Vital Pulp Therapy
What is it?
As in humans, the pet "endodontic system" is located in the mouth and encompasses the hollow area within a tooth filled with sensitive pulp tissue. Its purpose is to allow teeth to grow and respond to changes. When the pulp is stressed or traumatized, procedures are required to keep the tooth alive and protect it with medications and or restorations to remove the root canal entirely if it's causing undue harm.
At VDS, we specialize in treating both cases, as you'll see below.
As opposed to root canal therapy this procedure keeps the root canal intact by removing a small amount of the nerve and protecting it with medications and restorations.
Vital Pulp Therapy
This procedure is performed to keep the root canal system of a tooth alive.
The main indication for this procedure in veterinary patients is following crown reduction (lowering the height of the crown of the tooth). This is typically due to an orthodontic condition (malocclusion), causing a tooth to cause trauma to either another tooth or the oral soft tissues. This can result in painful ulcers and may even create a hole in the nasal cavity.
This can also result from certain oral surgeries, including major oral cancer surgery or a poorly aligned jaw fracture. However, the most common cause is the extraction of an upper canine tooth (especially in cats).
We try to avoid extractions of upper canines in cats for these reasons. In addition, having a veterinary dentist perform jaw fracture fixation reduces the risk of post-operative malocclusion. Finally, when this trauma is an unavoidable result of the planned surgery, a veterinary dentist will generally perform the procedure during the same anesthesia as the surgery.
Vital Pulp Therapy procedure consists of removing a small amount of the nerve. The living root canal is medicated to stimulate the tooth to lay down a protective layer of tooth structure. Following this, a layer of a restorative called glass ionomer is placed and then covered with a composite restoration (white filling) to provide an esthetic and strong restoration.
Outcomes and Research
This procedure has an excellent (near 100%) long-term success rate when properly performed on healthy teeth prior to crown reduction. In fact, Dr. Niemiec wrote the original technical papers on the subject.
This procedure was previously recommended for freshly fractured teeth in dogs and cats. However, studies (including one by Dr. Niemiec below) have shown that the long-term success rate for this procedure for fractured teeth is poor, mainly if it is not performed within a day or two.
Root canal therapy has an excellent long-term success rate and therefore is recommended in most cases of tooth fracture with direct nerve (root canal) exposure. The exception to this is in young patients. In young pets (under about a year of age), the tooth is not yet mature enough to accept a root canal. In these cases, this procedure can be performed to allow the tooth to mature to the point of accepting a root canal.