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Vital Pulp Therapy: Direct Pulp Capping

A direct pulp cap should be used to treat small (1mm or less) mechanical exposures during caries excavation. Before performing a direct pulp cap, it is important that the pulp vitality is established. The tooth should:

• not have a history of spontaneous pain
• should test vital to cold test and/or EPT
• the PA should not show any periapical pathology
• the tooth should be restorable

If the tooth fits the criteria listed above, you can proceed with performing a direct pulp cap.

Steps:

1. Place rubber dam isolation (if not already placed).
2. Control hemorrhage by applying pressure to exposure with cotton pellet.
   • If bleeding does not stop with pressure alone, soak cotton pellet with saline or dilute sodium hypochlorite (found on cart or on endo cart).
3. Place MTA.
4. Seal with Vitrebond.
5. Restore with permanent restoration.
6. Inform patient of situation and advise patient to return if any symptoms of irreversible pulpitis arise.
7. Reevaluate in 6 months.
   • Document history of symptoms
   • Perform vitality testing
   • Take new PA radiograph to monitor for periapical changes