Chipped amalgam
Fig. 1

An adult patient came to me to replace a chipped amalgam restoration. The marginal discoloration suggested the presence of bacterial infiltrate.

Fig. 2

The pre-operative x-ray showed the presence of a void between the amalgam and the cavity liner.

Rubber dam isolation
Fig. 4

First of all, the tooth was isolated with the rubber dam by placing a clamp on the tooth 4.8.

Fig. 5

The amalgam restoration was removed, showing the presence of brown stains. Obviously they have to be removed in order to achieve a good cavity cleaning and to improve the adhesion.

Fig. 6

After removing the decayed tissue, the communication between the pulp chamber and the cavity was visible.

Fig. 8

A probe was used to confirm the setting of the MTA.

Fig. 9

At this point, a direct composite restoration was executed.

1 yr
Fig. 10

The 1 year-recall x-ray confirms the tooth is still vital.


Even if the direct pulp capping is not so diffused in adult teeth, MTA offers us the possibility to keep the tooth vital for a longer period of time, according to a minimally invasive approach. The use of a bismuth-free material does not expose the tooth to the risk of staining.

A dedicated carrier makes the positioning easy and predictable.


Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. Journal of endodontics. 2011;37(5):581-7.

Brizuela C, Ormeno A, Cabrera C, Cabezas R, Silva CI, Ramirez V, et al. Direct Pulp Capping with Calcium Hydroxide, Mineral Trioxide Aggregate, and Biodentine in Permanent Young Teeth with Caries: A Randomized Clinical Trial. J Endod. 2017;43(11):1776-80.

Dammaschke T, Stratmann U, Wolff P, Sagheri D, Schafer E. Direct pulp capping with mineral trioxide aggregate: an immunohistologic comparison with calcium hydroxide in rodents. J Endod. 2010;36(5):814-9.