Selective caries removal (Indirect pulp treatment – IPT). Sloppy dentistry or biologically accepted treatment

Considerable progress has been made in understanding the molecular and cellular changes that take place during tooth development and how they are mimicked during tissue repair. This knowledge offers us the opportunity to assess the biologic validity of the various pulp treatments

Dental caries, if left untreated, can result in deep caries that threatens the vitality of the pulp. Currently, there are still three options to treat primary or young permanent teeth with deep caries approximating the pulp: Selective caries removal (indirect pulp therapy – IPT), Direct pulp capping (DPC), and Pulpotomy. Despite much research, dentists are still uncertain which of these three vital pulp therapy options has the best outcome.

Selective caries removal (Indirect pulp treatment – IPT) can be an acceptable procedure for primary or young permanent   teeth with reversible pulp inflammation, provided that this diagnosis is based on a good history, a proper clinical and radiographic examination, and the tooth had been sealed with a leakage-free restoration.  Stepwise excavation has been suggested as an alternative to IPT. 

Direct pulp capping (DPC) with calcium hydroxide has been widely used with high success rates in young permanent teeth, and a  recent meta-analysis  showed similar results  also in primary teeth.

However, as DPC has been shown to be less satisfactory in primary teeth, iatrogenic or carious exposures in younger children should be treated by pulpotomy. 

To address the uncertainty of which of the mentioned three vital pulp  therapy options has the best outcome, the American Academy of Pediatric Dentistry (AAPD)   conducted a systematic review and meta-analysis on vital pulp therapy in primary teeth that covered research published through November 2015.  The results of this meta- analysis will be  briefly presented.

Dra. Anna Fuks

  • Graduated in Dentistry by the Federal University of the State of Parana.
  • Post-graduate course in Pediatric Dentistry at the University of Alabama, U.S.A.
  • Residency at the Children’s Hospital of the University of Alabam.
  • Practiced and taught Pediatric Dentistry at the University of Parana until 1973.
  • Joined the Department of Pediatric Dentistry of the Hebrew University of Jerusalem, Israel, reaching  the degree of Professor that she maintains until the present date.
  • Was president  of the International Association of Pediatric Dentistry
  • Has received several international prizes in research
  • She has published over 130 articles and 85 abstracts in many international journals,
  • She had wrote 16  chapters in Pediatric Dentistry books, and continues serving actively as a member of  the Editorial Board of several dental journals.
  • Teacher at the Department of Pediatric Dentistry of the Hadassah School of Dental Medicine in Jerusalem
  • Principal Editor of the recently published the only book specialized in Pediatric Endodontics.

Dra. Anna Fuks

  • Graduated in Dentistry by the Federal University of the State of Parana.
  • Post-graduate course in Pediatric Dentistry at the University of Alabama, U.S.A.
  • Residency at the Children’s Hospital of the University of Alabam.
  • Practiced and taught Pediatric Dentistry at the University of Parana until 1973.
  • Joined the Department of Pediatric Dentistry of the Hebrew University of Jerusalem, Israel, reaching  the degree of Professor that she maintains until the present date.
  • Was president  of the International Association of Pediatric Dentistry
  • Has received several international prizes in research
  • She has published over 130 articles and 85 abstracts in many international journals,
  • She had wrote 16  chapters in Pediatric Dentistry books, and continues serving actively as a member of  the Editorial Board of several dental journals.
  • Teacher at the Department of Pediatric Dentistry of the Hadassah School of Dental Medicine in Jerusalem
  • Principal Editor of the recently published the only book specialized in Pediatric Endodontics.

Selective caries removal (Indirect pulp treatment – IPT). Sloppy dentistry or biologically accepted treatment

Considerable progress has been made in understanding the molecular and cellular changes that take place during tooth development and how they are mimicked during tissue repair. This knowledge offers us the opportunity to assess the biologic validity of the various pulp treatments

Dental caries, if left untreated, can result in deep caries that threatens the vitality of the pulp. Currently, there are still three options to treat primary or young permanent teeth with deep caries approximating the pulp: Selective caries removal (indirect pulp therapy – IPT), Direct pulp capping (DPC), and Pulpotomy. Despite much research, dentists are still uncertain which of these three vital pulp therapy options has the best outcome.

Selective caries removal (Indirect pulp treatment – IPT) can be an acceptable procedure for primary or young permanent   teeth with reversible pulp inflammation, provided that this diagnosis is based on a good history, a proper clinical and radiographic examination, and the tooth had been sealed with a leakage-free restoration.  Stepwise excavation has been suggested as an alternative to IPT.

Direct pulp capping (DPC) with calcium hydroxide has been widely used with high success rates in young permanent teeth, and a  recent meta-analysis  showed similar results  also in primary teeth.

However, as DPC has been shown to be less satisfactory in primary teeth, iatrogenic or carious exposures in younger children should be treated by pulpotomy.

To address the uncertainty of which of the mentioned three vital pulp  therapy options has the best outcome, the American Academy of Pediatric Dentistry (AAPD)   conducted a systematic review and meta-analysis on vital pulp therapy in primary teeth that covered research published through November 2015.  The results of this meta- analysis will be  briefly presented.