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CAPPING THE PULP. 413
pliers—notably the Bogiie pliers ; but in the majority of instances it is
preferable to previously coat the convex side of the metal with wax,
when, with an instrument adapted to the case, it may be carried into
position and then placed in tlie manner described. It should next
be pressed into position with sufficient force to bring the margins in
contact with the dentin. Any excess of dressing should be taken away
by light touches of an excavator, and when the cavity is to be filled
temporarily it is better to fix the cap in place by flowing over it a little
chloro-pereha, which, when dried, prevents disturbance of its position
in the filling procedure.
Care should be taken that when the pulp is found exposed in a de-
pression, as occurs sometimes in the molars, this depression should be
filled nearly or quite to a level with the floor of the cavity by taking a
little of the dressing upon a sviitable instrument and carefully filling
this point ; otherwise, when the cap is placed, the paste may not find its
way into contact with the ])ulp.
At the moment of placing the cap, as the paste is yielding under the
gentle pressure of forcing the edges of the cap into contact with the
dentin, a little pain will sometimes be observed ; but
^' ^^- ^^^•
unless the paste is too stiff no compression of the pulp
should be caused.
Pilling- the Cavity.—Whether the cavity shall be
filled temporarily or ])ermanently depends upon the
prognosis. This, as will be perceived, is based upon
the constitutional conditions and the state of the pulp
^,,^^ .^^ position.
at the time of treatment.
For those of small experience in this line of treatment it would not
be safe to attempt the permanent stopping of the cavity, except in acci-
dental exposures and in cases where the history of no previous dis-
turbance can be elicited and where the thermal reaction is slight. Even
in the latter class it is generally best to delay permanent closure by a
conductor of heat until after an experience of a year or more with a
non-conducting stopjnng. At the end of this time the filling may be
nearly all removed, care being taken not to disturb the cap, when with
suitable precaution a metallic filling may be inserted.
In the majority of instances it is safest to fill the cervical part wdth
gutta-percha stopping, carrying the material over the cap, and then to
complete the filling with zinc phosphate. In this way, with an occa-
sional renewal of this temporary work, cases may be carried forward
from ten to fifteen years.
They may, however, be closed permanently and safely after an
experimental trial of five years where no irritation has ai)peared.
In many instances recovery takes place by secondary deposits of