) direct pulp-capping – dressing is placed directly on the tooth pulp, and 2) indirect pulp-capping –dressing is placed on top of the dentin. https://doi.org/10.3290/j.qi.a29503 PubMedCrossRef, https://doi.org/10.3290/j.qi.a29503, Zurück zum Zitat Nowicka A, Lipski M, Parafiniuk M, Sporniak-Tutak K, Lichota D, Kosierkiewicz A, Kaczmarek W, Buczkowska-Radlinska J (2013) Response of human dental pulp capped with biodentine and mineral trioxide aggregate. The two major procedures used to perform pulp therapy in primary teeth, pulpotomy and pulpectomy, have evolved over the years. Teeth that have a history of trauma or previous restorations or that display pulpal calcification have a poorer prognosis than teeth showing only initial caries. Pulpotomy: removal of coronal pulp, leaving the healthy or reversibly inflamed radicular pulp. 19. This combination of desirable qualities makes MTA “the material of choice” for cases of pulp exposure in both primary teeth and permanent teeth13,14 (Figs. The teeth were randomly divided into two groups, according to the material used for protection of the dentin-pulp complex. J Dent Res 92:306–314. Direct pulp caps are usually used on adult teeth. Int Endod J 52:923–934. However, a shortcoming of these studies was their short‐term follow‐up. Oral Res. Int Dent J 62:33–39. OBJECTIVES: a) preservation of vitality of the radicular pulp. https://doi.org/10.1016/j.joen.2014.06.018 PubMedCrossRef, https://doi.org/10.1016/j.joen.2014.06.018, Zurück zum Zitat Qureshi A, Soujanya E, Nandakumar, Pratapkumar, Sambashivarao (2014) Recent advances in pulp capping materials: an overview. A clinical study on the success rates of indirect pulp capping and pulpotomy in the treatment of deep dentinal caries in primary second molars KB Vidya 1, Shruthi B Patil 2, Rajesh T Anegundi 2 1 Department of Pediatric Dentistry, Farooqia Dental College and Hospital, Farooqia Educational Complex, Eidgah, Mysore, Karnataka, India 2 Department of Pediatric Dentistry, Sri Dharmasthala Manjunatheshwara … … This choice is indirect pulp therapy (IPT), because the direct pulp cap in a primary tooth is contraindicated for carious exposures . indirect pulp treatment in primary teeth, such as calcium hydroxide liner,4,5,6 dentin bonding agents5,7 mineral trioxide aggregate 6, glass ionomer cement,8 zinc oxide/eugenol,9 calcium silicate 10 or medical Portland cement. https://doi.org/10.1074/jbc.M009705200 PubMedCrossRef, https://doi.org/10.1074/jbc.M009705200, Zurück zum Zitat Estrela C, Holland R (2003) Calcium hydroxide: study based on scientific evidences. Eur Sci J 2:315–318, Zurück zum Zitat Trowbridge H (2002) Histology of pulpal inflammation. J Dent 43:1235–1241 PubMedCrossRef, Zurück zum Zitat Vij R, Coll JA, Shelton P, Farooq NS (2004) Caries control and other variables associated with success of primary molar vital pulp therapy. Formocresol pulpotomy (FP) in the United States is most frequently used to treat asymptomatic caries near the pulp in primary teeth. American Journal of Dentistry. 2006;19(6):382–386. To summarize the clinical/radiographic outcomes from the evidence of studies published since 1988 on different DPC agents applied on vital pulp–exposed primary teeth. It is another method than Indirect pulp capping to treat deep caries but it is not a … PULP EXPOSURE; A direct pulp cap is done on permanent teeth when the removal of deep decay results in exposing the pulp. Direct pulp capping after pulp exposures resulting from excavating deep caries has been shown to have low success in permanent teeth [17, 18].In a randomized multicenter study on direct pulp capping or partial pulpotomy with calcium hydroxide involving 58 patients with exposed pulps after caries excavation in permanent teeth, the authors reported a low success rate (31.8 % vs. 34.5 %, respectively) and no … Of course, the success of both direct and indirect pulp-capping procedures is contingent on the health and vitality of the pulp complex to begin with. 3. • deep carious lesions where caries excavation was conservative and direct pulp exposures were avoided • either Ca (OH)2 or zinc oxide–eugenol (ZOE) in a one- or two-stage procedure. J Clin Pediatr Dent 33:131–135 PubMedCrossRef, Zurück zum Zitat Fernandes JM, Massoni AC, Ferreira JM, Menezes VA (2013) Use of calcium hydroxide in deep cavities of primary teeth. Int J Paediatr Dent 24:23–31. Quintessence Int 33:151–9, Zurück zum Zitat American Academy on Pediatric D and American Academy of P (2017) Use of vital pulp therapies in primary teeth with deep caries lesions. Am J Dent 20:189 PubMed, Zurück zum Zitat Menon NP, Varma BR, Janardhanan S, Kumaran P, Xavier AM, Govinda BS (2016) Clinical and radiographic comparison of indirect pulp treatment using light-cured calcium silicate and mineral trioxide aggregate in primary molars: a randomized clinical trial. Indirect pulp capping exhibited high clinical and radiographic success rates in the treatment of primary teeth regardless of the chosen pulp-capping agent. It is published bi-monthly and is internationally recognized as the leading journal in the area of pediatric dentistry. No Reference information available - sign in for access. In: Casamassimo PS, Fields HW Jr, McTigue DJ, Nowak AJ (eds) Pediatric dentistry: infancy through adolescence, 5th edn. b) relief of pain in patients with acute pulpagia. In addition, taking two cone‐beam computed tomography images within 6 … Mit e.Dent erhalten Sie Zugang zu allen zahnmedizinischen Fortbildungen und unseren zahnmedizinischen und ausgesuchten medizinischen Zeitschriften. 2006;19(6):382-386. Pulpotomy is thought to be indicated for primary teeth with carious pulp exposures, but research shows the majority of such teeth are nonvital or questionable for treatment with vital pulp therapy. PURPOSE: To evaluate clinical and radiographic outcomes of indirect pulp treatment (IPT) in primary molars after long-term function (up to 60 months). Seltzer and Benders Dental Pulp Carol Stream: Quintessence:227–45, Zurück zum Zitat Giraud T, Jeanneau C, Bergmann M, Laurent P, About I (2018) Tricalcium silicate capping materials modulate pulp healing and inflammatory activity in vitro. Quintessence Int 44:417–423. https://doi.org/10.1111/iej.13080 PubMedCrossRef, Zurück zum Zitat Innes NP, Frencken JE, Bjorndal L, Maltz M, Manton DJ, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Domejean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona A, Schwendicke F (2016) Managing carious lesions: consensus recommendations on terminology. The non-randomised study found a statistically significant difference in favour of indirect pulp capping for clinical and radiological success at 3 years but with high overall risk of bias. https://doi.org/10.1111/j.1875-595X.2011.00084.x PubMedCrossRef, https://doi.org/10.1111/j.1875-595X.2011.00084.x, Zurück zum Zitat Maltz M, de Oliveira EF, Fontanella V, Bianchi R (2002) A clinical, microbiologic, and radiographic study of deep caries lesions after incomplete caries removal. If the pulp appears infected or symptomatic, the dentist may decide a root canal is the best treatment option. Dieses Abonnement kann nur einmal getestet werden. VPT in primary teeth is to treat reversible pulpal injuries and maintaining pulp vitality. Affiliations. 100% success rate. Current literature indicates that there is inconclusive evidence that it is necessary to reenter the tooth to remove the residual caries. The journal promotes the practice, education and research specifically related to the specialty of pediatric dentistry. and P.S.S.) 2017;31:e101 1. The purpose of this article was to review the dental literature and new research in vital pulp therapy to determine the following: (1) Is a pulpotomy indicated for a true carious pulp exposure? Zurück zum Zitat Gruythuysen RJ, van Strijp AJ, Wu MK (2010) Long-term survival of indirect pulp treatment performed in primary and permanent teeth with clinically diagnosed deep carious lesions. The AAPD and the American Association of Endodontists recommend indirect pulp capping for primary teeth and young permanent teeth. This is a complex procedure requiring a specialist and is rarely used in routine … The evidence … Advanced mesial (smooth surface) caries is present, and there is also a shadow that suggests … Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date? Indirect pulp therapy (IPT) is also indicated and has a significantly higher long-term success. Pulp capping is a technique used in dental restorations to prevent the dental pulp from necrosis, after being exposed, or nearly exposed during a cavity preparation. J Endod 40:1932–1939. Pediatr Dent 26:214–220 PubMed, Zurück zum Zitat Franzon R, Casagrande L, Pinto AS, Garcia-Godoy F, Maltz M, De Araujo FB (2007) Clinical and radiographic evaluation of indirect pulp treatment in primary molars: 36 months follow-up. The appeal of direct pulp capping in primary teeth was tainted, however, by the higher success rates reported for other vital pulp treatments. Thirty six primary molar teeth with deep caries lesion were selected to apply indirect pulp therapy with calcium hydroxide. Indirect Pulp Cap The pulp is not exposed - a layer of infected dentine is deliberately left, rather than expose the pulp. (3) Is primary tooth pulpotomy out of date, and should indirect pulp therapy replace pulpotomy? … Since maintaining pulpal health is paramount when saving a tooth, your dentist may use a pulp cap to kill bacteria in the area, and stimulate the tooth to lay down more dentin just above the pulpal chamber. This course discusses the direct and indirect pulp therapy in primary teeth, pulpotomy, pulpectomy and materials used for each procedure. which primary tooth need metal crown in indirect pulp capping? In: Summitt JB, Robbins JW, Hilton TJ, Schwartz RS (eds) Fundamentals of operative dentistry a contemporary approach, 3rd. 14 Alternatively, an adhesive resin system may be used, directly over the dentine which has shown to have a success rate of 96% compared with 83% for calcium hydroxide. Pediatr Dent 401-9. Direct pulp capping: a review Lim KC, Kirk EEJ. Clin Oral Investig 10:134–139. KEYWORDS: Indirect pulp, Direct pulp capping, Pulpotomy Introduction The primary objective of pulp treatment is to maintain the integrity and health of the oral tissues. The procedures could involve longer treatment time due to careful tooth … https://doi.org/10.1016/j.dental.2018.09.008 PubMedCrossRef, https://doi.org/10.1016/j.dental.2018.09.008, Zurück zum Zitat Casagrande L, Falster CA, Di Hipolito V, De Goes MF, Straffon LH, Nor JE, de Araujo FB (2009) Effect of adhesive restorations over incomplete dentin caries removal: 5-year follow-up study in primary teeth. 2008;30(3):230-6. Although a tooth can remain functional without a vital pulp, it is desirable to attempt to maintain the vitality of the pulp [American … Pediatr Dent 39:377–382 PubMed, Zurück zum Zitat Schwendicke F, Dorfer CE, Paris S (2013) Incomplete caries removal: a systematic review and meta-analysis. https://doi.org/10.1016/j.joen.2018.06.009 PubMedCrossRef, https://doi.org/10.1016/j.joen.2018.06.009, Zurück zum Zitat Kim I, Moon SO, Kim SH, Kim HJ, Koh YS, Koh GY (2001) Vascular endothelial growth factor expression of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and E-selectin through nuclear factor-kappa B activation in endothelial cells. Pulpotomy is thought to be indicated for primary teeth with carious pulp exposures, but research shows the majority of such teeth are nonvital or questionable for treatment with vital pulp therapy. Eur Arch Paediatr Dent 17:413–417. J Dent 73:76–90. This peer-reviewed journal features scientific articles, case reports and abstracts of current pediatric dental research. Pulpotomy is thought to be indicated for primary teeth with carious pulp exposures, but research shows the majority of such teeth are nonvital or questionable for treatment with vital pulp … Indications: Indirect pulp treatment is indicated in a primary tooth with no pulpitis 18 or with reversible pulpitis when the deepest carious dentin is not removed to avoid a pulp exposure. J Endod 40:1846–1854. Indirect pulp cap is done when caries is judged to be so deep as to be approaching the pulp, such that removal of all caries may result in pulp exposure. This can lead to the pulp of the tooth either being exposed or nearly exposed which causes pulpitis (inflammation). J Esthet Restor Dent 29:403–408. 14 Alternatively, an adhesive resin system may be used, directly over the dentine which has shown to have a success rate of 96% compared with 83% for calcium hydroxide. Often this is recommended for primary, or baby, teeth. Endod Dent Traumatol 1987; 3: 213-219. Indirect pulp capping (IDPC) IDPC is recommended for teeth with deep carious lesions approximating the pulp but there are no signs or symptoms of pulp degeneration. Clinical and microbiological effect of calcium hydroxide protection in indirect pulp capping in primary teeth. So, this study will verify the in vivo response of dentine–pulp complex after SCTR in primary teeth with or without pulp liner material. 10. INDIRECT PULP THERAPY; This video by Aspire32 is a part of an ongoing series on Pulp capping. This combination of desirable qualities makes MTA “the material of choice” for cases of pulp exposure in both primary teeth and permanent teeth13,14 (Figs. J Endod 34:S34–S39. https://doi.org/10.1111/jerd.12338 PubMedCrossRef, Zurück zum Zitat Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE (2013) Operative caries management in adults and children. Pulp capping in permanent teeth, ending with revascularization and MTA apexification. J Dent Child (Chic) 76:117–122, Zurück zum Zitat Tuculina MJ, Raescu M, Dascalu IT, Popescu M, Andreescu CF, Daguci C, Cumpata CN, Nimigean VR, Banita IM (2013) Indirect pulp capping in young patients: immunohistological study of pulp-dentin complex. When only a relevant title without a listed abstract was available, a full copy of the article was used for … • Preoperative radiograph confirms the absence of radicular pathology . DIRECT PULP CAPPING. Hence, some infected dentine near the pulp is left intact, and a thin layer of calcium hydroxide (CaOH) is placed over the area near to the pulp, and a temporary restoration given, as described in the steps below. Formocresol pulpotomy (FP) in the United States is most frequently used to treat asymptomatic caries near the pulp in primary teeth. 13.01.2021 | Praxismanagement | Nachrichten, 29.12.2020 | Praxismanagement | Nachrichten | Onlineartikel, 16.12.2020 | GOÄ | Nachrichten | Onlineartikel. https://doi.org/10.1016/j.joen.2013.01.005 PubMedCrossRef, https://doi.org/10.1016/j.joen.2013.01.005, Zurück zum Zitat Rajasekharan S, Martens LC, Cauwels R, Anthonappa RP, Verbeeck RMH (2018) Biodentine material characteristics and clinical applications: a 3 year literature review and update. Elsevier Saunders, St. Louis, pp 490–494, Zurück zum Zitat American Academy of Pediatric D (2016) Guideline on pulp therapy for primary and immature permanent teeth. https://doi.org/10.1016/j.joen.2010.06.006 PubMedCrossRef, https://doi.org/10.1016/j.joen.2010.06.006, Zurück zum Zitat Schwendicke F (2017) Contemporary concepts in carious tissue removal: a review. Bitte aktivieren Sie Java-Script in Ihrem Browser, damit Sie alle Vorteile und Funktionen dieser Website nutzen können. All authors. As long as the tooth remains sealed from bacterial contamination, the prognosis is good for caries to arrest and reparative dentin to form to protect the … Technique • Pain control and isolation. LR7 (47) Pre-op Radiograph. It tried to explain the various reasons for the failure of Calcium hydroxide pulp capping in Primary teeth. Contemp Clin Dent 7:475–480. Direct pulp capping: a review. Pulp capping is a procedure that maintains pulp vitality and function, promotes healing/repair, prevents breakdown of peri radicular supporting tissues, and promotes formation of secondary dentin Direct pulp capping is a procedure used in asymptomatic teeth with deep caries reaching upto pulp. However, histological examination indicated that the pulp status was affected by the chosen capping material especially when selecting a resin-containing material such as TheraCal LC. Cochrane Database Syst Rev:CD003808. Pediatr Dent 24:241–248 PubMed, Zurück zum Zitat Koc Vural U, Kiremitci A, Gokalp S (2017) Randomized clinical trial to evaluate MTA indirect pulp capping in deep caries lesions after 24-months. In this procedure, the deepest layer of the remaining carious dentine is covered with biocompatible materials . The Direct Pulp Cap The following must hold true: The exposure is surgical, not carious. Für Ihren Erfolg in Klinik und Praxis - Die beste Hilfe in Ihrem Arbeitsalltag als Mediziner. Indirect pulp therapy (IPT) is also indicated and has a significantly higher long-term success. Pulpal exposure is inevitable when excavating many large carious lesions. 2. J Clin Pediatr Dent. … INDIRECT PULP THERAPY (IPT) STUDIES SHOWS SUCCESS RATES OF 90% OR GREATER OVER TIME USING DIFFERING TECHNIQUES AND MEDICAMENTS - "Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date?" Pediatr Dent 2004;26(5): the primary tooth pulpotomy out of date? independently assessed the identified publications and selected them by title and abstract based on the following inclusion criteria: clinical trials comparing different materials used for protection of dentin-pulp complex in primary teeth submitted to indirect pulp capping. Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial | springermedizin.de Skip to main content A success rate of 92% for indirect pulp capping with calcium hydroxide in primary incisors followed for 42 months has been reported, 13 and 96% in primary molars after 1 year. J Appl Oral Sci 11:269–282. https://doi.org/10.1177/0022034513477425 PubMedCrossRef, https://doi.org/10.1177/0022034513477425, Zurück zum Zitat Ricucci D, Loghin S, Siqueira JF Jr (2014) Correlation between clinical and histologic pulp diagnoses. Indirect Pulp Capping: In this process, a thin layer of the soft dentin is left over the pulp, and a protective dressing is placed over the soft dentin. When practitioners in a dental PBRN were given a hypothetical scenario that involved this question, only 17% responded that they would stop, leave the remaining caries in place and restore the tooth.32 This procedure, where caries is allowed to remain adjacent to a vital pulp rather than risk pulp exposure, covered with a cavity sealer or liner and restored, is termed an indirect pulp cap. Contraindications: Same as for primary teeth except for the information regarding root resorption. 2006;31(2):68-71. Teeth were divided into three groups according to the materials used for pulp capping. a small amount of bleeding. Am J Dent. 50. Eur J Paediatr moval: A systemic review and meta-analysis. Methods The following electronic databases were searched: PubMed, Embase, Cochrane Library, Dentistry and … https://doi.org/10.1007/s00784-014-1296-0 PubMedCrossRef, https://doi.org/10.1007/s00784-014-1296-0, Zurück zum Zitat Farooq NS, Coll JA, Kuwabara A, Shelton P (2000) Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. In the selection of a specific vital pulp treatment, it is important to consider the remaining tooth structure and future restorative plan. Indirect pulp therapy (IPT) is also indicated and has a significantly higher long-term success. There are two main types of pulp caps: indirect pulp caps and direct pulp caps. Before exposure and irreversible involvement of the pulp, indirect pulp capping (IPC) is the treatment of choice, but after the spread of inflammation within the pulp chamber and establishment of irreversible pulpitis, removal of inflamed pulp tissue is recommended. The Indirect Pulp Cap. Primary teeth with extremely deep carious lesions without signs of irreversible pulpitis can be treated successfully by either indirect pulp capping or iRoot BP Plus pulpotomy.