Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_113_библиотеки_им_акад_М_И_Перельмана

Over the last few years, there has been a significant shift towards maintaining the dental pulp(1–4). From a research perspective, this push can be viewed as a triumph resulting from years of data gathering to understand the biology of the dental pulp.

Medical diagnosis is the process of determining which disease or condition explains a person’s symptoms and signs, but for pulpitis, this is not exactly the same. Although it is an inflammatory disease, generally caused by bacterial infection, the diagnosis of pulpitis has remained a conundrum for reasons including the anatomical location of the dental pulp and limitations of current diagnostic tools(14, 15). Over the years, different classifications and diagnostic systems have been advocated for pulpitis, reflecting the challenges and lack of consensus amongst experts (12). Although histology is the gold standard in diagnosis, attempts to classify pulp disease based on histology and symptoms failed due to the lack of correlation(7, 9) and because the pulp must be removed in order to examine it histologically. A more pragmatic approach based on signs and symptoms was introduced, and a different classification was proposed (12). The American Association of Endodontists (AAE) called for a consensus on classification and terminology used for pulp disease that resulted in the current widely used classification(13). This classification describes pulpitis as reversible, indicating that the inflammation should resolve following appropriate management, or irreversible, indicating that the inflamed pulp is considered incapable of healing and for which root canal treatment is indicated. These terms, however, do not take into consideration the current evidence showing that in carious teeth, pulpal inflammation and necrosis may be locally limited to the pulpal tissue adjacent to the carious lesion, while the rest of the pulp remains relatively normal(6). Furthermore, an improved understanding of pulp biology provides evidence of the regenerative capabilities of the pulp. We now know that pulpal inflammation is part of the healing response of the pulp to infectious or noxious stimuli. With the advent of hydraulic calcium silicate cement materials, VPT can be used to predictably save at least part of the pulp in teeth which were preoperatively diagnosed with “irreversible pulpitis”(16, 17).

diagnosis is to determine the condition of the dental pulp, i.e. not just in an absolute sense (vital versus non- vital), but also the degree of pulp inflammation if present.