Direct Pulp Capping Flashcards
What is the purpose of a direct pulp cap?
To preserve pulp vitality and promote healing and mineralised tissue formation by odontoblasts to seal the exposure site by placing a bacterial directly over the pulp exposure.
For direct pulp capping, what conditions need to be in place?
Dentine surrounding the exposure is sound
Haemostasis can be achieved within 2-3 minutes of applying saline or sodium hypochlorite
No dentine chips displaced during excavation
Red, homogenous blood is found with no evidence of pus
What would be a successes following a direct pulp cap?
Asymptomatic tooth
Positive result in sensibility tests
Radiographically
- no signs of PA pathology
- Deposition of mineralised amorphous tissue between the pulp and the dentine- dentine bridge.
What materials can be used as a direct pulp cap?
Setting calcium hydroxide- dycal
Biodentine
MTA
What must you place over calcium hydroxide following placement?
RMGIC (vitrebond) because calcium hydroxide is very soluble and has a low compressive strength.
What are the limitations of setting calcium hydroxide?
Poor bonding to dentine
Mechanical instability and continuous resorption after placement
Does not prevent micro leakage over extended periods of time
Forms a dentine bridge- which has tunnel defects and is porous, so can allow micro-organisms access to the pulp.
What are the uses of biodentine?
Specification
Direct pulp cap
Restoration of perforations
Internal and external root resorption
Pulpotomy
Temporary sealing of cavities
How long does biodentine take to cure before you can cut it back?
12-15 minutes.
What are the two options you can choose from to restore with biodentine?
1 step- restore with composite 12-15 minutes after biodentine has been mixed.
1 step- wait 48 hours to 6 months later, cut back the biodentine and then restore with composite.
How does biodentine work as a direct pulp cap?
Releases calcium and hydroxyl ions to form hydroxyapatite crystals on the surface after contact with phosphate containing liquids.
- forms a dentine bridge.
What are the advantages of Biodentine compared to setting calcium hydroxide?
Chemically stronger
Less soluble
Produces tighter seals
If a perforation occurs in practice, what would you do?
Stop what you’re doing, inform the patient of what has happened (should have already told them about this risk).
Options
- Refer to specialist- place cotton wool over the perforation with calcium hydroxide and dress with GIC.
- Proceed in practice to restoring the perforation- Biodentine, MTA, ZOE or GIC can also be used.
