Endodontics in Primary Teeth Flashcards
List the disadvantages of unplanned primary tooth extractions.
(5)
- loss of space causing increased risk of malocclusion
- decreased masticatory funnction
- impeded speech development
- psychological disturbance
- trauma from anaesthesia/surgery
What are the indications for pulp treatment in the primary dentition?
(5)
- 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
What are the contra-indications for pulp treatment in the primary dentition?
(6)
- poor cooperation
- poor dental attendance
- cardiac defect
- multiple grossly carious teeth
- advanced root resorption
- severe/recurrent pain or infection
What are the pulp treatments that can be done for a vital primary tooth?
- pulp capping
- vital pulpotomy
What is the pulp treatment that can be done on a non-vital tooth?
pulpectomy (RCT)
What is the success rate of vital pulpotomy vs pulpectomy?
vital pulpotomy 85-100% over 3-5 years
pulpectomy 90%
Describe the clinical techique for vital pulpotomy.
- 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
What are the signs and symptoms of a non-vital primary molar?
Signs:
* hyperaemic pulp (abnormal bleeding)
* pulp necrosis and furcation involvement
Symptoms:
* irreversible pulpitis
* periapical periodontitis
* chronic sinus
When is a primary molar pulpectomy indicated?
excellent patient co-operation
What is the aim of a primary molar pulpectomy?
Prevent/control infection by extirpation of radicular pulp followed by cleaning and obturation of canals
What are the potential complications of a primary molar pulpectomy?
- early resorption leading to early exfoliation
- over-preparation
Describe the clinical techique for pulpectomy.
- 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
What is the follow-up regime for pulpotomy and pulpectomy?
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