Advertisement
AAE Position Statement| Volume 47, ISSUE 9, P1340-1344, September 2021

Download started.

Ok

AAE Position Statement on Vital Pulp Therapy

    Published:August 02, 2021DOI:https://doi.org/10.1016/j.joen.2021.07.015
        The following statement was prepared by the AAE Special Committee on Vital Pulp Therapy: Craig S. Hirschberg, DDS, Chair; George Bogen, DDS; Johnah C. Galicia, DMD, MS, PhD; Ronald R. Lemon, DMD; Ove A. Peters, DMD, MS, PhD; Nikita B. Ruparel, DMD, MS, PhD; Franklin R. Tay, BDSc, PhD; and David E. Witherspoon, BDS, MS.
        To read this article in full you will need to make a payment

        Purchase one-time access:

        Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
        One-time access price info
        • For academic or personal research use, select 'Academic and Personal'
        • For corporate R&D use, select 'Corporate R&D Professionals'

        Subscribe:

        Subscribe to Journal of Endodontics
        Already a print subscriber? Claim online access
        Already an online subscriber? Sign in
        Institutional Access: Sign in to ScienceDirect

        References

          • American Association of Endodontists
          Glossary of Endodontic Terms.
          Tenth Edition. 2020
          • Levin L.
          • Law A.S.
          • Holland G.R.
          • et al.
          Identify and define all diagnostic terms for pulpal health and disease states.
          J Endod. 2009; 35: 1645-1657
          • Chen E.
          • Abbott P.V.
          Dental pulp testing: a review.
          Int J Dent. 2009; 2009: 365785
          • Hargreaves K.
          • Swift J.Q.
          Mechanisms and management of pain due to inflammation.
          Northwest Dent. 1991; 70: 47-49
          • Diogenes A.
          • Henry M.A.
          Pain pathways and mechanisms of the pulpdentin complex.
          in: Hargreaves K.M. Goodis H.E. Tay F.R. Seltzer's and Bender's dental pulp. 2nd ed. Quintessence Publ, Hannover Park, IL2012
          • Owatz C.B.
          • Khan A.A.
          • Schindler W.G.
          • et al.
          The incidence of mechanical allodynia in patients with irreversible pulpitis.
          J Endod. 2007; 33: 552-556
          • McDonald R.E.
          • Avery D.R.
          • Dean J.A.
          Treatment of deep caries, vital pulp exposure, and pulpless teeth.
          in: Dean J.A. Avery D.R. McDonald R.E. McDonald and Avery's dentistry of the child and adolescent. 9th ed. Mosby/Elsevier, St. Louis, MO2011
          • Baume L.J.
          Diagnosis of diseases of the pulp.
          Oral Surg Oral Med Oral Pathol. 1970; 29: 102-116
          • Dummer P.M.H.
          • Hicks R.
          • Huws
          Clinical signs and symptoms in pulp disease.
          Int Endod J. 1980; 13: 27-35
          • Rechenberg D.-K.
          • Zehnder M.
          Call for a review of diagnostic nomenclature and terminology used in endodontics.
          Int Endod J. 2020; (in press)
          • Ricucci D.
          • Siqueira Jr., J.F.
          • Li Y.
          • Tay F.R.
          Vital pulp therapy: histopathology and histobacteriology- based guidelines to treat teeth with deep caries and pulp exposure.
          J Dent. 2019; 86: 41-52
          • Wolters W.J.
          • Duncan H.F.
          • Tomson P.L.
          • et al.
          Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs.
          Int Endod J. 2017; 50: 825-829
          • Rechenberg D.-K.
          • Galicia J.C.
          • Peters O.A.
          Biological markers for pulpal inflammation: a systematic review.
          PLoS One. 2016; 11: e0167289
          • Zanini M.
          • Meyer E.
          • Simon S.
          Pulp inflammation diagnosis from clinical to inflammatory mediators: a systematic review.
          J Endod. 2017; 43: 1033-1051
          • Zehnder M.
          • Wegehaupt F.
          • Attin T.
          A first study on the usefulness of matrix metalloproteinase 9 from dentinal fluid to indicate pulp inflammation.
          J Endod. 2011; 37: 17-20
          • Mente J.
          • Petrovic J.
          • Gehrig H.
          • et al.
          A prospective clinical pilot study on the level of matrix metalloproteinase-9 in dental pulpal blood as a marker for the state of inflammation in the pulp tissue.
          J Endod. 2016; 42: 190-197
          • Bogen G.
          • Dammaschke T.
          • Chandler N.
          Vital pulp therapy.
          in: Berman L. Hargreaves K.M. Pathways of the pulp. 12th ed. Elsevier, St. Louis, MO2021
          • Lin L.M.
          • Ricucci D.
          • Saoud T.M.
          • et al.
          Vital pulp therapy of mature permanent teeth with irreversible pulpitis from the perspective of pulp biology.
          Aust Endod J. 2020; 46: 154-165
          • Asgary S.
          • Hassanizadeh R.
          • Torabzadeh H.
          • Eghbal M.J.
          Treatment outcomes of 4 vital pulp therapies in mature molars.
          J Endod. 2018; 44: 529-535
          • Matsuo T.
          • Nakanishi T.
          • Shimizu H.
          • et al.
          A clinical study of direct pulp capping applied to carious-exposed pulps.
          J Endod. 1996; 22: 551
          • Ricucci D.
          • Siqueira Jr., J.F.
          • Rôças I.N.
          • et al.
          Pulp and dentine responses to selective caries excavation: a histological and histobacteriological human study.
          J Dent. 2020; 100: 103430
          • Ricucci D.
          • Siqueira Jr., J.F.
          Bacteriologic status of non-cavitated proximal enamel caries lesions. a histologic and histobacteriologic study.
          J Dent. 2020; 100: 103422
          • Nakajima M.
          • Sano H.
          • Burrow M.F.
          • et al.
          Tensile bond strength and SEM evaluation of caries-affected dentin using dentin adhesives.
          J Dent Res. 1995; 74: 1679-1688
          • Yoshiyama M.
          • Tay F.R.
          • Torii Y.
          • et al.
          Resin adhesion to carious dentin.
          Am J Dent. 2003; 16: 47-52
          • Hosoya Y.
          • Taguchi T.
          • Tay F.R.
          Evaluation of a new caries detecting dye for primary and permanent carious dentin.
          J Dent. 2007; 35: 137-143
          • Neves Ade A.
          • Coutinho E.
          • De Munck J.
          • Van Meerbeek B.
          Caries-removal effectiveness and minimal-invasiveness potential of caries-excavation techniques: a micro-CT investigation.
          J Dent. 2011; 39: 154-162
          • Sadasiva K.
          • Kumar K.S.
          • Rayar S.
          • et al.
          Evaluation of the efficacy of visual, tactile method, caries 26 detector dye, and laser fluorescence in removal of dental caries and confirmation by culture and polymerase chain reaction: an in vivo study.
          J Pharm Bioallied Sci. 2019; 11: S146-S150
          • Langeland K.
          Management of the inflamed pulp associated with deep carious lesion.
          J Endod. 1981; 7: 169
          • Fusayama T.
          Two layers of carious dentin: diagnosis and treatment.
          Oper Dent. 1979; 4: 63-70
          • Hafez A.A.
          • Cox C.F.
          • Tarim B.
          • et al.
          An in vivo evaluation of hemorrhage control using sodium hypochlorite and direct capping with a one- or two-component adhesive system in exposed nonhuman primate pulps.
          Quintessence Int. 2002; 33: 261-272
          • Cho S.-Y.
          • Seo D.G.
          • Lee S.J.
          • et al.
          Prognostic factors for clinical outcomes according to time after direct pulp capping.
          J Endod. 2013; 39: 327-331
          • Jang Y.
          • Song M.
          • Yoo I.S.
          • et al.
          A randomized controlled study of the use of proroot mineral trioxide aggregate and endocem as direct pulp capping materials: 3-month versus 1-year outcomes.
          J Endod. 2015; 41: 1201-1206
          • Kang C.M.
          • Sun Y.
          • Song J.S.
          • et al.
          A randomized controlled trial of various MTA materials for partial pulpotomy in permanent teeth.
          J Dent. 2017; 60: 8-13
          • Kundzina R.
          • Stangvaltaite L.
          • Eriksen H.M.
          • Kerosuo E.
          Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide.
          Int Endod J. 2017; 50: 924-932
          • Linsuwanont P.
          • Wimonsutthikul K.
          • Pothimoke U.
          • Santiwong B.
          Treatment outcomes of mineral trioxide aggregate pulpotomy in vital permanent teeth with carious pulp exposure: the retrospective study.
          J Endod. 2017; 43: 225-230
          • Linu S.
          • Lekshmi M.S.
          • Varunkumar V.S.
          • Sam Joseph V.G.
          Treatment outcome following direct pulp capping using bioceramic materials in mature permanent teeth with carious exposure: a pilot retrospective study.
          J Endod. 2017; 43: 1635-1639
          • Parinyaprom N.
          • Nirunsittirat A.
          • Chuveera P.
          • et al.
          Outcomes of direct pulp capping by using either proroot mineral trioxide aggregate or Biodentine™ in permanent teeth with carious pulp exposure in 6- to 18-year-old patients: a randomized controlled trial.
          J Endod. 2018; 44: 341-348
          • Qudeimat M.A.
          • Alyahya A.
          • Hasan A.A.
          Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: a preliminary study.
          Int Endod J. 2017; 50: 126-134
          • Suhag K.
          • Duhan J.
          • Tewari S.
          • Sangwan P.
          Success of direct pulp capping using mineral trioxide aggregate and calcium hydroxide in mature permanent molars with pulps exposed during carious tissue removal: 1-year follow-up.
          J Endod. 2019; 45: 840-847
          • Taha N.A.
          • Abdelkhader S.Z.
          Outcome of full pulpotomy using Biodentine™ in adult patients with symptoms indicative of irreversible pulpitis.
          Int Endod J. 2018; 51: 819-828
          • Taha N.A.
          • Abdulkhader S.Z.
          Full pulpotomy with Biodentine™ in symptomatic young permanent teeth with carious exposure.
          J Endod. 2018; 44: 932-937
          • Taha N.A.
          • Khazali M.A.
          Partial pulpotomy in mature permanent teeth with clinical signs indicative of irreversible pulpitis: a randomized clinical trial.
          J Endod. 2017; 43: 1417-1421
          • Taha N.A.
          • Ahmad M.B.
          • Ghanim A.
          Assessment of mineral trioxide aggregate pulpotomy in mature permanent teeth with carious exposures.
          Int Endod J. 2017; 50: 117-125
          • Tan S.Y.
          • Yu V.S.H.
          • Lim K.C.
          • et al.
          Long-term pulpal and restorative outcomes of pulpotomy in mature permanent teeth.
          J Endod. 2020; 46: 383-390
          • Uesrichai N.
          • Nirunsittirat A.
          • Chuveera P.
          • et al.
          Partial pulpotomy with two bioactive cements in permanent teeth of 6- to 18-year-old patients with signs and symptoms indicative of irreversible pulpitis: a noninferiority randomized controlled trial.
          Int Endod J. 2019; 52: 749-759
          • Demir T.
          • Cehreli Z.C.
          Clinical and radiographic evaluation of adhesive pulp capping in primary molars following hemostasis with 1.25% sodium hypochlorite: 2-year results.
          Am J Dent. 2007; 20: 182-188
          • Tang H.M.
          • Nordbö H.
          • Bakland L.K.
          Pulpal response to prolonged dentinal exposure to sodium hypochlorite.
          Int Endod J. 2000; 33: 505-508
          • Witherspoon D.E.
          Vital pulp therapy with new materials: new directions and treatment perspectives—permanent teeth.
          J Endod. 2008; 34: S25-S28
          • Bogen G.
          • Kim J.S.
          • Bakland L.K.
          Direct pulp capping with mineral trioxide aggregate: an observational study.
          J Am Dent Assoc. 2008; 139: 305-315
          • Bakland L.K.
          • Andreasen J.O.
          Will mineral trioxide aggregate replace calcium hydroxide in treating pulpal and periodontal healing complications subsequent to dental trauma? a review.
          Dental Traumatol. 2012; 28: 25-32
          • Parirokh M.
          • Torabinejad M.
          • Dummer P.M.H.
          Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview– part I: vital pulp therapy.
          Int Endod J. 2018; 51: 177-205
          • Asgary S.
          • Eghbal M.J.
          • Bagheban A.A.
          Long- term outcomes of pulpotomy in permanent teeth with irreversible pulpitis: A multi- center randomized controlled trial.
          Am J Dent. 2017; 30: 151-155
          • Caliskan M.K.
          Pulpotomy of carious vital teeth with periapical involvement.
          Int Endod J. 1995; 28: 172-176
          • Caliskan M.K.
          Success of pulpotomy in the management of hyperplastic pulpitis.
          Int Endod J. 1993; 26: 142-148
          • Bergenholtz G.
          Evidence for bacterial causation of adverse pulpal responses in resin-based dental restorations.
          Crit Rev Oral Biol Med. 2000; 11: 467-480
          • de Souza Costa C.A.
          • do Nascimento A.B.
          • Teixeira H.M.
          Response of human pulps following acid conditioning and application of a bonding agent in deep cavities.
          Dental Mater. 2002; 18: 543-551
          • Asgary S.
          • Shahabi S.
          • Jafarzadeh T.
          • et al.
          The properties of a new endodontic material.
          J Endod. 2008; 34: 990-993
          • Byers M.R.
          • Narhi M.V.
          Dental injury models: experimental tools for understanding neuroinflammatory interactions and polymodal nociceptor functions.
          Crit Rev Oral Biol Med. 1999; 10: 4-39
          • Ding S.-J.
          • Kao C.-T.
          • Chen C.-L.
          • et al.
          Evaluation of human osteosarcoma cell line genotoxicity effects of mineral trixoide aggregate and calcium silicate cements.
          J Endod. 2010; 36: 1158-1162
          • Faraco Jr., I.M.
          • Holland R.
          Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement.
          Dent Traumatol. 2001; 17: 163-166
          • Kohli M.R.
          • Yamaguchi M.
          • Setzer F.C.
          • Karabucak B.
          Spectrophotometric analysis of coronal tooth discoloration induced by various bioceramic cements and other endodontic materials.
          J Endod. 2015; 41: 1862-1866
          • Luo Z.
          • Li D.
          • Kohli M.R.
          • et al.
          Effect of Biodentine™ on the proliferation, migration and adhesion of human dental pulp stem cells.
          J Dent. 2014; 42: 490-497
          • Moinzadeh A.T.
          • Aznar Portoles C.
          • Schembri Wismayer P.
          • Camilleri J.
          Bioactivity potential of EndoSequence BC RRM putty.
          J Endod. 2016; 42: 615-621
          • Opačić-Galić V.
          • Petrović V.
          • Živković S.
          • et al.
          New nanostructural biomaterials based on active silicate systems and hydroxyapatite: characterization and genotoxicity in human peripheral blood lymphocytes.
          Int Endod J. 2013; 46: 506-516
          • Paranjpe A.
          • Smoot T.
          • Zhang H.
          • Johnson J.D.
          Direct contact with mineral trioxide aggregate activates and differentiates human dental pulp cells.
          J Endod. 2011; 37: 1691-1695
          • Rao A.
          • Rao A.
          • Shenoy R.
          Mineral trioxide aggregate–a review.
          J Clin Pediatr Dent. 2009; 34: 1-7
          • Wongwatanasanti N.
          • Jantarat J.
          • Sritanaudomchai H.
          • Hargreaves K.M.
          Effect of bioceramic materials on proliferation and odontoblast differentiation of human stem cells from the apical papilla.
          J Endod. 2018; 44: 1270-1275
          • Alsalleeh F.
          • Chung N.
          • Stephenson L.
          Antifungal activity of endosequence root repair material and mineral trioxide aggregate.
          J Endod. 2014; 40: 1815-1819
          • Huang T.H.
          • Yang C.C.
          • Ding S.J.
          • et al.
          Inflammatory cytokines reaction elicited by root-end filling materials.
          J Biomed Mater Res B Appl Biomater. 2005; 73: 123-128
          • Yoo J.S.
          • Chang S.W.
          • Oh S.R.
          • et al.
          Bacterial entombment by intratubular mineralization following orthograde mineral trioxide aggregate obturation: a scanning electron microscopy study.
          Int J Oral Sci. 2014; 6: 227-232
          • Steffen R.
          • van Waes H.
          Understanding mineral trioxide aggregate/Portland-cement: a review of literature and background factors.
          Eur Arch Paediatr Dent. 2009; 10: 93-97
          • Camilleri J.
          • Cutajar A.
          • Mallia B.
          Hydration characteristics of zirconium oxide replaced Portland cement for use as a root-end filling material.
          Dental Materials. 2011; 27: 845-854
          • Siboni F.
          • Taddei P.
          • Prati C.
          • Gandolfi M.G.
          Properties of NeoMTA Plus and MTA Plus cements for endodontics.
          Int Endod J. 2017; 50: e83-e94
          • Torabinejad M.
          • Parirokh M.
          • Dummer P.M.H.
          Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview– part II: other clinical applications and complications.
          Int Endod J. 2018; 51: 284-317
          • Aly M.M.
          • Taha S.E.E.
          • El Sayed M.A.
          • et al.
          Clinical and radiographic evaluation of Biodentine™ and mineral trioxide aggregate in revascularization of non-vital immature permanent anterior teeth (randomized clinical study).
          Int J Paediatr Dent. 2019; 29: 464-473
          • Barrieshi-Nusair K.M.
          • Qudeimat M.A.
          A prospective clinical study of mineral trioxide aggregate for partial pulpotomy in cariously exposed permanent teeth.
          J Endod. 2006; 32: 731-735
          • Brizuela C.
          • Ormeño A.
          • Cabrera C.
          • et al.
          Direct pulp capping with calcium hydroxide, mineral trioxide aggregate, and Biodentine™ in permanent young teeth with caries: a randomized clinical trial.
          J Endod. 2017; 43: 1776-1780
          • Chailertvanitkul P.
          • Paphangkorakit J.
          • Sooksantisakoonchai N.
          • et al.
          Randomized control trial comparing calcium hydroxide and mineral trioxide aggregate for partial pulpotomies in cariously exposed pulps of permanent molars.
          Int Endod J. 2014; 47: 835-842
          • Harms C.S.
          • Schafer E.
          • Dammaschke T.
          Clinical evaluation of direct pulp capping using a calcium silicate cement-treatment outcomes over an average period of 2.3 years.
          Clin Oral Investig. 2019; 23: 3491-3499
          • Hilton T.J.
          • Ferracane J.L.
          • Mancl L.
          Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial.
          J Dent Res. 2013; 92: 16S-22S
          • Mente J.
          • Geletneky B.
          • Ohle M.
          • et al.
          Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome.
          J Endod. 2010; 36: 806-813
          • Qudeimat M.A.
          • Barrieshi-Nusair K.M.
          • Owais A.I.
          Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries.
          Eur Arch Paediatr Dent. 2007; 8: 99-104
          • Marques M.S.
          • Wesselink P.R.
          • Shemesh H.
          Outcome of direct pulp capping with mineral trioxide aggregate: a prospective study.
          J Endod. 2015; 41: 1026-1031
          • Mente J.
          • Hufnagel S.
          • Leo M.
          • et al.
          Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results.
          J Endod. 2014; 40: 1746-1751
          • Demarco F.F.
          • Rosa M.S.
          • Tarquínio S.B.
          • Piva E.
          Influence of the restoration quality on the success of pulpotomy treatment: a preliminary retrospective study.
          J Appl Oral Sci. 2005; 13: 72-77
          • Alqaderi H.E.
          • Al-Mutawa S.A.
          • Qudeimat M.A.
          MTA pulpotomy as an alternative to root canal treatment in children's permanent teeth in a dental public health setting.
          J Dent. 2014; 42: 1390-1395
          • Asgary S.
          • Eghbal M.J.
          Treatment outcomes of pulpotomy in permanent molars with irreversible pulpitis using biomaterials: a multi-center randomized controlled trial.
          Acta Odontol Scand. 2013; 71: 130-136
          • Asgary S.
          • Eghbal M.J.
          • Fazlyab M.
          • et al.
          Five-year results of vital pulp therapy in permanent molars with irreversible pulpitis: a non-inferiority multicenter randomized clinical trial.
          Clin Oral Investig. 2014;
          • Asgary S.
          • Eghbal M.J.
          • Ghoddusi J.
          • Yazdani S.
          One-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter, randomized, non-inferiority clinical trial.
          Clin Oral Investig. 2013; 17: 431-439
          • Asgary S.
          • Eghbal M.J.
          • Ghoddusi J.
          Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter randomized clinical trial.
          Clin Oral Investig. 2014; 18: 635-641
          • Caliskan M.K.
          • Guneri P.
          Prognostic factors in direct pulp capping with mineral trioxide aggregate or calcium hydroxide: 2- to 6-year follow-up.
          Clin Oral Investig. 2017; 21: 357-367
          • El-Meligy O.A.S.
          • Avery D.R.
          Comparison of mineral trioxide aggregate and calcium hydroxide as pulpotomy agents in young permanent teeth (apexogenesis).
          Pediatr Dent. 2006; 28: 399-404
          • Galani M.
          • Tewari S.
          • Sangwan P.
          • et al.
          Comparative evaluation of postoperative pain and success rate after pulpotomy and root canal treatment in cariously exposed mature permanent molars: a randomized controlled trial.
          J Endod. 2017; 43: 1953-1962
          • Nosrat A.
          • Seifi A.
          • Asgary S.
          Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial.
          Int J Paediatr Dent. 2013; 23: 56-63
          • Ricucci D.
          • Loghin S.
          • Siqueira Jr., J.F.
          Correlation between clinical and histologic pulp diagnoses.
          J Endod. 2014; 40: 1932-1939
          • Krastl G.
          • Galler K.
          • Dammaschke T.
          • Schäfer E.
          Is pulpotomy a valid treatment option for irreversible pulpitis?.
          Dtsch Zahnärztl Z Int. 2021; 3: 80-87