[Long-term clinical supervision of direct pulp capping (performed by the students of the School of Dentistry, Geneva)].

Of 123 teeth treated by direct pulp capping 110 could be rechecked clinically and radiographically after periods of 1 1/2 to 7 years, 4 on the average. In 25 cases a change in endodontic treatment has been recorded on the files: In 18 cases biopulpectomy was performed for symptomatic (pain) reasons considered as failure of the capping treatment; in 5 cases biopulpectomy was indicated for periodontal and prosthetic reasons (not considered as failure); in 5 cases of the 110 rechecked necrosis and periapical involvement was diagnosed. The rate of failure thus was 22 cases or 17%. This relatively high ratio of unfavorable results (Tab. VII) is in part due to lack of operative skill of the students while progressing tooth morbidity statistically established in the Genevan population also was taken into account. Advancing tooth ages according to graph figure 6 in accordance with other recent surveys were found to constitute no impediment for direct pulp capping. The success of this endodontic treatment is best ascertained by observing a strict selection of the case and the observance of an exacting operative procedure, namely: - Only accidentally exposed pulps without symptoms of previous spontaneous pain (Category I) are liable to successful conservation by direct pulp capping using calcium hydroxide. Previously painful pulps (Category II) according to Table VIII are either indirectly capped using corticosteroids particularly in young teeth or after exposure subject to coronal or radicular pulpotomy (Category III). Rigorous aseptical procedure and lasting hermetical sealing of the calcium hydroxide pulp dressing are additional prerequisites for success.