who cares about the dental pulp?

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    isberequire post retention for large restorations, i.e., the rootcanal could still harbor a vital pulp if treated properly.

    Pulp capping, in the way it is commonly practiced,hapama








    Apropatient with a diseased or injured endodontium.

    Endodontists are today infatuated by implants, andan undeserving amount of effort has been diverted from

    Vol. 104 No. 5 November 2007s a low rate of success. This is despite the fact thatho cares about the dental pulp?

    odern endodontic therapy originated in the early 20thntury with pioneers like W. C. Davis and C. J. Grovescribing successful ways of treating the vital pulp.1,2time passed and the profession overcame the scare

    focal infection, successful treatment of teeth withinfected pulp space became a predictable proce-

    re.3 In the middle of the 20th century the technique tody the dental pulp was refined, allowing consider-le improvement in our understanding of healing pro-sses of pulp tissues.4-7 The clinical procedures re-ired for optimal healing after superficial pulp surgeryre well outlined more than 30 years ago.8-11 Duringlast 10-15 years, attempts to enhance pulp healing

    th osteogenic proteins and growth factors have beende with modest success.12 There have recently been

    ggestions of regrowing pulp space tissue throughsue engineering.13 However, this idea is 30-40 years14,15 and little progress has been shown since.

    Endodontology is the science that deals with thedodontium. An endodontist is supposed to be anpert on diseases of the endodontium as well as able toat the diseases thereof. Presently, however, the mostmmon therapy for the exposed and/or diseased pulpa total amputation. This crude therapy is unfortunate,cause today there are restorative materials that rarely

    EDITORIALst research has clearly outlined how it should opti-lly be done to result in a high rate of success.8-11is performance problem can often be tracked back tok of basic training in pulp biology and insufficientatment experience in dental school. When dentaldents have the rare opportunity to perform a super-ial pulp surgical procedure, it is rarely supervised orght by someone who has a solid understanding oflp biology. Worse yet, the endodontic teaching fac-y are rarely involved. As a matter of fact, I am not


    cure myself if I dare whisper the term pulp cappingd still be considered an endodontist.Superficial pulp surgery on permanent teeth, al-ugh an endodontic procedure, is most frequently

    ne in a general practice setting. Much research stillains to be done with this therapy to achieve a high

    el of success and predictability. This treatment ap-ars to be of little interest, however, to endodonticanizations on any continent. The International As-

    ciation for Dental Research Pulp Biology group haso shown little interest in the clinical application ofir basic science research efforts. This leaves anportant form of therapy without any active and pro-ssive interest group behind it. This is a pity, becausetooth is probably better off with a functioning pulp

    t is healed by hard tissues rather than a root canalplant. That would also relieve some of the existingh anxiety concerning the effect of coronal leakage.rthermore, we are still unaware of why the pulpsue is among the most densely innervated tissues in

    body, and proprioceptive functions, protecting theth from overload, cannot be ruled out.

    During the last couple of years, much endodonticearch has focused on implants and pulpal stem cells.substantial amount of money is spent on thesejects with little visible return for the endodonticlogic endodontic research. We have been led tolieve by implant proponents that the success rate ofplants greatly surpasses the success of endodonticatment. That has without doubt jolted the profession.cent available literature does not support that con-sion, however. We often tend to compare the reten-n rate of implants with endodontic treatment success.is is comparing apples to oranges. Success for im-nt procedures is vaguely defined. Therefore, the termtention is commonly used when outcome is dis-

    ssed. Implant retention does not exclude disease con-


  • ditions. Recent studies clearly show that many retainedimplants experience progressive bone loss, inflamma-tion, and infection. Retention rate for time periodsbeyond 5 years never exceed 92%. Comparable end-odontic data of retained teeth can be gleaned frominsurance data showing an endodontic retention rate of96%-97% after 8 years, which is substantially betterthan implant data. In my opinion, the endodontist needsto be well informed about these issues and assurehim/herself that the endodontic treatment provided isoptimal and offers better outcome than implant replace-ment for restorable teeth. In addition, the endodontistneeds to be less concerned about implants, which havethethedeen









    specialist knowledge and research grant support. This isan area the American Association of EndodontistsFoundation ought to focus on as high priority. It may beexciting to attempt to build connective tissue inside theroot canal but it is exceedingly more valuable to thepatient to preserve a real pulp, which is already there.

    Larz S. W. Spngberg, DDS, PhDSection Editor, Endodontology
















    OOOOE588 Editorial November 2007ir role in prostodontics. Instead, they should broadenir role in pulpal diagnosis and the treatment of the

    ntin and the dental pulp. This would lead to newhanced treatment options for the vital pulp beyondan amputation. The intellectual component of end-

    ontic practice would also be significantly improvedsuch changes.

    Stem cell research and scaffolding are nowzzwords in basic science pulp research. However,ffolding for tissue growth into the pulp space are oldas, and much can be learned from earlier stud-.14,15 Unfortunately, many computer search enginesnot return older studies, resulting in time-consumingnventions of the wheel. What is more important toember, however, is the fact that in most cases where

    dodontic procedures are done after pulp exposure, aly developed pulp already exists. Instead of ampu-ing the organ and then rebuilding it, a better ideauld be to treat and heal the diseased pulp that iseady established. In the world of contemporary mo-ular biology and pharmacology, it ought to be pos-le to save major parts of the endodontium.The endodontic community needs to enhance itsnical understanding of the vital pulp and dentin andbrace its treatment. Endodontic postgraduate stu-

    nts need vastly more education in this area to supportir future practices and to function as future leaders oflp biology in their dental communities. This field ofdodontology needs drastically more support both inFERENCESDavis WC. Pulpotomy vs. pulp-extirpation. Dent Items Interest1922;44:81-101.Grove CJ. Natures method of making perfect root fillings fol-lowing pulp removal, with a brief consideration of the develop-ment of secondary dentin. Dent Cosmos 1921;63:968-82.Strindberg LZ. The dependence of the result of pulp therapy oncertain factors. Acta Odont Scand 1956;14(Suppl):21.Zander HA. Reaction of the pulp to calcium hydroxide. J DentRes 1939;18:373-9.Glass RL, Zander HA. Pulp healing. J Dent Res 1949;28:97-107.Nyborg H. Healing Processes in the pulp on capping. Acta OdontScand 1955;13(Suppl):16.Nyborg H. Capping of the pulp. The processes involved and theiroutcome. Odont T 1958;66:296-364.Granath LE, Hagman G. Experimental pulpotomy in humanbicuspids with reference to cutting technique. Acta Odont Scand1971;29:155-63.Schrder U, Granath LE. Early reactions of intact human teeth tocalcium hydroxide following experimental pulpotomy and itssignificance to the development of hard tissue barrier. OdontRevy 1971;22:379-96.Schrder U. Evaluation of healing following experimental pulp-otomy of intact human teeth and capping with calcium hydrox-ide. Odont Revy 1972;23:329-40.Cvek M. A clinical report on partial pulpotomy and capping withcalcium hydroxide in permanent incisors with complicatedcrown fracture. J Endod 1978;4:232-7.Rutherford B, Fitzgerald M. A new biological approach to vitalpulp therapy. Crit Rev Oral Biol Med 1995;6:218-29.Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerativeendodontics: a review of current status and a call for action. JEndod 2007;33:377-90.Nevins AJ, Finkelstein F, Borden BG, Laporta R. Revitalizationof pulpless open apex teeth in rhesus monkeys, using collagen-calcium phosphate gel. J Endod 1976;2:159-65.Nygaard-stby B. The role of the blood clot in endodontictherapy. An experimental histologic study. Acta Odont Scand1961;19:323-53.