Direct Pulp Capping — ORE Part 1 MCQ

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HardEndodonticsDirect Pulp CappingORE Part 1

In an adult patient, a vital permanent tooth has a small pulp exposure during operative treatment. Rubber-dam isolation, haemostasis and an immediate well-sealed definitive restoration are achieved. Which factor is most strongly associated with a reduced likelihood of successful direct pulp capping?

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Correct answer: D — A carious rather than mechanical pulp exposure

**A is correct.** A carious exposure indicates a substantially greater bacterial and inflammatory challenge than a clean mechanical exposure, reducing the likelihood that the remaining pulp will recover after direct capping. In one clinical cohort, success was 33.3% for carious exposures compared with 92.2% for mechanical exposures; age and tooth location were not significant predictors. Calcium hydroxide is associated with inferior longer-term outcomes compared with MTA in cariously exposed mature teeth, so D is a credible distractor, but it is not the principal discriminator in this controlled scenario. Exposure size may matter clinically, but does not outweigh the biological difference between a contaminated carious and clean mechanical exposure. Posterior location alone is not an independent reason to expect failure when isolation and coronal seal are adequate.

Reference: Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA. The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study. Journal of the American Dental Association, 2006. https://pubmed.ncbi.nlm.nih.gov/17138715/