Protocol for Managing Pinpoint Exposure During Cavity Preparation in Permanent Teeth

Introduction

Cavity preparation in permanent teeth requires precision to remove carious dentin while preserving pulp vitality. Despite careful technique, pinpoint pulp exposures may occur, requiring immediate and effective management. Proper intervention is essential for ensuring long-term tooth viability and preventing complications like pulpitis or necrosis.

Understanding Pinpoint Pulp Exposure

Pinpoint pulp exposure refers to a small breach in the dentin that exposes the pulp chamber. This typically occurs in deep carious lesions or during aggressive cavity preparation. The prognosis depends on the pulp’s health, the exposure size, and timely intervention.

Step-by-Step Protocol for Managing Pinpoint Pulp Exposure

1. Assess the Exposure

   • Evaluate the size and location of the exposure.
   • Check for pulp vitality by assessing bleeding and response to vitality tests.
   • Ensure the exposure is free from contamination by saliva or debris.

2. Hemostasis Control

   • Use a sterile cotton pellet dampened with saline or a hemostatic agent (e.g., sodium hypochlorite at 0.5%-1%) to control bleeding.
   • Avoid excessive pressure to prevent further damage to the pulp tissue.

3. Pulp Capping

   • Direct Pulp Capping: If the pulp is vital with controlled bleeding, apply a biocompatible material such as:
     • Calcium hydroxide (Ca(OH)₂): Promotes dentin bridge formation but has lower long-term success.
     • Mineral trioxide aggregate (MTA): Exhibits better sealing ability and biocompatibility.
     • Biodentine: Provides superior dentin replacement properties and promotes healing.
   • Ensure the pulp capping material completely covers the exposure without excessive bulk.

4. Sealing the Preparation

   • Apply a resin-modified glass ionomer liner or adhesive bonding agent over the pulp cap.
   • Restore the tooth with a definitive restorative material, ensuring a well-sealed restoration to prevent bacterial microleakage.

5. Post-Treatment Care and Follow-Up

   • Educate the patient on possible post-operative sensitivity and symptoms.
   • Schedule follow-ups at 6-8 weeks and 3-6 months to assess pulp vitality and healing.
   • If symptoms such as lingering pain or signs of infection arise, consider further endodontic treatment.

Prevention of Pulp Exposure

• Use caries detection dyes to selectively remove infected dentin.
• Apply a stepwise excavation technique for deep lesions.
• Utilize magnification (loupes or microscopes) for better visualization.

Conclusion

Timely and proper management of pinpoint pulp exposures can preserve pulp vitality and prevent the need for root canal therapy. Using evidence-based materials and techniques ensures optimal outcomes for both the patient and clinician.

About the Author

Dr. Hajeera Banu is a skilled dentist who graduated from RGUHS in 2014 and has since built a successful career in the field. With a strong focus on implants, restorative dentistry, and aligners, she has honed her expertise to offer her patients the highest level of care. Based in Mysore, India, Dr. Banu runs her own private practice, where she combines advanced dental techniques with a patient-centered approach.

Her passion for dentistry extends beyond her practice; she stays up-to-date with the latest advancements in the field to ensure she delivers the best outcomes. Outside of her professional life, Dr. Banu enjoys blogging, where she shares insights and experiences from her dental journey, as well as her love for cooking and traveling. These interests help to balance her dynamic lifestyle, and she continues to seek personal and professional growth in all aspects of her life. Dr Hajeera can be contacted on denitstryunited@gmail.com