3: Direct Pulp Capping Flashcards
direct pulp capping: how does it work? what is placed over exposed pulp? done in attempt to maintain? to avoid what?
a medicament is placed directly over the exposed pulp in an attempt to maintain pulp vitality and avoid more extensive treatment by extraction or endodontic treatment
direct pulp capping; indications?
- pulpal exposure due to caries: pulp likely inflamed
- traumatically exposed pulp: due to trauma, cavity, crown prep, placement of dentine pins. pulp is likely normal
direct pulp capping of carious exposures
- degenerative changes in odontoblasts occur before what?
- inflammatory changes
direct pulp capping: criteria for successful direct pulp cap?
- no history of recurring or spontaneous pain
- no swelling
- normal sensibility test
- not tender to percussion
- no radiological evidence of periradicular pathology, obvious pulp chamber and root canal
- young patient
direct pulp capping: contra-indications?
- history of previous toothache
- deciduous teeth
- elderly patient
- single rooted teeth, normal root canals
- large carious exposures
- pulp hyperaemic at site of exposure
- pulp necrotic at site of exposure
- exposure heavily contaminated with saliva
size of expose: in carious and traumatic exposures?
why do large carious exposures have poor prognosis?
traumatic exposure: size not important
carious exposure: small, larger exposures have poorer prognosis due to a more inflamed pulp, risk of necrosis and bacterial contamination.
age of patient: why should it be assessed?
- with increased age the pulp becomes more fibrous, pulp volume is reduced because of physiological secondary dentine formation and reactionary dentine
- pulpal blood supply decreases with age, reducing the regenerative capacity and response to pulp capping
location of exposure: why should there be no pulpal tissue coronal to exposure site? what should the teeth undergo instead?
- exposure of cervical cavity would lead to reactionary dentine formation, restricting blood supply to the tissues more coronal to it, causing necrosis and failure
- should have RCT instead
pulpal bleeding: indicative of?
moisture and contamination of dentine adjacent to exposure site due to bleeding can cause?
- increased bleeding -> greater degree of pulp inflammation, diminished capacity for repair
- make it more difficult to obtain an adequate seal
ideal properties of pulp capping agents
- able to maintain pulp vitality
- stimulate reparative dentine
- bactericidal or bacteriostatic, able to provide bacterial seal
- adhere well to dentine and restorative material
- resist the forces under restoration for a long time
- sterile
- preferably radiopaque
most common direct pulp capping agent?
what does it do?
- calcium hydroxide
- antibacterial, disinfects superficial pulp
calcium hydroxide - how does it work?
neutralizes toxicity in deeper layers
coagulates necrosis of adjacent pulp
minor inflammatory response and formation of hard tissue barrier
requires layer of RMGI to further seal exposed pulp
mineral trioxide aggregate: CaOH reaction with water forms? calcium oxide in the form of? aids release of? requires layer of?
- silicate cement
- tricalcium silicate, dicalcium silicate, tricalcium aluminate, bismuth oxide
- bioactive dentine matrix proteins
- RMGI, protection during placement of restoration
- comparable to calcium hydroxide
what is bio-aggregate
root canal repair material composed of bio-ceramic nano-particles
- modified mineral trioxide aggregate
biodentine?
dentine substitute
