Conservative Pulp Treatment 1 Flashcards
What can cause pulp exposure? How do the causes differ in the outcome?
Trauma and caries.
Trauma usually results in clinically healthy pulp being exposed. Caries lead to infected pulp.
What factors should be considered when deciding to do endodontic treatment following traumatic pulp exposure?
Diagnosis of pulp status: Normal, pulpitis (reversible or irreversible), necrosis (+- infection), and pulpless + infected root canal.
Stage of root development: Fully developed vs incompletely developed.
Other concurrent injuries (luxation, avulsion, etc)
Size of exposure (Small vs Large)
Time since exposure (minutes vs days as the pulp is open for bacteria)
Restorative dental needs (Post needed?)
How should incompletely developed teeth be managed?
Always wait for pulp revascularization (allows further root development and improves long term prognosis of the tooth)
More immature teeth have better pulp revascularization.
How common are cervical root fractures in incompletely developed teeth and how do they differ from completely developed teeth?
As the root development progresses there are less cervical fractures. This is because the dentine and root thicken.
Do small exposures have better prognosis than large exposures?
Not necessarily.
What are the alternatives to endodontic treatment following traumatic pulpal exposure?
Pulp capping
Pulpotomy: Partial or cervical
Pulpectomy: Partial
What should be the aim when treating pulp exposures?
Aim to preserve the pulp especially in incompletely developed teeth
Allow further root development which improves long term prognosis.
What pulp status is ideal?
Viable pulp
Preferably no pulp inflammation
No necrosis or only surface necrosis at the site of exposure
What is the healing frequency of pulp capping, partial pulpotomy, and cervical pulpotomy?
Pulp capping = 72 - 81
Partial pulpotomy = 94 - 96%. Similar healing rate to RCT.
Cervical pulpotomy = 72 - 79%
What is the partial pulpotomy technique described by Cvek?
Remove necrotic pulp while preserving the rest of the pulp. This can be done with high speed diamond bur. The reason for using a diamond bur is that it is abrasive and does not cause damage beyond the wound surface laceration is more common with tungsten carbide burs.
Cut through the pulp until the bleeding is controlled. Check by applying pressure with a cotton pellet to the pulp chamber and assess bleeding. If there is continued bleeding then go deeper until the haemorrhage can be controlled. Then place capping agent (Ca(OH)2 followed by GIC)
To assess healing check radiograph for signs of healed pulp.
What materials should be used for partial pulpotomy, pulp capping, and cervical pulpotomy?
Ca(OH)2, CS-AB cement mixture (Not paste), or MTA.
Ca(OH)2 use form that sets hard. Highly researched but most research on clinically normal teeth. However, with caries it isn’t as effective.
CS-AB consists of more ZnO Eugenol cement as well as Ca(OH)2 creating a hard setting base
What is the typical healing response seen with Ca(OH)2?
Initial calcification above it a dense zone, lysed blood, necrosis, debris, and on top of that is the initially applied Ca(OH)2
Is a dentin bridge important for pulp healing?
Not necessarily. It doesn’t block bacteria from getting to the pulp. However, the restoration if it is effective will block the bacteria from getting to the pulp.
How fast does triamcinolone get released from ledermix cement?
70% is released by the end of day 1 and the rest by the end of day 3
Does ledermix cement cause necrosis of the pulp without symptoms?
No this is a long held misconception. However, if the pulp is irreversibly inflamed it won’t help. It arose from lack of diagnosis and poor understanding of the disease processes.
