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Lazy Lit Review- Pulp capping of carious exposures

Posted Jan 11 2009 5:44pm
The article: Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study.

The journal: J Endod. 2000 Sep;26(9):525-8

The author: Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF

Why we should we know it: Management of pulp exposures are a controversial topic due to different philosophies held by different universities.

What we need to know: This study followed 123 pulp caps. A portion of the 123 were followed up at five years, the other portion at 10 years. After the respective time had passed, the teeth were tested with cold, an EPT, percussion, and palpation. Radiographs were also taken of all the teeth. Results were as follows:
5 year group- 44.5% failure, 18.5% questionable, and 37% success
10 year group- 79.7% failure, 7.3% questionable, and 13% success

As a factor of influence, the placement of a definitive restoration within the first 2 days after pulp exposure was found to contribute significantly to the survival rate of these teeth.
Failures were teeth that became symptomatic and required endodontic treatment. Questionable teeth had symptoms but did not yet require endodontic therapy.

I was trained to try pulp caps always as long as the exposure was small and hemostasis was achieved. From this data, I can see that direct pulp caps of carious exposures just delay the inevitable of endodontic therapy for the most part. This data will most likely alter the way I handle carious exposures. As long as the apex is mature, I will seriously consider starting endodontic therapy at that time.

Does anyone else have any other interpretation of this data?
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