4. OpTec Lectures Flashcards
A child should reach adulthood with (4)
An intact dentition
No active caries
As few restored teeth as possible
A positive attitude to their future dental care
Operative differences between children and adults (7)
Developmental maturity/behaviour Constant change Developing dentition Operator access Tooth size and shape Preventive care Choice of restoration
Sequence of treatment planning and restorations in cooperative children (6)
Prevention Fissure sealants Preventive restorations Simple fillings (shallow cervical cavities) Fillings requiring LA but not into pulp Pulpotomies (upper arch first)
Summary of restoration longevity (5)
PMC > amalgam = composer > RMGIC > GIC
Crown prep. for conventional paediatric PMCs (2)
Occlusal reduction by 1-2mm
Buccal/lingual - peripheral reduction only
Common problems with stainless steel crowns (3)
Rocking
Canting
Loss of space
When is the Hall Technique used (2)
When no clinical/radiographic signs of plural involvement
Tooth should have sufficient sound tissue left to retain the crown
Hall technique crown review minor failures (4)
New/secondary caries
Filling/crown worn, lost or requiring other intervention
Restoration lost but tooth restorable
Reversible pulpitis treated without requiring pulpotomy or extraction
Hall technique crown review major failures (4)
Irreversible pulpitis
Abscess requiring pulpotomy or extraction
Interradicular radiolucency
Filling lost and tooth not restorable
Disadvantages of unplanned primary tooth extractions (5)
Loss of space causing increased risk of malocclusion Decreased masticatory function Impeded speech development Psychological disturbance Trauma from anaesthesia
Indications for pulp treatment (5)
Good co-operation Medical history precludes extraction Missing permanent successor Over-riding necessity to preserve tooth (space maintainer) Child under 9 years of age
Contraindications for pulp treatment (6)
Poor co-operation Poor dental attendance Cardiac defect Multiple grossly carious teeth Advanced root resorption Severe/recurrent pain or infection
Features of vital pulpotomy (2)
Carious or traumatic exposure of a bleeding pulp
Radicular pulp is preserved, and bleeding controlled
Vital pulpotomy technique (6)
Always use LA and rubber dam
Remove caries prior to access
Remove entire roof of pulp chamber using sterile diamond fissure bur
Remove coronal pulp with sterile excavator or slow-running large round steel bur
Place a cotton pledget with ferric sulphate for 20 seconds until minimal oozing
Place zinc oxide/eugenol in pulp chamber and restore using a PMC
Direct plural evaluation (2)
Normal bleeding – non-inflamed pulp (bright red colour, good haemostasis
Abnormal bleeding – inflamed pulp (deep crimson colour, continued bleeding after pressure (with ferric sulphate))
Pulpectomy indications (2)
Non-vital or hyperaemic (increased/excess blood flow) pulp
Irreversible pulpitis
Signs of a non-vital primary molar (2)
Hyperaemic pulp (increased bleeding) Pulp necrosis and furcation involvement
Symptoms of a non-vital primary molar (3)
Irreversible pulpitis
Periapical periodontitis
Chronic sinus
Aim of a primary molar pulpectomy
Prevent/control infection by extirpation of radicular pulp followed by cleaning and obturation of canals
Indication for a primary molar pulpectomy
Excellent patient cooperation
Pulpectomy procedure (8)
Non-vital/hyperaemic pulp
Open roof of pulp chamber
Remove contents of pulp chamber
Use files to remove pulpal tissue from canals to 2mm short of estimated working length (EWL)
Irrigate with chlorhexidine and dry with paper points
Obturate canals with Vitapex (CaOH and iodoform paste) or alternatively, a very thin mix of ZOE
Seal with thick mix of ZOE/GI and restore with PMC
Post-treatment radiograph in clinical setting
Potential complication of primary pulpectomy (2)
Early resorption leading to early exfoliation
Over-preparation
Follow-up of pulpotomy and pulpectomy (2)
Clinical review - 6 monthly
Radiographic review 12-18 monthly
Clinical failure of pulpotomy/pulpectomy (3)
Pathological mobility
Fistula/chronic sinus
Pain
Radiographic failure of pulpotomy/pulpectomy (3)
Increased radiolucency
External/internal resorption
Furcation bone loss