Endodontics in Primary Teeth Flashcards

1
Q

List the disadvantages of unplanned primary tooth extractions.

(5)

A
  • loss of space causing increased risk of malocclusion
  • decreased masticatory funnction
  • impeded speech development
  • psychological disturbance
  • trauma from anaesthesia/surgery
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2
Q

What are the indications for pulp treatment in the primary dentition?

(5)

A
  • good cooperation
  • medical history precludes extraction
  • missing permanent successor
  • over-riding necessity to preserve the tooth (e.g. space maintainer)
  • child under 9 years of age
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3
Q

What are the contra-indications for pulp treatment in the primary dentition?

(6)

A
  • poor cooperation
  • poor dental attendance
  • cardiac defect
  • multiple grossly carious teeth
  • advanced root resorption
  • severe/recurrent pain or infection
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4
Q

What are the pulp treatments that can be done for a vital primary tooth?

A
  • pulp capping
  • vital pulpotomy
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5
Q

What is the pulp treatment that can be done on a non-vital tooth?

A

pulpectomy (RCT)

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6
Q

What is the success rate of vital pulpotomy vs pulpectomy?

A

vital pulpotomy 85-100% over 3-5 years

pulpectomy 90%

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7
Q

Describe the clinical techique for vital pulpotomy.

A
  • administer LA
  • use rubber dam
  • remove caries/
  • remove roof of pulp chamber
  • remove coronal pulp with sterile excavator or slow running large round steel bur
  • assess pulpal bleeding (normal bleeding is bright red colour and good haemostatis; abnormal bleeding is deep crimson and continued bleeding after pressure)
  • place a cotton pledget with ferric sulphate for 20 seconds
  • place zinc oxide eugenol in the pulp chamber over root stumps
  • GIC core
  • restore using a preformed metal crown

if bleeding is abnormal, proceed with pulpectomy

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8
Q

What are the signs and symptoms of a non-vital primary molar?

A

Signs:
* hyperaemic pulp (abnormal bleeding)
* pulp necrosis and furcation involvement

Symptoms:
* irreversible pulpitis
* periapical periodontitis
* chronic sinus

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9
Q

When is a primary molar pulpectomy indicated?

A

excellent patient co-operation

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10
Q

What is the aim of a primary molar pulpectomy?

A

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

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11
Q

What are the potential complications of a primary molar pulpectomy?

A
  • early resorption leading to early exfoliation
  • over-preparation
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12
Q

Describe the clinical techique for pulpectomy.

A
  • administer LA
  • rubber dam
  • remove caries
  • remove roof of pulp chamber
  • remove contents of pulp chamber
  • use files to remove pulpal tissues from canals to 2mm short of EWL
  • irrigate with CHX and dry with paper points
  • obturate canals with Vitapex (CaOH and iodoform paste) or a very thin mix of zinc oxide eugenol
  • seal with thick mix of zinc oxide eugenol or GIC and restore with a preformed metal crown
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13
Q

What is the follow-up regime for pulpotomy and pulpectomy?

A

Assess clinically after 6 months:
* pathological mobility
* fistula/chronic sinus
* pain

Assess radiographically after 12-18 months:
* increased radiolucency
* external/internal resorption
* furcation bone loss

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