Pulp-dentin biology in restorative dentistry. Part 7: The exposed pulp

Exposure of the dental pulp, through a caries lesion, accidentally during routine cavity preparation, or as a result of tooth fracture, is a clinical reality that requires optimal treatment. The potential for healing by formation of a dentinal bridge is good, provided that the pulp is not inflamed. Calcium hydroxide has a long history of inducing dentinal bridge formation to promote successful healing. Resin composites are emerging as alternative materials for pulp capping, but healing is slower, and relatively little clinical experience is available for analysis. The prognosis for healing is poor after exposure of an inflamed pulp. Pulpotomy should be considered to create a wound in an uninflamed location. If an exposure is expected through a caries lesion, stepwise excavation of the carious dentin should be considered to allow healing of the dentin and pulp prior to the final excavation of the carious dentin.