Vital Pulp Therapy and Endo Essentials for GPs with Dr. Judy McIntyre

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Should you perform a pulpotomy, a direct pulp cap, or a full root canal on a mature tooth with deep caries? Endodontist Dr. Judy McIntyre gives general dentists a candid, practical guide to vital pulp therapy, when a preoperative CBCT is essential, what separates a well-done root canal from a compromised one, and how to know your limits and build a real partnership with your endodontist.

In this episode, you'll learn:

• What vital pulp therapy is and isn't, from open-apex teeth to mature adult teeth
• Why preoperative symptoms matter when choosing between vital pulp therapy and root canal therapy
• Her pulpotomy technique: diamond bur, hemostasis, sodium hypochlorite, and a bioceramic or MTA cap
• Why you lose cold testing after vital pulp therapy, and the follow-up system to catch failures early
• Annual radiographs on endo-treated teeth and pulp testing before crowns
• When a preoperative CBCT is a must: molars, retreatments, apicoectomies, premolars with fast breaks, and two-canal canines
• Endo-resolution CBCT versus large field of view scans, and why she dislikes image filters
• Minimally invasive and ninja access cavities: when conservation stops serving the patient
• Avoiding the cowboy mentality and building a reciprocal relationship with your endodontist
• The elements of a well-done root canal: anesthesia, rubber dam, full armamentarium, irrigation, obturation, and a sealed restoration
• Single-cone technique versus lateral and hybrid obturation, and why bioceramic sealer should not replace gutta-percha

Questions answered in this episode:

Pulpotomy, pulp cap, or root canal on a mature tooth with deep caries? It depends on symptoms, your true abilities, and whether the patient will return for follow-up. Frank expectations and a recall system are essential.

Which endo cases need a preoperative CBCT? Dr. McIntyre recommends it for all molars, retreatments, and apicoectomies, and for premolars or anteriors when 2D imaging shows fast breaks, curvature, or resorption.

Is the single-cone technique acceptable? Yes, when the cone intimately fits the prepared canal. Sealer is a vehicle, not the filling, and gutta-percha keeps the canal retreatable.

About the guest: Dr. Judy McIntyre is an endodontist and educator who teaches general dentists about CBCT, vital pulp therapy, and endodontic setup, and is known for encouraging GPs to love their endodontists.

Hosted by Dr. Melissa Seibert, DMD, MS, FAGD, ABGD. The Dental Digest Podcast is a top 1% podcast for general dentists focused on clinical dentistry: restorative dentistry, occlusion, endodontics, implants, imaging, and practice growth. For CE, case discussions, and a community of GPs who love clinical dentistry, join Elevated GP at theelevatedgp.com.