u/AlDumaz

I am a recently graduated dentist and have just started working in a private practice under the supervision of the practice owner.

Today, I treated a 40-year-old patient presenting with a large buccal cervical carious lesion on tooth 47. During caries excavation, I encountered extensive soft, infected dentin and a carious pulp exposure occurred. At the time of exposure, carious dentin was still present around the exposure site.

I informed the senior dentist that I was planning to proceed with a pulpotomy, and the patient had already been informed preoperatively of this possible outcome. However, he decided against further caries excavation and instead placed a calcium hydroxide liner directly over the exposed pulp and the surrounding carious dentin before restoring the tooth with composite resin.

This management approach seems questionable to me. During my undergraduate training, I was taught that a carious pulp exposure in a mature permanent tooth is generally an indication for root canal treatment. If a direct pulp cap is considered, complete removal of infected dentin and placement of a bioactive material such as MTA or Biodentine would typically be recommended. In this case, neither MTA nor Biodentine was available in the practice.

I would be interested to hear your opinion on the appropriateness of placing calcium hydroxide directly over an exposed pulp while carious dentin remains at the exposure margins and then proceeding with a definitive composite restoration. How would you manage such a case according to current evidence and clinical guidelines?

I am a recently graduated dentist and have just started working in a private practice under the supervision of the practice owner.

Today, I treated a 40-year-old patient presenting with a large buccal cervical carious lesion on tooth 47. During caries excavation, I encountered extensive soft, infected dentin and a carious pulp exposure occurred. At the time of exposure, carious dentin was still present around the exposure site.

I informed the senior dentist that I was planning to proceed with a pulpotomy, and the patient had already been informed preoperatively of this possible outcome. However, he decided against further caries excavation and instead placed a calcium hydroxide liner directly over the exposed pulp and the surrounding carious dentin before restoring the tooth with composite resin.

This management approach seems questionable to me. During my undergraduate training, I was taught that a carious pulp exposure in a mature permanent tooth is generally an indication for root canal treatment. If a direct pulp cap is considered, complete removal of infected dentin and placement of a bioactive material such as MTA or Biodentine would typically be recommended. In this case, neither MTA nor Biodentine was available in the practice.

I would be interested to hear your opinion on the appropriateness of placing calcium hydroxide directly over an exposed pulp while carious dentin remains at the exposure margins and then proceeding with a definitive composite restoration. How would you manage such a case according to current evidence and clinical guidelines?