Saving the Day: Direct Restoration of Third Molar with Pulp Capping to Preserve Vitality and Function

Deep carious lesions are characterized by active caries lesion in the deep dentin with no pulp exposure. They are often associated with symptoms such as pain, sensitivity to temperature, and difficulty in mastication. If left untreated, they can lead to irreversible pulpitis or even pulp necrosis, necessitating endodontic treatment or extraction. Indirect pulp capping is a treatment option for deep carious lesions that aims to preserve the pulp vitality and function. The procedure involves removal of the infected dentin, followed by the application of a pulp capping agent over the remaining dentin to stimulate the formation of reparative dentin. In this case report, we present a successful treatment of a deep carious lesion on the third mandibular molar using indirect pulp capping followed by direct composite restoration.

The patient was a 30-year-old female who presented with extreme pain when drinking cold water. She had no spontaneous pain , but reported one-sided mastication when eating. Upon examination, a large cavity with an active carious lesion in deep dentin was observed on her third mandibular molar. There was no pulp exposure, and the adjacent tissue was normal. The percussion test was negative, indicating that there was no inflammation in the periapical region. Vitality testing showed that the tooth had a positive response. A radiograph revealed a deep caries lesion with thin dentin remaining.

The patient underwent caries excavation to remove the infected dentin. Indirect pulp capping was then performed using calcium hydroxide, which was left in place for 8 weeks to stimulate the formation of reparative dentin. After the 10-week period, the tooth was restored with a direct composite restoration. The restoration was polished for a smooth surface finish.

The patient reported no pain complaints , and convenient mastication was achieved using both sides of the mouth. The evaluation was done before the final restoration and 1 week after the final restoration, and the patient expressed satisfaction with the result.

In conclusion, the treatment of deep carious lesions with indirect pulp capping followed by direct composite restoration was successful in maintaining the pulp vitality and function. The procedure allowed for the preservation of the natural tooth and prevented the need for endodontic treatment or tooth extraction

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