While endodontists excel at performing root canal therapy on teeth compromised by injury or infection, they also have other effective techniques for saving natural teeth. One procedure that can provide excellent results is vital pulp therapy, or VPT. Once considered something that could only be performed on younger patients with still-developing adult teeth, today VPT has been proven even more broadly effective when patients meet a select set of circumstances related to the state of their pulp — the mass of blood vessels, nerves and connective tissues that represent the living center of a tooth.
How Vital Pulp Therapy Works To Preserve Natural Teeth
There are three main versions of VPT. Endodontists determine which one has the greatest chance of success by a careful examination of a patient’s tooth and of the decay or infection present in the pulp.
Direct capping of the pulp is most often used in immature adult teeth or in teeth that do not show evidence of irreversible pulp inflammation. This approach calls for the removal of all the infected pulp, followed by irrigation of the affected area with a solution of 17 percent ethylenediaminetetraacetic acid (EDTA). Once the area from which the pulp was removed has been capped with a bioceramic material, the healing can begin.
Indirect capping is a technique that is similar to direct capping, but in this case, some or all of the infected pulp is left in place to avoid direct exposure of the pulp during examination or the capping process itself. A cap is placed over the infected pulp to stop the infection from spreading and to promote reparative dentin development in the tooth.
Pulpotomies are yet another type of vital pulp therapy. They are performed by removal of infected pulp down to healthy coronal tissue, or even into the canals of the tooth if necessary. Medicines may be applied to address the inflammation and the infection. As with the previous two treatments, the area is capped with a biocompatible ceramic restoration. A light-cured glass ionomer may be added above the cap to ensure the solution for saving the tooth is permanent and leak proof.
“Vital pulp therapy offers another opportunity for endodontists to preserve natural teeth — in some cases, the pulp itself can be preserved,” says Dr. Susan L. Wood, who practices with the Phoenix Endodontic Group. “Our specialty is constantly evaluating therapeutic techniques like VPT for their efficacy in saving teeth over the long term.”