Indirect Pulp Treatment, Direct Pulp Capping, and Stepwise Caries Excavation

Abstract

In children with deep carious lesions, the tooth’s pulp can become inflamed. If this lesion is not treated properly, the caries can approximate the pulp resulting in pain and infection. The treatment of these pulp conditions often results in extraction or root canal therapy. Vital pulp therapy procedures can treat the decay approximating the pulp to avoid the pulp becoming infected or being treated with pulpotomy. An alternative to pulpotomy, extraction, or pulpectomy for deep carious lesions where the pulp is vital is indirect pulp treatment (IPT). IPT has been shown to be successful using stepwise caries excavation in two appointments or using partial caries excavation as a one-appointment procedure. These procedures are indicated for primary, immature permanent, and mature permanent teeth in children and adolescents. Direct pulp capping in primary teeth due to a carious exposure is not indicated but is used in permanent teeth. This chapter will review the literature and systematic reviews on these treatments, show their advantages and disadvantages, and offer conclusions as to the treatment of choice.