endodontics in primary molars Flashcards
4 consequences of inadequate endodontic treatment of primary molars
Pain
Infection
Damage to permanent successor
Loss of space if primary molar is extracted and the arch isn’t spaced
5 endodontic considerations for primary molars
Rapid caries progression
Small teeth with relatively large pulp chambers
Broad contact areas
Irreversible pathological changes before pulp exposure
Early radicular pulp involvement
what happens when there is greater than 2/3 marginal ridge breakdown (in primary molars)
likely to be AT LEAST pulp horn inflammation and an increased likelihood of this inflammation extending into the rest of the pulp in the pulp chamber and even down the root canals
child indications for primary tooth pulp treatment
Good co-operation
Avoid GA
Medical history precludes extraction
- Bleeding disorder/ coagulopathies
Lack of permanent successor
Age of patient
Ortho considerations
space preservation
contraindications in child pulp treatment
Poor co-operation
Medical history precludes pulp treatment
- Cardiac/ Immunocompromise
Age of patient
Ortho considerations
- space closure desired
Severe/recurrent pain
Space management
Advanced root resorption
Cellulitis
Pus in pulp chamber
Gross bone loss
primary vital tooth endodontic treatment
pulpotomy
primary non-vital tooth endodontic treament
pulpectomy
assessment and diagnosis of endodontic treatment
History
Clinical examination
Radiographic examination
- extent of caries
Pulp status evaluation
- Healthy -> total pulp necrosis
clini cal indications for primary vital pulpotomy (4)
Pulp minimally inflamed/ reversible pulpitis
Marginal ridge destroyed
Caries extending > 2/3 into dentine on radiograph
Any doubt that pulp exposed
- Caries
- Iatrogenic
3 aims for primary vital pulpotomy
stop bleeding
disinfection
preserve vitality of apical portion of radicular pulp
technique for vital primary pulpotomy
LA
- topical using cotton wool roll
- can provide infiltration until first permanent molar erupts
Dental Dam (with clamp and floss for safety)
Access
- caries removal
- remove roof of pulp chamber using sterile diamond fissure but
amputation
- remove coronal pulp (sterile excavator/large round steel bur)
- haemorrhage control
- evaluate pulp stumps
medication
- Place ferric sulphate (on a cotton pledget) over root stumps for 20 secs
- Remove cotton wool pledget
restoration
- Cover root stumps with CaOH or MTA
- GIC Core
Restore stainless steel crown
direct pulpal evaluation - normal bleeding
uninflammed pulp
- bright red colour
- good haemostasis
direct pulpal evaluation - abnormal bleeding
inflammed pulp
- deep crimson
- continued bleeding after pressure
how to spot a non vital molar
Signs:
- Hyperaemic pulp
bleeding lots
- Pulp necrosis & furcation involvement
Symptoms:
- irreversible pulpitis,
- periapical periodontitis
- chronic sinus
NOTE: severe infection with facial swelling = extraction
signs of non vital molar
- Hyperaemic pulp
bleeding lots - Pulp necrosis & furcation involvement
symptoms of non vital molar
- irreversible pulpitis,
- periapical periodontitis
- chronic sinus
severe infection with facial swelling of molar needs
extraction
treatment options for non-vital molars
extraction
pulpectomy
indications for primary molar pulpectomy
excellent patient co-operation
aim of primary molar pulpectomy
prevent/control infection by expiration of radicular pulp followed by cleaning and obturation of canals
technique for primary molar pulpectomy
access
coronal pulp extirpation
root canal preparation
- (2mm short of apex)
obturation
- CaOH iodoform paste
(vitapex)
GIC core
stainless steel crown
what do you use for obturation in primary pulpectomies
CaOH Iodoform paste (vitapex)
what core is used in primary pulpectomies
GIC
clinical problems encountered in primary pulpectomies
Child management difficulties
- Unexpected pulp exposure & no LA given
- Inadequate anaesthesia when performing pulpectomy
- Child in acute pain - emergency / casual patient
how to overcome pain problem in primary pulpectomies
control and prevent pain by
antiseptic/antibiotic dressing (Ledermix paste)
how to apply antiseptic/antibiotic dressing in primary pulpectomy to reduce pain
Place directly over exposed pulp
Dress IRM and review within 1 week
Complete pulpectomy once symptoms subside
2 potential complications of primary pulpectomies
early resorption leading to early exfoliation
over-preparation
success rate of vital tooth pulp capping
poor
success rate of vital pulpotmoy
85-100% (3 years)
success rate of non vital pulpectomy
90%
when is the clinical review of pulp therapies
6 months
clinical failure of pulp therapies can be seen as
patological mobility
fistula/chronic sinus
pain
when is radiographic review of pulp therapies
12-18 months
radiographic failure of pulp therapies can be seen as
increased radiolucency
external/internal resorption
furcation bone loss
medication used in vital primary pulpotomies
Place ferric sulphate (on a cotton pledget) over root stumps for 20 secs
Remove cotton wool pledget
restoration used in primary molar pulpotomies
Cover root stumps with CaOH or MTA
GIC Core
Restore stainless steel crown
what is the amputation step used in primary pulpotomies
remove coronal pulp (sterile excavator/large round steel bur)
haemorrhage control
evaluate pulp stumps
what is used to cover root stumps in primary pulpotomies
CaOH or MTA
