CATEGORY 70 AUSTRALASIAN DENTIST CLINICAL Summary Vital pulp therapy using MTA vpt allowed for minimally invasive and biologically respectful treatment of a deep carious lesion in a young adult. The procedure preserved pulp vitality, eliminated the need for provisional restorations, and restored aesthetics and function in a single visit, laying the foundation for a comprehensive rehabilitation with long-term success. Keywords vital pulp therapy, deep caries management, biological approach, MTA. Introduction The preservation of pulp vitality is a primary objective in modern conservative dentistry, especially when managing teeth with deep carious lesions. Vital pulp therapy (VPT) has evolved considerably over the last decades, offering clinicians predictable and biologically respectful alternatives to traditional endodontic treatment, especially in cases of reversible pulpitis and strategically important teeth. Techniques such as indirect and direct pulp capping, as well as pulpotomy, have gained prominence due to their ability to promote pulpal healing and continued root development, while reducing the need for invasive procedures [1,2]. Among the materials available for VPT, mineral trioxide aggregate (MTA) is one of the most extensively studied and clinically validated options. Its high biocompatibility, excellent sealing ability, and capacity to promote dentine bridge formation have established it as the gold standard for pulp capping procedures [3]. Newer formulations, such as MTA vpt (VOCO GmbH), offer improved handling properties and setting times while maintaining the same regenerative benefits and exhibiting no discolouration potential. Following pulp protection, the coronal restoration becomes a decisive factor in ensuring the long-term success of the treatment. A well-sealed, durable and biomimetic restoration protects the pulp, supports the remaining tooth structure and restores function and aesthetics. Recent developments in composite resin technologies have introduced thermo-viscous bulk-fill composites such as VisCalor bulk (VOCO GmbH). This material requires pre-heating and it offers enhanced adaptability during placing. When composite resins are preheated, their viscosity decreases, allowing improved cavity adaptation and handling. Additionally, elevated temperatures have been associated with increased degree of conversion and improved mechanical performance after polymerisation [4]. This innovation enables a simplified, timeefficient technique with excellent marginal adaptation, which is particularly valuable for structurally compromised teeth [4]. This case documentation demonstrates a conservative approach to treating a tooth with a deep carious lesion. It highlights the synergistic use of pulp protection treatment and advanced composite technology to provide a minimally invasive yet highly effective solution that aligns with the principles of restorative biomimetic dentistry. Clinical Case Presentation A 21-year-old female patient attended the dental clinic, reporting pain when eating chocolate or when food remained in the affected lower right molar. Upon clinical and radiographic examination (Figs. 1-3), it was found that tooth 47 had a deep, cavitated carious lesion involving the distal marginal ridge. The tooth responded positively to pulp sensitivity testing with cold (EndoIce, Maquira), indicating a diagnosis of reversible pulpitis. Given the young age of the patient, the absence of spontaneous pain, and the favourable response to vitality tests, a conservative approach was selected, using VPT with MTA (MTA vpt, VOCO GmbH), with the aim of preserving pulp vitality and the natural tooth structure. After anaesthesia and isolation with rubber dam (Dental Dam, Nic Tone), the carious tissue was selectively removed using caries-detecting dye (Caries Finder, Danville) to avoid contact with or exposure of the pulp (Figs. 4-7). Unfortunately, pulp exposure occurred at the disto-buccal base in the course of cavity preparation (Fig. 8). The bleeding from the vital pulp was stopped using cotton pellets soaked with sodium hypochlorite (NaOCl, 5.25 %) for 2 min. To protect the pulp, a biocompatible, calcium silicate-based material (MTA vpt, VOCO GmbH) was carefully placed over the area (Fig. 9) for direct pulp capping. This was done to induce and promote the formation of a hard tissue barrier between the pulp and the subsequent restoration. Before application of MTA vpt, the cavity was thoroughly cleaned with a microbrush soaked with NaOCl. Afterwards it was gently dried with a cotton pellet, ensuring a sufficiently dry environment without overdrying the dentine or exposing the pulp to desiccation. Excess moisture was avoided in order to prevent the material’s setting reaction from being compromised. MTA vpt does not require the use of a bonding agent prior to placement and can be applied directly to the dental hard tissues. Before mixing, the powder component of MTA vpt was shaken to ensure homogeneity. One level measuring scoop of powder was dispensed onto a mixing pad, and the jar was immediately closed to avoid exposure to ambient humidity. Two drops of the supplied liquid were then added, and the components were mixed thoroughly for approximately 30–60 seconds until a creamy, homogeneous consistency was obtained. The freshly mixed MTA vpt was carefully applied to the base of the cavity with a fine periodontal probe. The material was gently placed and adapted to cover the deepest portion of the cavity, especially the area of pulp exposure. After placement, the MTA vpt was left undisturbed for three minutes. The area was then inspected to confirm sufficient initial stability, after which a layer of resin-modified glass ionomer (Ionoseal, VOCO GmbH) was applied and light-cured for 20 seconds (Fig. 10). MTA vpt requires coverage with a protective restorative material, such as a flowable composite, resin-modified glass ionomer, or conventional glass ionomer, to provide sealing and serve as a transitional liner. Vital pulp therapy in deep caries using MTA-based direct pulp capping and adhesive restoration By Dr. Alejandra Darras Saavedra Dr. Alejandra Darras Saavedra
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