Long term clinical assessment of direct pulp capping

Appropriate definitions, history and success rates of direct pulp capping procedures are reviewed. Two of the disadvantages of this form of treatment are infection of the pulp, either preoperatively or postoperatively due to a non-sterile procedure or bacterial leakage at the capping site. Past results of directly capping potential inflamed pulps have been unsatisfactory, but now an increasing number of endodontists advocate capping when conditions are favourable. Direct capping should only be used on vital pulp which has been accidentally injured and shows no other symptoms. Direct capping with calcium hydroxide should not be used on pulp which has been exposed as a result of penetrating caries. Clinical studies 2338 cases have shown that the risk of failure is increased if the pulp is diseased before capping, but that the age of the tooth does not have an adverse effect. It also appears that capping performed by skilled practitioners is more successful than that performed by students. The results of a re-examination of 110 patients, a minimum of 4 years after they had received direct capping treatment from students, showed a success rate of 80 per cent. In skilled hands, the success rate for direct capping with calcium hydroxide is now 90 per cent provided that a hermetic seal is obtained.