Considerations for the direct pulp capping procedure in primary teeth: a review of the literature

In reviewing the various studies concerning the direct pulp capping procedure in primary teeth, using rigid criteria for case selection and procedure appears to insure a significant amount of success. It is acknowledged that vital primary pulp tissue is capable of healing without resorting to complete pulpectomy, although statistically direct pulp capping has been found to be less successful in primary teeth than indirect pulp therapy or coronal amputation (pulpotomy). To achieve success for direct pulp capping in primary teeth, the considerations involve: selecting teeth with minimal or no clinical signs of pulpal inflammation; or pretreating the carious tooth with a sedative restoration before excavating the caries; disinfecting the cavity floor; enlarging the actual exposure, and flushing out dentinal debris with mild solutions; controlling bleeding by not allowing a clot to form; placing a hard-set, CaOH material over the exposure, followed by a fast-setting, zinc oxide-eugenol cement to achieve a hermetic seal; and lastly, placing a stainless steel crown to minimize microleakage and prevent a fractured or defective restoration. These procedural steps can hardly ensure complete success in direct pulp capping of a primary tooth; but, based on the many cited investigations in this review, a significant amount of success can be expected without resorting more frequently to invasive techniques. Surely the evidence presented leading to the feasibility of direct pulp capping in primary teeth merits further investigations, before dogmatically rejecting this procedure of pulp therapy.