Vital pulp therapy (VPT) is an endodontic procedure used to treat a very recently fractured tooth with pulp exposure or when lowering the clinical crown height of a tooth in order to prevent trauma to other teeth or oral structures.
General Tooth Anatomy
The part of the tooth visible in the mouth is the crown. The crown is covered with a thin layer of hard, smooth enamel. This is the only part of the tooth that is not alive and supplied by nerves. The bulk of the tooth’s hard structure under the enamel is called dentin. Although this tissue appears hard, it is actually alive, very porous and has direct communications with the pulp. It’s more bone-like. The root is below the gum line and is not visible to us. It is composed of mostly dentin and makes up about 60% of the tooth’s volume. Pulp tissue is the tissue present within pulp chamber. This is the hollow area inside the pet’s tooth. It is and is made up primarily of blood vessels, nerves and connective tissue.
With any injured tooth, the main concern is whether the pulp chamber has been directly exposed by a fracturing or if it has suffered just a concussion with no visible trauma. With direct exposure after a fracture, the pulp will likely die (see below) unless it is treated almost immediately. If there is a concussion, with no physical evidence of fracturing, it may still die. Whenever the pulp does die, it will become infected; it is only a matter of time.
VPT is a treatment option for a tooth under two general circumstances: 1) For teeth that are acutely fractured with pulp exposure. Timing is very important! 2) For malocclusions with bite trauma to other teeth and/or the surrounding tissues.
- If a patient is less than 18 months old it has been shown that treatment from the time of the fracture out to about two weeks results in a high likelihood for a successful treatment.
- If a patient is older than 18 months old the window for a successful outcome for vital pulp therapy drops rapidly after 24 to 48 hours after pulp exposure.
- The longer the pulp has been exposed, the poorer the chances for successful treatment.
- For bite trauma patients, a crown reduction may be necessary to remove the source of trauma. Almost any crown reduction will expose the pulp. VPT will be needed immediately. This is more of a controlled exposure and the prognosis for tooth survival is better.
In pets where a vital pulp therapy is deemed an option they should be placed on a broad spectrum antibiotic and pain medication until the procedure can be performed.
Follow-up dental X-Rays will be needed to verify the tooth is remaining alive and healthy. A successful treatment is identified by rechecking the patient three to six months after vital pulp therapy; under anesthesia with a radiograph. A live tooth will show evidence of continuing to grow and become stronger as the tooth lays down more dentin internally to thicken the walls. The pulp canal becomes smaller as more dentin is deposited
If the tooth shows evidence that it has died and/or become infected, either an extraction or root canal treatment will be needed.