7. Vital Pulp Treatment Flashcards
what is the definition of vital pulp treatments
“strategies aimed at maintaining the health of all or part of the pulp” - european society of endo
What are the 4 clinical pulp diagnosis according to the new diagnostic system by the international endodontic journal?
Initial pulpitis
Mild pulpitis
Moderate pulpitis
Severe pulpitis
What is the definition of indirect pulp capping?
Application of a biomaterial onto a thin dentine barrier in a one-stage carious tissue removal technique generally to hard dentine
What is the definition of selective carious-tissue removal in one stage?
removal of soft or firm dentine - immediate placement of a permanent restoration
What is the definition of stepwise excavation?
first stage involves selective carious removal to soft dentine, to an extent that facilitates proper placement of a temporary restoration, and second stage removal to firm dentine. Final placement of permanent restoration
What are the 2 classes of direct pulp capping?
Class I - exposure due to a traumatic injury to the tooth or an iatrogenic exposure
Class II - pulp exposure judged clinically to be through a zone of bacterial contamination
What is the definition of direct pulp capping?
Following the preservation of an aseptic working field, application of a biomaterial directly onto the exposed pulp, prior to immediate placement of a permanent restoration
What is the definition of a partial pulpotomy?
Removal of a small portion of coronal pulp tissue after exposure, followed by application of a biomaterial directly onto the remaining pulp tissue prior to placement of a permanent restoration
What is the definition of a full pulpotomy?
Complete removal of the coronal pulp and application of a biomaterial directly onto the pulp tissue at the level of the root canal orifice(s), prior to placement of a permanent restoration
What is the definition of a pulpectomy?
Total removal of the pulp from the root canal system followed by root canal treatment, prior to placement of a permanent restoration
What responds to trauma to the dentine?
the dentine-pulp complex
What does damaged dentine release when experiencing trauma or a carious lesion?
Bioactive dentine matrix components (DMCs)
What are the roles of bioactive dentine matrix components?
Releases - cytokines, chemokines and growth factors
Orchestrates - recruitment, migration, proliferation and differentiation of pulpal progenitor cells which are critical for formation of newly deposited dentine
What is the difference of reparative vs reactionary dentine
Reactionary dentine is formed when stimulated by a mild stimulus or slowly advancing caries. It is formed by surviving odontoblasts and forms new tubular dentine
Reparative dentine is formed when stimulated by a severe/aggressive stimuli or rapidly carious lesions. It is formed when the primary odontoblasts die due to severe stimulus, so odontoblast-like cells produce low quality atubular mineralised tissue
Why would you use selective/stepwise caries removal over complete caries removal?
to reduce the risk of pulp exposure
Would light yellow caries clinically represent active/quick progressing carious lesion or slow?
Active at a fast rate
Would dark brown caries represent active/quick progressing or slow progressing/arrested caries
slow progressing/arrested
For direct pulp capping, there is low evidence due to high risk of bias, but what dental material was showed to be superior to Ca(OH)2?
MTA - mineral trioxide aggregate
Endodontic diagnosis - irreversible pulpitis with normal apical tissues.
What is the management of this?
Partial or full pulptomy initially
Why use pulpotomy?
- To preserve the pulp vitality and its functions while retaining more structural integrity of the tooth
- To simplify treatment protocol and avoid procedural errors associated with root canal treatment
- Minimally invasive endodontic procedures are meant to be less painful
- Potential for more efficient procedures reducing costs and number of appointments for patients which would be more sustainable and open access to treatment for more patients
What is the sequence for a full pulpotomy for protocol?
- LA
- Rubber dam placement
- Disinfect tooth surface with NaOCI (Sodium hypochlorite)
- Excavate caries with low-speed bur
- prepare cavity with high-speed bur under water coolant
- rinse cavity with NaOCI
- access and unroof pulp chamber
- Disinfect pulp chamber with 5% NaOCI
- Amputate exposure pulp tissue with high speed diamond to the level of the canal orifices
- Identify all canal orifices and assess bleeding
- achieve haemostasis - apply moistened cotton pelet with NaOCI for 2 mains with dry pellet on top
(if bleeding persists re-apply for up to 5 mins) - record bleeding time
- dry pulp chamber with cotton pellet
- reassess status in all canal orifices
- mix biodentine and place into cavity 3mm layer
- wait 12 mins for initial set
- apply gic layer (glass ionomer cement) - allow at least 2mm space
- restore with composite
- post-op radiograph
How would you assess the success of a vital pulp treatment?
- pulp sensibility testing (EPT or cold test)
- if there has been a full pulpotomoy and tooth has been restored with a crown - you would need to do a clinical and radiograph assessment with a PA radiograph
what materials are most evidenced success for vital pulp treatments?
hydraulic calcium silicate cements (MTA, biodentine, bioroot, totalfill etc)
what is the most historic filling material which is still used today?
MTA - mineral trioxide aggregate
