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MEDTECH How can your selection of pulp therapy and medicament for treating deep caries in primary teeth be more personalized and grounded in biologic considerations?
Advancements in vital pulp therapies can significantly affect dental treatment plans for children with deep caries lesions. Understanding these evolving techniques can help dental practitioners make informed decisions and provide optimal care.
Key Points:
- The American Academy of Pediatric Dentistry (AAPD) guideline on vital pulp therapies for primary teeth with deep caries lesions recommends a biologic approach, noting high success rates with indirect pulp treatment (IPT), direct pulp cap (DPC), and pulpotomy.
- The choice of medicament in IPT and DPC does not influence their success, hence the panel recommends clinicians to select based on individual preferences.
- For pulpotomies, the panel strongly recommends the use of mineral trioxide aggregate (MTA) and formocresol, and conditionally recommends ferric sulfate, lasers, sodium hypochlorite, and tricalcium silicate. The panel recommends against the use of calcium hydroxide for pulpotomy.
Additional Points:
- The guideline was published by the AAPD on October 1, 2017, and last updated on March 14, 2022.
- It targets dental practitioners treating children with deep caries lesions, including female, male, and adolescent patients.
- The guideline’s scope includes the management and treatment of various dental conditions like pediatric dentistry and dental pulp capping.
Conclusion:
In treating deep caries lesions in primary teeth, the panel underscores the importance of a biologic approach over a one-size-fits-all strategy, pointing to the high success rates of IPT, DPC, and pulpotomy. The guideline highlights the role of practitioner preference in selecting medicaments for IPT and DPC, but provides specific recommendations for pulpotomy medicaments.
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“The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions. The panel noted the high success rates among IPT, DPC, and pulpotomy and recommends that the choice of pulp therapy in vital primary teeth with deep caries lesions should be based on a biologic approach.”
AAPD Guidelines, 2022
