Simon, Stéphane

The recent development of new biomaterials and improved understanding of pulp biology have allowed a reconsideration of the systematisation of endodontic treatments in the case of pulp exposure. The importance of tissue conservation for the durability of treatments has been demonstrated. Pulp capping corresponds to the placement of a biomaterial in direct contact with the pulp. The objective of the treatment is to obtain a biological seal of the site. The prognosis of pulp capping depends on the material used, the age of the patient, the topographical location of the exposure and, above all, the inflammatory status of the pulp. Clinical evaluation of the inflammatory status of the pulp has proven to be the main limiting constraint to systematisation of this procedure. To mitigate this difficulty, in coming years, chamber pulpotomy could be considered as an alternative therapeutic option to endodontic treatment. Clinical implications: The objective of this article is to review the knowledge required for optimisation of therapeutics for pulp vitality conservation and to detail the factors that influence the prognosis. Parole chiave: pulp capping, pulp chamber pulpotomy, pulp vitality

Aim: To review the latest developments in the field of pulp biology, particularly those elements of specific interest to clinical dentists, whilst highlighting the importance of maintaining pulp vitality for conservative dentistry. Pulp biology is crucial to everyday practice in dentistry and the knowledge acquired, especially in the last five years on the pulp healing process, has highlighted simple but effective applications. However, difficulties in communication between biologists and clinicians, mostly due to the complexity of biology as a discipline, are a significant obstacle to therapeutic developments and their application on a larger scale. Methods: A literature review was undertaken on the current understanding of the biology of the dentine- pulp complex, especially in the context of conservative dentistry. Results: Novel biotechnological insights have recently been discovered, including the presence of stem cell-like cells within the tooth and their potential roles in reparative and regenerative processes. A greater understanding is also developing regarding the structure of the dentine-pulp complex, both macroscopically and microscopically, which may have important consequences for therapeutic choices. Conclusions: The emergence of new adhesive systems, together with disinfecting molecules, represent a first step towards the application of new biological approaches to the treatment of pulpal disease. Improved understanding of the many pathophysiological processes of the dentine-pulp complex and the development of new materials, which are being adapted to clinical conditions, has led to significant advances for the therapeutic principles underpinning conservative dentistry. Parole chiave: pulp biology, pulp regeneration, growth factors, reactionary dentinogenesis, TGFß1