Root canal treatment can be avoided and some other alternative procedures can be done to maintain pulp vitality if:
(1) The pulp should have symptoms of reversible pulpitis ( application of hot, cold stimulus will cause sharp pain for 10-15 seconds but resolves upon removal)
(2) No periradicular disease is shown in radiograph ( no radiolucency/transparency around the roots)
(3) Tooth of interest should respond to pulp testing (to test for whether your tooth is still alive)
STEP WISE EXCAVATION
Caries can be excavated in 2 -3 appointments over few weeks to few months time. In every appointment, glass ionomer cement is placed to allow mineralization and zinc oxide eugenol cement is placed as a temporary restoration so that the dentist can continue excavating the caries in the next appointment. Advantage of this procedure is pulp exposure can be prevented but it is only applicable to those that believe pulp is capable to response to lesser insults.
INDIRECT PULP CAPPING
Soft, carious dentine is excavated with a spoon excavator or a slow speed handpiece and calcium hydroxide is placed on the floor of cavity. Review will be done after 6 weeks to assess whether there is any signs or symptoms persist.
DIRECT PULP CAPPING
If pulp is exposed by caries or during cavity preparation, after bleeding is controlled, we can either cap the pulp with calcium hydroxide or another type of material which is called mineral trioxide aggregrate followed by glass ionomer cement and a permanent restoration . This procedure is only applicable to reversible pulpitis. Success rate for direct pulp capping is high for small exposures where is lower in those who are exposed by carious lesion.
This procedure is done in young permanent teeth. Carious dentine is removed until radicular pulp .After bleeding is controlled, the surface is rinsed with sodium hypochlorite and filled with calcium hydroxide/Mineral Trioxide Aggregate and followed by Glass ionomer cement and a permanent restoration. Root formation should continue after this and providing no signs and symptoms occur.