Pulp Therapy: Evidenced Based Recommendations for Primary and Permanent Teeth-Pulp Therapy Evidenced Based Recommendations for Primary and Permanent Teeth

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Video Summary

Dr. James Cole delivered an extensive lecture on the latest guidelines and evidence-based practices for pulp therapy in primary and permanent teeth, sponsored by the CSPD Foundation. With nearly four decades of pediatric dental practice and research, Dr. Cole emphasized updated approaches focusing on vital pulp therapy (VPT) and non-vital treatments. He highlighted the newly published AAPD guidelines recommending selective caries removal over complete removal to avoid pulp exposures, based on strong evidence favoring fewer exposures and successful outcomes. For pulp therapy agents, calcium silicate-based materials like MTA and biodentine are strongly recommended due to superior long-term success compared to formocresol or ferric sulfate. Indirect pulp treatment (IPT) with selective caries removal is seen as equally effective as pulpotomy and preferred over direct pulp caps. The Hall crown technique also has conditional support as a viable treatment for deep caries. Diagnosis remains challenging, with insufficient evidence supporting any definitive diagnostic tool beyond clinical signs, symptoms, and radiographs. Dr. Cole recommended interim therapeutic restorations (ITRs) with glass ionomer to aid diagnosis and treatment success, particularly in questionable cases. He stressed cautious interpretation of symptoms like pain duration and the presence of radiographic features such as a dentin bridge or furcation radiolucency. Non-vital treatment options like pulpectomy and lesion sterilization tissue repair (LSTR) were discussed but less commonly used. The workgroup’s systematic reviews analyzed thousands of studies, informing these updated guidelines emphasizing minimally invasive, pulp-preserving treatments with a strong focus on material choice and caries management strategy.

Keywords

pulp therapy

vital pulp therapy

non-vital treatment

pediatric dentistry

AAPD guidelines

selective caries removal

indirect pulp treatment

calcium silicate materials

MTA

biodentine

Hall crown technique

interim therapeutic restorations

minimally invasive dentistry