Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

Indirect pulp capping
An indirect pulp cap is essentially where not all carious affected 
dentine has been removed and involves placement of a dressing on
the deepest dentine. There is some confusion in the literature (even 
in recent publications) with regards to definition of ‘indirect pulp
cap’. This term is often used to describe the situation where stained,
demineralised dentine is not removed and a calcium hydroxide lining
placed to encourage formation of tertiary dentine and kill any remain-
ing bacteria. An alternative definition is where calcium hydroxide is
used in a similar manner over soft, carious dentine.
Greater understanding of the caries process has led to the distinc-
tion between infected and affected dentine
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. Stained dentine may be
affected by caries (may be slightly demineralised or conversely may
be sclerosed) but may not necessarily be infected and thus removal of
such dentine would, in fact, be over preparation with unnecessary
loss of tooth structure. Thus it could be argued that the first definition
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of an indirect pulp cap (where stained, demineralised dentine is not
removed and a calcium hydroxide lining placed) reflects nothing
more than routine practice for pulp protection.
Although several studies have been completed with regard to pro-
gression of caries and prognosis of teeth in which permanent restora-
tions are placed over caries, there is at present insufficient evidence 
to support this approach. Thus the second approach to indirect pulp
capping (where soft, carious dentine is left) describes a procedure
that, with current evidence, should not be performed.
Given the above arguments and with confusion over the term 
indirect pulp cap, it is best to avoid this term and consider the use 
of calcium hydroxide for three lining purposes:
• For deeper cavities where it is estimated that less than 2 mm of 
dentine remains, a preparation liner should be placed in the 
deepest parts of the preparation (to encourage formation of tertiary
dentine and minimise risk of future exposure).
• For direct pulp capping procedures (to stimulate formation of calcific
repair).
• For stepwise caries removal (to encourage formation of tertiary dentine,
kill any remaining bacteria and reduce risk of exposure).