Review Article
Volume 20 Issue 7 - 2021
Conservative Management of Endodontic Exposure
Mahmoud Nasser Alwesaidi1*, Badr Ali Albedair2, Suhail Mohammad Binmahmoud2, Ahmed Fahad Alamri2, Feras Majed Alwesaidi2, Omar Hamza Alamri2, Almuayad Mansour Alhejeili2, Abdulaziz Mohammed Almuzaini2 and Abdulmajeed Mohammed Alhumaidi2
1Specialty Dental Centre, King Fahad Hospital, Jeddah, Saudi Arabia
2Taibah University, College of Dentistry, Al Madinah Al Munawwarah, Medina, Saudi Arabia
*Corresponding Author: Mahmoud Nasser Alwesaidi, Specialty Dental Centre, King Fahad Hospital, Jeddah, Saudi Arabia.
Received: June 22, 2021; Published: June 29, 2021


Introduction: Healthy pulp tissue is of utmost importance so as to prevent the inflammation throughout the pulp causing various periapical pathosis therefore, the maintenance of the same forms the basis of minimally invasive dentistry. Although, the dental pulp itself exhibits various protective mechanisms against irritation, yet the conservative management of the exposed pulp has been unpredictable. Vital pulp therapy (VPT) is a commonly done procedure in deciduous dentition for maintenance of pulp and preservation of tooth. The same has been advocated in mature permanent teeth as well as a conservative method for mechanical, iatrogenic, and carious pulpal exposure. The earlier studies showed the poor outcome of VPT but the advent of more advanced dental biomaterial and evolving understanding of molecular biology and regenerative medicine have led to the era of new treatment strategies for the exposed pulp. Knowledge of histopathology and bacteriology of the cariously exposed pulp is also a key factor for proceeding to this ultraconservative management of pulp exposure. The healing potential of the inflamed pulp, proper case selection, appropriate restorative and capping material selection, strict aseptic condition, good marginal seal are some crucial factors for the long-term success of these treatments.

Aim of the Study: The purpose of this review is to understand and have a different perspective of vital pulp therapy and its better role in the preservation of pulpal inflammation and disease in pulpal exposure along with the various advanced capping material used for the same.

Methodology: The review is a comprehensive research of PUBMED, MEDLINE, SCOPUS, SCHOLAR from year 1963 to 2020.

Conclusion: Maintenance of pulp vitality by the adoption of minimally invasive procedures is highly encouraged in adult teeth with carious pulp exposure. Parallel with the need for an update of the diagnostic terminology of the state of the pulp, there is an urgent need for a more representative pulpal diagnostic method.

Keywords: Vital Pulp Therapy; Calcium Hydroxide; Calcium-Silicate-Based Biomaterials; Pulp Exposure


  1. Bergenholtz G. “Iatrogenic injury to the pulp in dental procedures: aspects of pathogenesis, management and preventive measures”. International Dental Journal2 (1991): 99-110.
  2. Taha N A., et al. “Conservative management of mature permanent teeth with carious pulp exposure”. Journal of Endodontics9 (2020): S33-S41.
  3. Seltzer S., et al. “The dynamics of pulp inflammation: correlations between diagnostic data and actual histologic findings in the pulp”. Oral Surgery, Oral Medicine, Oral Pathology7 (1963): 846-871.
  4. Swift Jr E J., et al. “Vital pulp therapy for the mature tooth–can it work?” Endodontic Topics1 (2003): 49-56.
  5. American Association of Endodontists (AAE)Glossary of Endodontic Terms, ninth edition (2015).
  6. Zilberman U., et al. “Partial pulpotomy in carious permanent molars”. American Journal of Dentistry4 (4): 147-150.
  7. Aguilar P and Linsuwanont P. “Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review”. Journal of Endodontics5 (2011): 581-587.
  8. Ricucci D., et al. “Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure”. Journal of Dentistry 86 (2019): 41-52.
  9. Duncan H F and Yamauchi Y. “Pulp exposure management”. Clinical Dentistry Reviewed1 (2019): 1-9.
  10. Matsuo T., et al. “A clinical study of direct pulp capping applied to carious-exposed pulps”. Journal of Endodontics10 (1996): 551-556.
  11. Pigg M., et al. “Validity of preoperative clinical findings to identify dental pulp status: a National Dental Practice-Based Research Network Study”. Journal of Endodontics6 (2016): 935-942.
  12. Taha N A and Abdelkhader S Z. “Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis”. International Endodontic Journal8 (2018): 819-828.
  13. Asgary S., et al. “Treatment outcomes of 4 vital pulp therapies in mature molars”. Journal of Endodontics4 (2018): 529-535.
  14. Linsuwanont P., et al. “Treatment outcomes of mineral trioxide aggregate pulpotomy in vital permanent teeth with carious pulp exposure: the retrospective study”. Journal of Endodontics2 (2017): 225-230.
  15. Bjørndal L., et al. “Management of deep caries and the exposed pulp”. International Endodontic Journal7 (2019): 949-973.
  16. Bogen G., et al. “Direct pulp capping with mineral trioxide aggregate: an observational study”. The Journal of the American Dental Association3 (2008): 305-315.
  17. Ghoddusi J., et al. “New approaches in vital pulp therapy in permanent teeth”. Iranian Endodontic Journal1 (2014): 15.
  18. Barthel C R., et al. “Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study”. Journal of Endodontics9 (2000): 525-528.
  19. Murray P E and Garcia-Godoy F. “The incidence of pulp healing defects with direct capping materials”. American Journal of Dentistry3 (2006): 171.
  20. Paranjpe A., et al. “Direct contact with mineral trioxide aggregate activates and differentiates human dental pulp cells”. Journal of Endodontics12 (2011): 1691-1695.
  21. Witherspoon D E., et al. “Mineral trioxide aggregate pulpotomies: a case series outcomes assessment”. The Journal of the American Dental Association5 (2006): 610-618.
  22. Hirschman W R., et al. “Cytotoxicity comparison of three current direct pulp-capping agents with a new bioceramic root repair putty”. Journal of Endodontics3 (2012): 385-388.
  23. Bidar M., et al. “Effect of calcium hydroxide premedication on the marginal adaptation of calcium-enriched mixture cement apical plug”. Dental Research Journal6 (2012): 706.
  24. Nakamura Y., et al. “Enamel matrix derivative promotes reparative processes in the dental pulp”. Advances in Dental Research1 (2001): 105-107.
  25. Burdock GA. “Review of the biological properties and toxicity of bee propolis (propolis)”. Food and Chemical Toxicology4 (1998): 347-363.
  26. Mohanty S and Ramesh S. “Comparing Quality and Quantity of Dentin Bridge Formed Using Mineral Trioxide Aggregate, Biodentine, and Propolis: A Double-blinded Randomized Controlled Clinical Trial”. World 5 (2020): 374.
Citation: Mahmoud Nasser Alwesaidi., et al. “Conservative Management of Endodontic Exposure”. EC Dental Science 20.7 (2021): 89-97.

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