endo in primary molars

Question 1

consequences of inadequate tx

Answer 1

pain
infection (overall growth)
damage to permanent successor
 - hypoplasia
loss of space (drifting)

Question 2

considerations

Answer 2

rapid caries progression
small teeth, large pulp chambers
broad contact areas
irreversible pathological changes before pulp exposure
early radicular pulp involvement

Question 3

at what point is there likely to be at least pulp horn inflammation?

Answer 3

> 2/3 marginal ridge breakdown

Question 4

indications

Answer 4

good cooperation
avoid GA
MH precludes ext - bleeding disorder
lack of permanent successor - hypodontia
pt age (under 9)
ortho considerations - space preservation

Question 5

contraindications

Answer 5

poor cooperation
MH precludes pulp tx - immunocompromised/cardiac
pt age >9
ortho - space closure desired
severe/recurrent pain
space management
advanced RR
cellulitis
pus in pulp chamber
gross bone loss

Question 6

clinical indications for vital pulpotomy

Answer 6

pulp minimally inflamed/reversible pulpitis
marginal ridge destroyed
caries extending >2/3 into D on radiograph
any doubt that pulp exposed
- caries
- iatrogenic

Question 7

aims of vital pulpotomy

Answer 7

stop bleeding
disinfection
preserve vitality of apical portion of radicular pulp

Question 8

procedures

Answer 8

vital - pulpotomy
non-vital - pulpectomy

pulp caps don’t work on primary molars like they do on permanent

Question 9

vital pulpotomy technique

Answer 9

prep - LA and dam
access - remove caries and roof of pulp chamber
amputation
 - remove coronal pulp (sterile excavator/large steel round bur)
 - haemorrhage control
 - evaluate pulp stumps
medication
 - ferric sulphate on cotton pledget over root stumps for 20s
Rx
 - CaOH/MTA
 - GIC core
 - SSC

Question 10

options for non-vital tooth

Answer 10

extract

pulpectomy

Question 11

direct pulpal evaluation

Answer 11

normal bleeding/uninflamed pulp
 - bright red
 - good haemostasis
abnormal bleeding/inflamed pulp
 - deep crimson
 - continued bleeding after pressure

Question 12

signs of a non-vital molar

Answer 12

hyperaemic pulp

pulp necrosis and furcation involvement

Question 13

symptoms of a non-vital molar

Answer 13

irreversible pulpitis
periapical periodontitis
chronic sinus

Question 14

aim of pulpectomy

Answer 14

prevent/control infection by extirpation of radicular pulp followed by cleaning and obturation of canals

Question 15

pulpectomy technique

Answer 15

access
coronal pulp extirpation
RC prep (2mm short of apex)
 -no WL radiograph as too dangerous
obturation - vitapex (CaOH iodoform paste)
GIC core
SSC

Question 16

potential complications of pulpectomy

Answer 16

early resorption leading to early exfoliation

over-preparation

Question 17

clinical failure

Answer 17

pathological mobility
fistula/chronic sinus
pain

Question 18

radiographic failure

Answer 18

PA 12-18m (may have no clinical symptoms)

• increased radiolucency
• external/internal resorption
• furcation bone loss