Pulp RegenerationDepth and Activity of Carious Lesions as Indicators for the Regenerative Potential of Dental Pulp after Intervention
Section snippets
Treatment Variation
The biological concept of vital pulp therapy associated with deep caries involves the treatment and evaluation of unexposed and exposed pulp, but, interestingly, the clinical diagnosis is typically the same 5, 6. In a dental practitioner environment, deep caries with reversible pulpitis may receive differing treatment modalities such as avoidance of pulp exposure, pulp capping, or pulpotomy. These treatment options have led to both pulp-invasive 7, 8 and non–pulp-invasive treatment strategies 9
Caries Progression and the Pulp-Dentin Organ
The belief that there is no correlation between pulp inflammation and the presence or absence of a toothache including an abnormal response to thermal testing has led to the opinion among clinicians that it is justified to excavate deep caries to pulp exposure (7) because the pulp may be severely inflamed even though it remains “silent” in terms of subjective symptoms. If caries remains untreated, a frank exposure may occur, and classic articles have shown that the pulp reacts with an
The Conversion of Lesion Activity in Caries
It has previously been described in detail how the cariogenic ecosystem may change during the natural development of a deep caries lesion (35). When the demineralized enamel breaks down and the microbial ecosystem is converted from a closed environment toward a more open environment, the activity of the lesion is declining. Of course, in a clinical setting, it is not possible to follow a deep lesion during total breakdown, but when IPT is performed, the same principle changes within the
How Can Lesion Activity and Depth Be Monitored in a Clinical Setup?
A principle classification can categorize estimates on lesion activity in clinical terms (Fig. 3A–C). An example of an active progressing caries lesion is displayed showing a premolar during caries removal. The demineralized discolored dentin has a light yellow/yellow appearance, the surface texture has a wet/moist appearance, and it is easy to disintegrate the soft organic matrix (Fig. 3A). The signs of slowly progressing caries are a browner and dry surface texture (Fig. 3B). In cases of
Direct and Indirect Pulp Therapy and Level of Evidence
Caries is mentioned several times in the review of the diagnostic condition of the pulp (4), but, as discussed earlier, it is not defined more accurately in terms of activity and depth. Nadin et al (42) performed a systematic Cochrane Review about pulp therapy in so-called extensive caries in primary molars. All included participants had symptom-free, cariously exposed vital pulp as a baseline description. However, it was not possible from the review to gain information about the carious depth
Conclusions
It might be beneficial to incorporate more details in clinical studies regarding the characteristics of caries lesions as indicators for the regenerative potential of the dental pulp after intervention. Literature is sparse within this topic. The following are suggested:
- 1.
Future protocols for the regenerative potential of dental pulp (in the clinic as well in the laboratory) should include more details about the caries lesion before intervention (if present and possible).
- 2.
It is hypothesized that
Acknowledgments
The authors deny any conflicts of interest related to this study.
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This paper is based on a presentation from the International Association for Dental Research (IADR) Pulp Biology and Regeneration Group Satellite Meeting, which was held March 24–26, 2013 in San Francisco, California.