Question 1

When is direct pulp capping (DPC) indicated?

Accepted Answer

Direct pulp capping is indicated for small, pinpoint mechanical or traumatic pulp exposures (<0.5 mm) in asymptomatic or reversibly symptomatic mature permanent teeth, where haemostasis is achieved within 10 minutes. DPC is generally not recommended for carious exposures, where partial pulpotomy is preferred due to bacterial contamination of the pulp surface.

Question 2

What is the difference between direct pulp cap, partial pulpotomy, and full pulpotomy?

Accepted Answer

Direct Pulp Cap (DPC): a biocompatible material (MTA, Biodentine, TheraCal) is placed directly over the exposed pulp tissue without removal. Partial Pulpotomy (Cvek procedure): 2–3 mm of superficially inflamed pulp tissue is removed at the exposure site before placing a capping material. Full Pulpotomy: the entire coronal pulp is removed to the orifice level, leaving the radicular pulp vital and covered with a capping material.

Question 3

Is MTA or Biodentine better for vital pulp therapy?

Accepted Answer

Both MTA and Biodentine are calcium silicate-based materials with comparable clinical outcomes for vital pulp therapy. MTA has the largest evidence base and is considered the gold standard, but has a slow setting time (4+ hours) and is more expensive. Biodentine sets in approximately 12 minutes and can also be used as a temporary dentine substitute. TheraCal LC is light-cured, easier to handle at chairside, but has a smaller long-term evidence base than MTA or Biodentine.

Question 4

Why is haemostasis important in vital pulp therapy?

Accepted Answer

If haemostasis cannot be achieved within 10 minutes using gentle irrigation with sodium hypochlorite or saline, this indicates that the remaining pulp tissue is irreversibly inflamed. In this case, vital pulp therapy will have a poor prognosis and root canal treatment (RCT) is indicated. Controlled haemostasis within 10 minutes is one of the key clinical criteria for VPT success.

Question 5

What vital pulp therapy is recommended for an immature permanent tooth?

Accepted Answer

For immature permanent teeth (open apex), vital pulp therapy should always be attempted before root canal treatment, even with larger exposures. Maintaining radicular pulp vitality allows continued root development (apexogenesis), resulting in a stronger, more favourable root anatomy. Full pulpotomy is preferred for larger exposures; partial pulpotomy (Cvek) for smaller ones. MTA or Biodentine are the materials of choice.

Question 6

What vital pulp therapy is used for primary (baby) teeth?

Accepted Answer

For primary teeth with vital pulp and no signs of irreversible pulpitis, pulpotomy (removal of the coronal pulp) is the standard treatment. MTA or Biodentine are preferred over formocresol based on current evidence. If irreversible pulpitis, periapical pathology, or abscess is present — particularly if the permanent successor is close to erupting — extraction is indicated.

Vital Pulp Therapy Decision Tool

Clinical Parameters

Welcome to SureDataPro Tools

Vital Pulp Therapy Decision Tool

Clinical Parameters