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Direct pulp cap in a traumatic exposure — ORE Part 1 MCQ

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HardRestorative DentistryDirect pulp cap in a traumatic exposureORE Part 1

A 19-year-old attends within two hours of fracturing an upper central incisor. There is a pinpoint pulp exposure, the tooth is vital, bleeding is controlled, and the periapical radiograph shows a mature root with no apical pathology. The field can be isolated with rubber dam. What is the correct anatomical/physiological explanation for managing this tooth?

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Correct answer: A — A vital minimally contaminated pulp can heal if sealed with a biocompatible material

The physiological basis for managing traumatic pulp exposure via direct pulp capping is that a vital, minimally contaminated pulp—when promptly sealed with a biocompatible material (e.g. MTA, Biodentine, CEM)—has the intrinsic capacity to heal by forming a reparative dentinal bridge and maintaining vitality. This case meets all criteria: vital status (responded to percussion/colour), traumatic (not carious) origin, minimal contamination (pinpoint, <2 hours), controlled haemostasis, and rubber dam isolation for seal. Option D is wrong: mature teeth *do* form secondary and reparative dentin and dentinal bridges. Option B is wrong: sterilisation is not the mechanism; the seal prevents further contamination. Option C is wrong: sensibility testing indicates viability, not absence of inflammation. Option E is wrong: radiographs assess apical/root status, not intra-pulpal pathology. Answer A encapsulates the core principle: a properly sealed, vital, minimally traumatised pulp has excellent healing potential.

Reference: SDCEP Management of Acute Dental Problems Interim Guidance (MADP) – Injuries to the Mouth, Face and Jaws; ESE/IADT Vital Pulp Therapy guidelines (2023); PMC11414326 (2024), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11026997/