SP-28 Misconception of Vital Pulp Therapy: Stem Cells/odontoblasts, Canal Calcification and Material Toxicity

CE Hours: 0.75

Description: Vital pulp therapy (VPT) has gained more attention in the past decade due to the use of calcium silicate-based cement, understanding of the biological and molecular basis of pulp response to infection and knowing the regenerative capacity of dental pulp stem cells. Calcium hydroxide has been the pulp capping materials for half a century; however, it has not been a popular practice for carious pulp exposure or teeth with symptomatic pulpitis due to low success rates. Furthermore, it has been a clinical perception that pulp capping with Ca((OH)2 would lead to severe canal calcification. For these reasons, VPT therapy has not been a mainstream practice in the endodontic specialty. The introduction of MTA, discovery of dental pulp stem cells, and the advancement of the understanding of pulp inflammation in the past decade led to the resurrection of VPT. This presentation will discuss several key areas concerning VPT that either have been misunderstood or lack of understanding: i) Source of replacement odontoblasts and the quality of the new dentin, ii) progression of pulp inflammation responding to infection, iii) pulp stem cell response to the capping materials, iv) the mystery of pulp undergoing calcific metamorphosis after capping, and v) biological basis of clinical failure and how to improve success rates.

Learning Objectives:  

• Describe the source of replacement odontoblasts from the pulp.
• Clarify the nature of pulp calcific metamorphosis.
• Relate the knowledge of the biological and molecular basis of pulp inflammation to diagnosis and treatment outcomes including clinical failures.