Title
Direct Pulp Capping with MTA Under Microscope and Absolute Isolation Followed by Adhesive Composite Restoration
Abstract
This case report describes the conservative management of a deeply carious posterior tooth using direct pulp capping with Mineral Trioxide Aggregate (MTA) under dental microscope magnification and strict rubber dam isolation. Following biologic pulp management, the tooth was restored with a direct adhesive composite restoration. The case highlights the role of magnification, isolation, and material selection in preserving pulp vitality and achieving predictable restorative outcomes.
Clinical Situation
A patient presented with a posterior tooth exhibiting deep caries and food impaction. Clinical examination revealed extensive dentinal involvement approaching the pulp. Radiographic assessment confirmed deep caries without periapical pathology, indicating a vital pulp with favorable prognosis for conservative treatment.
A decision was made to preserve pulp vitality using direct pulp capping rather than proceeding with endodontic treatment.
Treatment Objectives
- Preserve pulp vitality
- Maintain a contamination-free operative field
- Perform treatment under magnification for precision
- Restore the tooth with a durable direct adhesive restoration
Clinical Procedure
Isolation and Caries Removal
The tooth was isolated using rubber dam isolation, ensuring complete moisture control and bacterial exclusion. All procedures were performed under dental microscope magnification, allowing accurate differentiation between infected and affected dentin.
Caries removal was carried out conservatively to preserve maximum tooth structure.
Direct Pulp Capping Under Microscope
During excavation, a small mechanical pulp exposure was encountered. The exposure was clean, and bleeding was minimal.
Hemostasis was achieved gently without excessive pressure. Under magnification, the pulp tissue was inspected and appeared healthy and vital.
Mineral Trioxide Aggregate (MTA) was selected for direct pulp capping due to its:
- High biocompatibility
- Excellent sealing ability
- Proven capacity to stimulate reparative dentin formation
- Long-term clinical success in vital pulp therapy
MTA was carefully placed directly over the pulp exposure under strict isolation, ensuring precise adaptation without contamination.
Direct Composite Restoration
After initial setting of MTA, the cavity was restored using an adhesive protocol. Enamel and dentin bonding was performed according to manufacturer guidelines, followed by incremental placement of resin composite.
A layered technique was used to:
- Reinforce remaining tooth structure
- Restore proper occlusal anatomy
- Minimize polymerization shrinkage
Occlusion was checked and adjusted to avoid excessive loading on the restored tooth.
Outcome and Follow-Up
The patient remained asymptomatic post-operatively. Clinical evaluation showed good marginal integrity and functional stability. Radiographic follow-up demonstrated no periapical changes, indicating successful preservation of pulp vitality.
Discussion
Direct pulp capping remains a reliable treatment option when strict case selection, isolation, and biologic principles are followed. The use of MTA under microscope magnification significantly enhances procedural accuracy and success rates.
Rubber dam isolation plays a critical role in preventing bacterial contamination, while magnification allows precise placement of pulp capping material and careful assessment of pulpal status.
Immediate direct adhesive restoration helps seal the pulp capping material and protects the tooth from microleakage.
Clinical Takeaways
- Vital pulp therapy is predictable under strict isolation
- Microscope use improves diagnostic and operative precision
- MTA is a gold standard material for direct pulp capping
- Direct composite restorations provide effective coronal sealing
Conclusion
Direct pulp capping with MTA under dental microscope magnification and absolute isolation, followed by immediate adhesive composite restoration, offers a predictable and biologically sound approach for managing deep carious lesions while preserving pulp vitality.
References
1.Bjørndal L, Simon S, Tomson PL, Duncan HF.
Management of deep caries and the exposed pulp.
International Endodontic Journal. 2019;52(7):949–973.
doi:10.1111/iej.13128
2.Mente J, Geletneky B, Ohle M, et al.
Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome.
Journal of Endodontics. 2010;36(5):806–813.
doi:10.1016/j.joen.2010.02.024
3.Dammaschke T, Leidinger J, Schäfer E.
Long-term evaluation of direct pulp capping—treatment outcomes over an average period of 6.1 years.
Clinical Oral Investigations. 2010;14(5):559–567.
doi:10.1007/s00784-009-0326-3
4.Hilton TJ, Ferracane JL, Mancl L.
Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial.
Journal of Dental Research. 2013;92(7 Suppl):16S–22S.
doi:10.1177/0022034513484336
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