Animal study has demonstrated complete pulpal healing with and without complete tertiary dentin bridge formation. If most carious dentin is removed and an adequate synthetic seal is provided, is tertiary dentin bridge formation an absolute requirement for long term pulp cap success? Thank you.
Article Possible mechanisms of lack of dentin bridge formation in re...
Thanks for the question Suzan and thanks for the attachment Ali. I am reading it and learning.
Thank you Ali and Hashem. I am learning as well. I look forward to reading the attachments. If I come across any other literature that helps to answer my question, I will share. With my best regards.
Evaluation of formocresol, calcium hydroxide, ferric sulfate, and MTA primary molar pulpotomies
From what i know and according to what i've read about this subject, dentin bridge formation is one of the indicators of success of vital pulp therapies that can be accessed by radiographic means. However, we cannot access the quality of that "dentin". More important than the complete formation of the bridge is the quality of the hard tissue formed. That osteoid tissue (not entirely dentin but something more like "dentin like" tissue) has the objective of acting like an barrier for future agressions. The quality of the hard barrier is somehow related to the new odontoblast-like cells (that are not 100% true odontoblasts) and the inflammation degree.
Now, if we do not observe the complete formation of the "dentin bridge" but still have a positive response to sensibility tests, and the tooth seems to have reverted to an clinically health status, lets say, for about 6 months, I believe we can say that the tooth will have to rely on the sealing ability of the material you have used. Still, i believe that these teeth from a long term perspective will be more prone to fail than one with a completly formed hard tissue bridge.
In any case, its recommended to do a periodic control of the tooth. 1 week after the pulp capping aiming for the presence or absence of symptomatology. 6 months after the pulp capping searching once again for presence of symptoms, but this time you should also do a radiografic control. And finaly, you should do this check up every year from now on.
On the other hand, even with complete formation of the new hard tissue bridge you can expect a lot of variations of the success rates.
I've made my graduation theses about direct pulp capping, so i've read some literature about the subject. But still, i am no expert. One of the researchers that i liked the most was Dr. Domenico Ricucci, search for him here on researchgate and i bet that he'll have a more acurate answer for you.
Hope this helps.
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