# Vital Pulp Therapy > Vital pulp therapy for NEET-MDS Conservative Dentistry: direct and indirect pulp caps, Cvek pulpotomy, MTA versus calcium hydroxide and case selection. - Canonical URL: https://prepelephant.com/topics/neet-mds/conservative-dentistry/vital-pulp-therapy-mds - Exam / course: NEET-MDS · Subject: Conservative Dentistry - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Vital Pulp Therapy", PrepElephant, https://prepelephant.com/topics/neet-mds/conservative-dentistry/vital-pulp-therapy-mds ## Direct answer Vital pulp therapy keeps a reversibly inflamed pulp alive instead of removing it, through a graded ladder: indirect pulp capping (now framed as selective caries removal, leaving affected dentine over the pulp), direct pulp capping of a pinpoint clean exposure, and pulpotomy amputating inflamed coronal pulp to healthy tissue. Success hangs on three variables the exam expects you to defend — diagnosis (reversible pulpitis only), material (calcium hydroxide's dentine bridge versus the mineral trioxide aggregate family's superior sealing), and the final restoration, because a leaking margin kills every pulp on the ladder. The young tooth with an open apex is the ideal candidate; the cariously exposed mature tooth is the frequent failure. ## What you must remember - Indications demand reversible pulpitis: sharp pain provoked by stimuli and gone within seconds, no spontaneous or nocturnal pain, normal periapical radiograph — anything else is pulpectomy territory. - Calcium hydroxide (pH about 12.5) necrotises a thin superficial layer and stimulates a dentine bridge, but the bridge contains tunnel defects; MTA sets in the presence of moisture, seals better and is the current standard, though it sets over hours and may grey the crown. - Biodentine and similar tricalcium-silicate cements set in roughly 10-15 minutes as "dentine replacement" beneath composite. - Direct pulp cap is for small, clean, uncontaminated exposures (mechanical or traumatic); a carious exposure in a mature tooth with symptoms generally proceeds to root canal treatment. - The Cvek (partial) pulpotomy removes 1-2 mm of traumatically exposed pulp in a young permanent incisor with a high-speed diamond under copious irrigation — reported success exceeds ninety per cent. - Stepwise excavation leaves caries-affected dentine over the pulp, seals for months (classically re-entered between roughly 3 and 12 months), and avoids exposure in deep caries; full re-entry and restoration completes the protocol. - Haemostasis is the intraoperative decision gate: bleeding that cannot be controlled within a few minutes with a damp cotton pellet signals irreversible inflammation — convert to pulpotomy or pulpectomy. - The coronal seal decides outcomes: same-visit definitive adhesive restoration, and a cusp-covering restoration for posterior teeth, are parts of the pulp therapy, not afterthoughts. ## Treating a fractured young incisor A nine-year-old trips at school and fractures the right central incisor with a pinpoint pulpal exposure, three hours old. The apex is open, the fracture margin is clean, and the pain is stimulus-provoked only — an ideal Cvek pulpotomy case. Under rubber dam, amputate 1-2 mm of pulp with a small diamond bur under copious water spray to reach healthy tissue. Control bleeding with a damp dilute-sodium-hypochlorite pellet — bleeding that stops cleanly confirms health; persistent ooze forces a deeper pulpotomy. Place a thin layer of white MTA or Biodentine over the wound, cover it with a flowable glass ionomer to protect the tricalcium silicate while it hydrates, and restore the crown with bonded composite at the same visit. Review through the first year: continued root development, a positive vitality response and absence of symptoms constitute success — apexogenesis achieved chairside. Contrast the adult deep-caries case: selective removal leaving firm affected dentine, glass ionomer lining, definitive restoration — the same principle, that a healthy pulp given a seal heals itself. ## Where students slip The material comparison is where candidates recite marketing instead of mechanism: calcium hydroxide works through controlled necrosis and bridge formation, MTA through a sealed, bioactive surface — and saying the bridge has tunnel defects is the sentence that earns the mark. The second slip is patient selection: direct pulp capping pitched at a carious exposure in a 45-year-old with night pain has chosen the failure arm of every study. The third is forgetting the restoration: examiners routinely ask "what decides the success of a pulp cap" and expect "the seal of the final restoration" before any material name. Finally, terminology matters: "selective caries removal" is the modern framing of indirect pulp therapy, and it is why aggressive excavation near the pulp is now discouraged. ## Frequently asked questions ### Compare calcium hydroxide with MTA as pulp-capping agents. Calcium hydroxide (pH about 12.5) forms a dentine bridge with tunnel defects; MTA seals better and shows higher success, at the cost of slow setting and discolouration. ### When is direct pulp capping contraindicated? Carious exposures in mature teeth, uncontrollable bleeding, any history of spontaneous pain, and teeth already needing full coverage. ### What is the Cvek pulpotomy? Amputation of 1-2 mm of exposed pulp after traumatic fracture in a young permanent tooth — success above ninety per cent, preserving apexogenesis. ### What happens at re-entry in stepwise excavation? After months of sealed arrest, the sclerotic affected dentine is excavated and the tooth definitively restored — the second stage distinguishing stepwise from permanent selective removal. ### Why is the final restoration part of vital pulp therapy? Microleakage along a defective margin re-infects the wound; the adhesive or cuspal seal is as decisive as the dressing. ### Which signs make you abandon vital pulp therapy mid-procedure? Persistent bleeding from the amputation site, purulent exudate or necrotic tissue — each converts the plan to pulpectomy.