Keys to clinical success with pulp capping: a review of the literature.

The consequences of pulp exposure from caries, trauma or tooth preparation misadventure can be severe, with pain and infection the result. The morbidity associated with treating pulp exposures is consequential, often requiring either extraction or root canal therapy. Both the loss of the tooth and its replacement, or endodontic treatment and tooth restoration, involve multiple appointments and considerable expense. An alternative procedure to extraction or endodontic therapy is pulp capping, in which a medicament is placed directly over the exposed pulp (direct pulp cap), or a cavity liner or sealer is placed over residual caries (indirect pulp cap) in an attempt to maintain pulp vitality and avoid the more extensive treatment dictated by extraction or endodontic therapy. Although many products have been suggested, a recent Cochrane Review found that evidence is lacking as to the most appropriate pulp capping material. In addition, various factors are believed to influence the success of both direct and indirect pulp capping. It is the purpose of this literature review to examine the evidence, issues and materials relevant to pulp capping.