Conservative Pulp Treatment 2

Question 1

When should endodontic treatment be done?

Answer 1

Irreversible pulpitis

Pulp necrosis + infection

Pulpless + infected

Question 2

What factors affect the outcome of conservative pulp treatment?

Answer 2

Original state of the pulp

Atraumatic technique

Use of vasoconstrictor

Extra-pulpal blood clot (Should be at the level of the exposure)

Material used on the pulp

Restorative material used

Question 3

What are the problems with diagnosis that could affect the outcome of conservative pulp treatment?

Answer 3

Difficult to distinguish between reversible and irreversible pulpitis.

History provided by young patients may not be very accurate

Responses to pulp sensibility tests vary between individuals

Lack of correlation between clinical findings and histological state of the pulp

Inflammation of the pulp may not extend all the way to the apex but still a PA radiolucency can appear. So histological studies have shown that periapical pathosis is not necessarily associated with total pulp necrosis and inflammation

Question 4

What is the significance of the finding that you can simultaneously have PA radiolucency AND irreversible pulpitis overlying clinically health pulp closer to the apices?

Answer 4

Indications for conservative pulp therapy may be greater than previously thought.

We can be conservative with tooth structure.

More long term options for the tooth

Less expensive

Less time

Question 5

What is the favourable outcome rate of conservative pulp therapy?

Answer 5

About the same as endodontic treatment. 80 - 96% compared with 80 - 100%

Question 6

What are the major problems with trying to use conservative approaches to pulp treatment?

Answer 6

Diagnosis: Reversible vs irreversible

Dentists: Existing attitudes and approaches, poor understanding of pulp diseases, treatment modalities, and materials

Financial decisions dominate the decision making process

Question 7

What material should be used for conservative pulp treatment?

Answer 7

Ca(OH)2 is effective but leads to pulp canal calcification or diffuse calcifications throughout root canal which makes endo treatment more difficult and borderline impossible.

Using ledermix cement leads to increased success considering it already has Ca(OH)2 as well as anti-inflammatory and AB components.

MTA takes very long to set making it less appropriate and causes discoloration.

Ideal material is ledermix cement.

MTA vs Ca(OH)2 for partial pulpotomies shows no real difference in survival rate.