LAUSR

Abstract The maintenance of pulp vitality is a major goal of endodontics. Direct pulp capping for tooth decay has always been considered a controversial procedure generating unpredictable and often contraindicated outcomes. The Mineral Trioxide Aggregate (MTA), introduced by Torabinejad about 20 years ago, 1 , 2 , 3 , 4 , 5 , 6 , 7 retains resistance to bacterial infiltration and can effectively protect the pulp, hastening its repair and maintaining tooth vitality if used correctly and in combination with an adequate coronal restoration. In a group of 77 patients aged 14–68 years, direct pulp capping with MTA was performed in 80 teeth affected by tooth decay, diagnosed with reversible pulpitis by the cold-temperature test and radiographic examination. Four patients had pain, in three teeth the radiograph showed a small area of bone loss due to a widening of the periodontal space. The author has removed the caries by using only rotating instruments and has then placed a thin layer of MTA on the exposed pulp and the surrounding dentin. In some cases 5% sodium hypochlorite solution was used to achieve hemostasis of the operating field. In a second visit, after X-ray examination, pulp vitality-check with the cold thermal test and the assessment of effective hardening of the material, the teeth were reconstructed by using two-component adhesives and last-generation composite resins. Patients were recalled at regular intervals for 10 years to assess the condition of the pulp, the presence of a reparative dentine layer, pulpal or root canal calcifications or root resorptions, pain on percussion and radiographically visible endodontic lesions. After 10-years follow-up period, 6 out of 80 teeth required an endodontic treatment, we did not find an increase of pulp calcifications, root resorptions, endodontic lesions. All teeth still alive have responded positively to the cold-temperature test. The three lesions had disappeared at the last X-ray control. All four symptomatic teeth preserved their pulp vitality. The successful treatment rate was 92.5%. Direct pulp capping with MTA can be considered an effective treatment of exposure due to tooth decay and can be considered a valid treatment option for teeth with a diagnosis of not-severe reversible pulpitis.