4A–4D. The chief steps in performing vital pulp therapy, in this case on the left mandibular canine tooth in a dog. In 4A,
a tooth stump after amputation of the crown (an intentional complex crown fracture) is seen, with the red dot representing
bleeding pulp tissue. In 4B, powdered mineral trioxide aggregate is being introduced into the pulp chamber with a sterile
paper point. In 4C, a glass ionomer is being used as a cavity liner. And in 4D, a bonded composite restoration is being cured
with ultraviolet light.; 5A & 5B. In the dental radiograph at top (5A), the left maxillary first incisor in a dog has a complex
crown fracture (1) and periapical radiolucency (2), indicating endodontic disease. The dental radiograph at bottom (5B) shows
the same tooth after root canal treatment. The root canal has been cleaned, shaped, and filled with a combination of rubber
(gutta percha) and cement (AH-26—Dentsply International).
Vital pulp therapy is an endodontic procedure that involves removing most of the coronal portion of the pulp, placing a pulp-capping
agent to stimulate formation of tertiary dentin over the pulp, and then applying a bonded composite restoration (Figures 4A-4D). Recent research indicates that mineral trioxide aggregate is superior to traditional calcium hydroxide as a pulp-capping
agent.14 The goal of vital pulp therapy is to maintain vital pulp tissue beneath the restoration and protect that vital tissue from
noxious stimuli and bacterial invasion.
Root canal treatment
Root canal treatment involves completely removing pulp tissue and the diseased dentin and then completely filling the débrided
canal with a sealant and core material (most often gutta percha.) It is a much less invasive treatment than tooth extraction,
and the patient retains its teeth (Figures 5A & 5B).
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