Vital Pulp Therapy - AAPD Guidelines

The American Academy of Pediatric Dentistry creates a really hand series of guidelines. They have recently updated the Vital Pulp Therapy one this year. The evidence was gathered by the working group in 2024. It is not available on their website yet. But this is the link: Use of Vital Pulp Therapies in Primary Teeth 2024 - PubMed (nih.gov)

If you are treating children it is a good read. A brief summary of points

  • Hall crowns or Indirect Pulp Therapy have high success rates on vital teeth. On par with pulpotomies when you have good case selection

  • Direct pulp caps have lower success rates than HCs, IPCs or pulpotomies

  • Pulpotomies are successful when MTA or biodentine are used

  • Formocresol, Ferric Sulphate, CaOH, Lasers and ZOE are not suitable pulpotomy materials.

  • The restoration should be placed at the time of the pulpotomy.

  • Primary anterior tooth pulpotomies have similar success rates to posterior

  • We need more evidence for pulpotomies on irreversibly inflamed teeth. Permanent teet have success rates in the 80%

Main Take Away

The main point to take away here is this once again confirms you need to use a bioceramic silicate cement as a pulpal material. This could be MTA or Biodentine. Not using these materials WILL RESULT IN GREATER FAILURES FOR YOU. Our advice would be if you work in a clinic that refuses to provide you with these materials, you should cease offering pulpotomies. It will become increasingly indefensible to use inferior products as more evidence comes out.

Previous concerns were the cost of materials. But MTA has come down substantially. We organised for TGA approval for a simple and cheap MTA that can be purchased from: MTA – The Paediatric Dental Company (tp-dc.com.au) (We sell this product. There are plenty of others out there if you want to use them. Just make sure its MTA or Biodentine)

 

We hope this is helpful.

 Cheers

Tim, Sarah, Erica

 

 

Tim Keys