Читать книгу Endodontic Materials in Clinical Practice - Группа авторов - Страница 36

For predictable and successful VPT, careful material selection is required. The demands on the material itself are numerous, as it is situated in a unique environment in which it must interface with vital tissue that has a blood supply, hard dental tissues, and other restorative materials. Historically, numerous different materials have been used in VPT, including gold foil [88], aqueous calcium hydroxide [89], commercial preparations of calcium hydroxide [90], glycyrrhetinic acid/antibiotic mixture [91], resin bonding agents [92], corticosteroid/antibiotic mixture [93], isobutyl cyanoacrylate [94], resin‐modified glass ionomer [95], and, more recently, HCSC [96].

The fundamental aim of any material used in VPT is to maintain a viable pulp so that it can continue normal homeostatic and protective functions of the tooth. As the pulp has the ability to lay down dental hard tissue in the form of reactionary or reparative dentine, the chosen material should promote this response in order to increase the thickness of dentine between the pulp and the deepest part of any cavity (Figure 2.2). The production of a thicker layer of mineralized tissue over the pulp renders it well protected from future noxious stimuli. Any pulp‐capping material should also have antimicrobial properties, as it is well established that pulp necrosis will not result without the presence of microorganisms [12].

Materials used in VPT should have the following characteristics:

 Antimicrobial activity

 Creation of a bacterial tight seal and prevention of microleakage

 Promotion of tertiary dentinogenesis and control of hard tissue barrier formation

 Biocompatibility (prevention of ‘over’‐irritation and avoidance of induction of a severe inflammatory response

 Radiopacity

 Clinical ease of handling

 Resistant to forces of displacement following the subsequent application of a further material over the agent used in VPT

 Lack of induction of tooth discolouration

No one material demonstrates all of these properties, but in recent years significant advances have been made. Recently used pulp‐capping agents will be considered in this section.