In modern dental practice, preserving dental pulp is always a top priority, especially for primary teeth in children. On May 21, 2020, the Ministry of Health issued Decision No. 2121/QĐ-BYT on Guidelines for Technical Procedures in Odonto-Stomatology. Based on this official document, the Medical Knowledge section would like to introduce to colleagues the technical procedure of “Pulp capping of primary teeth using biomaterials” to ensure accuracy and effectiveness in clinical treatment.

General overview of the technique

Pulp capping of primary teeth using biomaterials is a technique to protect dental pulp by using highly biocompatible materials. Biomaterials in dentistry are defined as materials used in treatment to supplement, alter, or replace a part of body tissue, helping to stimulate the self-repair and protective capabilities of the dental pulp.

Indications and Contraindications

Selecting the correct clinical case is a prerequisite for treatment success. According to the Ministry of Health guidelines, this technique is applied and restricted in the following cases:

Indications:

The technique of pulp capping using biomaterials is indicated for:

• Teeth diagnosed with reversible pulpitis.
• Teeth with deep dentin caries close to the pulp, accompanied by symptoms of dentin sensitivity.
• Cases of small pulp exposure (less than 1mm in size) occurring during cavity preparation by the dentist.

Contraindications:

Absolutely do not perform this technique on teeth that already have pulp exposure points accompanied by clinical manifestations identified as irreversible pulpitis.

Preparation for the technical procedure

To ensure safety and effectiveness, the preparation process needs to adhere to personnel and equipment requirements strictly:

Personnel: The technique needs to be performed by an Odonto-Stomatology Specialist with the support of a dental assistant.

Means and instruments: It is necessary to fully prepare the dental chair unit, suitable handpieces and burs, standard examination set (tray, mirror, explorer, tweezers), and tooth isolation means. Especially, a specialized dental filling instrument set is indispensable.

Drugs and materials: Including antiseptics, biomaterials for pulp capping, and materials for coronal restoration (such as Composite, GIC).

Detailed procedure steps

The technical procedure is performed through the following standardized steps:

Step 1: Examination and evaluation

Before intervention, the doctor needs to check the medical records according to regulations, and simultaneously thoroughly evaluate the general health, local condition, and the tooth requiring treatment of the patient.

Step 2: Cavity preparation

The doctor uses suitable burs to widen the enamel margin, helping to clearly expose the carious cavity. Next, proceed to remove all necrotic dentin using suitable burs. After cleaning the diseased tissue, the cavity needs to be cleaned with physiological saline and dried properly.

Step 3: Placing biomaterials

This is the most important step of the procedure. The doctor uses a filling instrument to take the biomaterial and cover the cavity floor completely. Then, use a small cotton pellet to gently condense and smooth the surface of this biomaterial layer, ensuring tight adaptation and maximum protection for the dental pulp.

Step 4: Restorative filling

After the capping layer has stabilized, proceed to restore the remaining part of the cavity using suitable materials such as Composite or GIC. Finally, the doctor needs to check the occlusion and finish the restoration to ensure chewing function and aesthetics for the patient.

Monitoring and management of complications

During and after the treatment process, close monitoring is required to strictly handle complications that may occur:

During treatment: If pulp bleeding occurs, hemostasis must be performed immediately with a sterile cotton pellet. If bleeding cannot be stopped, consider switching to pulpotomy or pulpectomy techniques.

After treatment: If the tooth appears to have symptoms of irreversible pulpitis, pulpectomy is indicated for definitive treatment.

MSc. Dr. Cao Thanh Hoa – Deputy Director of the Center for Support & Continuing Education