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Paediatrics > Endodontics > Flashcards

Endodontics Flashcards

1
Q

Why does pulpal involvement occur faster in carious primary molars than permanent molars?

A
  1. Teeth smaller in size
  2. Relatively large pulp chambers
  3. Broad contact points (caries diagnosis difficult)
  4. Irreversible pathological changes occur before pulpal involvement (marginal ridge breakdown -> irreversible pulp changes)
  5. Early radicular pupal involvement
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2
Q

Why can conventional RCT NOT be used for primary teeth?

A
  1. Roots vary in number and shape
  2. Roots undergo resorption prio exfoliation
  3. Root morphology changes with age (resorbable materials must be used)
  4. Canals ribbon-shaped with many interconnections
  5. Potential damage to permanent successor (instrumentation past apex)
  6. Restricted access (small mouths)
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3
Q

What are the indications for pulp therapy in primary molars rather extractions?

A
  1. Co-operation
  2. Avoidance of GA
  3. MH = bleeding disorders (haemophillia)
  4. Age
  5. Space maintenance
  6. Hypodontia
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4
Q

When is extraction preferred over pulp therapy?

A
  1. Poor co-op
  2. Poor motivation (attendance, compliance etc.)
  3. Multiple grossly carious teeth (balance and compensate)
  4. MH = CHD, hx of rheumatic fever (extr under AB prohylaxis), immunosuppression (leukaemia)
  5. Tooth unrestorable
  6. Severe pain/ infection/ cellulitis/ pus
  7. Space management (uncrowded arches)
  8. Tooth soon to exfoliate
  9. Gross bone loss
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5
Q

What are the indications for a VITAL PULPOTOMY?

A
  • Carious/ traumatic exposure of bleeding pulp
  • No symptoms or symptoms of REVERSIBLE PULPITIS
  • No clinical or radio signs of infection
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6
Q

Describe the procedure for a pulpotomy

A
  1. LA and isolation (dam)
  2. Caries removal and access (diamond fissure bur)
  3. Amputation of coronal pulp (spoon excavator or slow speed round bur –> ferric sulphate 20s)
  4. Assess radicular pulp stumps
    - -> arrested bleeding = continue pulpotomy
    - -> abnormal bleeding = pulpectomy
  5. Dress and restore (ZOE, CaOH or MTA –> SSC cemented with GI luting cement)
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7
Q

What is the success rate for a PULPOTOMY over 3 yrs?

A

83 - 100%

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8
Q

What are the indications for a PULPECTOMY?

A
  • Exposure of non-bleeding pulp
  • Exposure of hyperaemic pulp
  • Irreversible pulpitis (spontaneous pain, mobility, sinus)
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9
Q

Describe the procedure for a pulpectomy

A
  1. LA and isolation (dam)
  2. Caries removal and access (diamond fissure bur)
  3. Amputation of coronal pulp (spoon excavator or slow speed round bur)
  4. Root canal preparation (locate canals –> remove pulp with barbed broach/ files [NO SHAPING, NO CLOSER THAN 2mm OF APEX] –> irrigate with CHX/ sodium hypochlorite –> dry with paper points)
  5. Canal obturation (VITAPEX = CaOH + iodoform paste)
  6. Dress and restore (ZOE, CaOH or GI –> SSC cemented with GI luting cement)
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10
Q

Why is the use of a stainless steel crown following pulp therapy of a primary molar tooth an ideal restoration?

A
  1. Tooth usually severely broken down

2 Predictable seal

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11
Q

How often should a pulpotomy and pulpectomy followed up?

A

CLINICALLY = every 6 months

RADIOGRAPHICALLY = every 12-18 months

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12
Q

What are the clinical and radiographic signs of failure following pulp therapy of a primary molar tooth?

A

CLINICAL

  • Mobility
  • Fistula
  • Pain

RADIOGRAPHIC

  • Radiolucency
  • Resorption (internal or external)
  • Bone loss at furcation
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13
Q

What are the potential complications following pulp therapy of a primary molar tooth?

A
  1. Early loss (pulpotomy tx tooth commonly exfoliate early)
  2. Failure to exfoliate (ankylosis and/or deflection of successor)
  3. Enamel defects of successor
  4. Perforation (over-prep; amputation with bur, over-filing of canals)
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14
Q

What are the treatment options for (permanent) IMMATURE TEETH (OPEN APEX) and their indications?

A

VITAL

  • Pulp cap = <1mm and <24hrs old, CaOH/ MTA
  • Pulpotomy (partial or full coronal) = >1mm and/or >24hr, dress coronal pulp with CaOH, place GIC on top and restore in comp
    • -> full coronal pulpotomy is the same process but more pulp if removed (i.e. the full coronal pulp is removed)

NON-VITAL

  • Pulpectomy = Apical Barrier Formation with MTA or apexification with nsCaOH
    • -> cotton wool + temp GIC
    –> Apexification becoming outdated (CaOH causes root dentine brittleness –> ABF preferred)
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15
Q

Describe the process of an apical barrier formation

A

Pulpectomy of non-vital open apex tooth

  • 5mm of MTA placed at apex
  • Wait 24hrs to dry
  • Obturate canal with heated GP system
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16
Q

What are the treatment options for (permanent) MATURE TEETH (CLOSED APEX) and their indications?

A
  • Pulp cap = <1mm exposure, <24 hrs old, vital pulp
  • Pulpotomy = >1mm, >24hrs old, vital pulp
  • Conventional RCT

Paediatrics (10 decks)

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