L.10 PULP Therapy Flashcards
TERMS/Abbreviations: Protective Liner AKA:
A base
TERMS/Abbreviations: IPT
Indirect Pulp Therapy (Treatment)(Cap)
TERMS/Abbreviations: DPC
Direct Pulp Cap
TERMS/Abbreviations: PT or Pulp
Pulpotomy
TERMS/Abbreviations: RCT
Root Canal, Pulpectomy, Endodontics, Endo
TERMS/Abbreviations: ITR
Interim Therapeutic Restoration
TERMS/Abbreviations: ART
Alternative Restorative Treatment
TERMS/Abbreviations: IRM
Intermediate Restorative Material (ZOE)
TERMS/Abbreviations: TempIt
non-eugenol Zinc Oxide
TERMS/Abbreviations: FMC
(FC): Formocresol
TERMS/Abbreviations: FS
: Ferric Sulfate
TERMS/Abbreviations: MTA
: Mineral Trioxide Aggregate
TERMS/Abbreviations: BioCeramics:
EndoSequence, MTA
An Objective of pulp therapy: Immature Permanent tooth requires vital pulp to continue __________
Apexogenesis
An Objective of pulp therapy: Maintain a non-vital tooth clinically ________
functional
What are the 3 topics covered at every single dental appointment and will help us diagnose a pulp problem?
1.Dental Hx 2.Med Hx 3.Social Hx
Characterizing Pain: What diagnosis do these pain signs support? Spontaneous, Prolonged, Nocturnal
IRREVERSIBLE PULPITIS
Characterizing Pain: What diagnosis do these pain signs support? Thermal, Chemical, Intermittent
REVERSIBLE PULPITIS
Extra Oral Examination: _________ needs immediate attention Hospitalization needs to be considered
Facial Swelling
Once the tooth has ________, it is often times asymptomatic
fistulated
A primary incisor that has been INJURED and is exhibiting a _______ color change with no other symptoms, and no radiographic changes, may NOT need treatment
>____% remain asymptomatic
grayish…50%
Can you perform Apexogenesis with Pedo Teeth?
No, needs to be perm.
How much of a permanent tooth’s root needs to be present to perform Apexogenesis?
2/3 of the root
Pulp Test Reliability: Primary teeth, electric testing?
Not an indicator
Pulp Test Reliability: Immature permanent teeth, electric testing?
Yes, but not a very strong indicator
Pulp Test Reliability: Mature permanent teeth, electric testing?
yes, but not a very strong indicator
Pulp Test Reliability: primary teeth, thermal testing?
yes, but not the best indicator (percussion/mobility is)
Pulp Test Reliability: Immature permanent teeth, thermal testing?
yes, but not a very strong indicator
Pulp Test Reliability: mature permanent teeth, thermal testing?
yes, BEST teeth that thermal testing works on!
Pulp Test Reliability: primary teeth, percussion/palpation/mobily testing?
YES, BEST indicator for primary teeth!
Pulp Test Reliability: immature permanent teeth, percussion/palpation/mobily testing?
yes
Pulp Test Reliability: permanent teeth, percussion/palpation/mobily testing?
yes, good indicator
Overall, is pulp testing reliable in primary teeth?
NO
What are the 5 questions you need to answer to make a proper diagnosis in a pulp situation?
1.Vital? 2.Can it be saved? 3.Should it be saved? 4.Functional? 5.Alternative?
If the treatment leads to exposure of the pulp, a final determination of pulpal status can be obtained by inspection and evaluation of the quality (_____) and ______ of bleeding from the pulp tissue.
COLOR…AMOUNT
Profuse bleeding or purulent exudate are indications of ___________ .
irreversible pulpitis
Reversible pulpitis should exhibit WHAT COLOR bleeding that can be arrested within HOW MANY minutes by mild pressure from a cotton pellet.
BRIGHT RED…5 minutes
What are the 4 options for PULP therapy in a VITAL primary tooth? What is the 1 option for a NON-vital tooth?
Vital: 1.Protective Layer 2.Direct Pulp Cap 3.Pulpotomy 4.Indirect pulp therapy….NON-vital: Pulpectomy
What is the main goal of using a protective liner?
to Promote Tertiary dentin
What are the two main Protective Liners used? Which one is used more?
- GI (Fuji, VITREBOND) 2.Calcium Hydroxide (DyCal)…DyCal is being phased out, so used less than GI
YOU ONLY DO A DIRECT PULP CAP WHEN THE EXPOSUE IS _______ IN SIZE!! (
pinpoint (
What pulp therapy treatment is NOT recommended in a Primary tooth with carious exposure?
Direct Pulp Cap
Why is a direct pulp cap NOT recommended in a primary tooth?
Mesenchyme–>odontoblasts–>INTERNAL RESORPTION…aka: Primary carious DPC are not successful due to inflammation leading to internal resorption
What are the three materials for a direct pulp cap?
MTA, BIO, CaOH
In Primary tooth, do _______ for carious exposure or if in doubt about type of exposure
pulpotomy
Is the primary tooth vital or non-vital when considering a pulpotomy?
Vital!
Contraindication for a Pulpotomy is an Indication for WHAT TWO PROCEDURES?
- Non-Vital Pulpectomy or 2.Extraction
How much do you extend the walls of your chamber access in a pulpotomy on a primary tooth?
1/2 the cusp width
What bur do you use to remove pulp tissue?
SLOW SPEED 6 or 8 round
After the coronal pulp is amputated, healing can occur in 3 ways…1: the remaining radicular pulp can be rendered inert, by using _________. It fixes or denatures the vital pulp so it is no longer pulp tissue. In addition to its bactericidal properties.
formocresol
After the coronal pulp is amputated, healing can occur in 3 ways…2: the radicular pulp might be preserved through minimal inflammatory insult by using a hemostatic agent such as _________ to form a clot barrier to preserve the deeper remaining pulp tissue.
ferric sulfate
After the coronal pulp is amputated, healing can occur in 3 ways…3) pulpotomy mechanism encourages
the radicular pulp to heal and form a dentin bridge by using ____________.
mineral trioxide aggregate (MTA)
Pulpotomy: Once you have established that the pulp is vital and you have gained hemostasis with light pressure…
Formocresol pellet; damp-not wet; ___ minute application
5 minute
Pulpotomy: Once you have established that the pulp is vital and you have gained hemostasis with light pressure…Ferric Sulfate direct application for ___ seconds; rinse away when done with application; remove EXCESS moisture
15
Do you ever use Ferric Sulfate and Formocresol together?
HELL NO.
Pulpotomy: AFTER amputating the radicular pulp, seal/fill (obturate) the chamber with _______, and then finish the restoration with _______
ZOE (IRM)….a stainless steal crown
ZOE + hardener (aka “steroids) =
IRM (intermediate restorative material)
Pulpotomy: What material has similar success or better with less resorption than formocresol or ferric sulfate
MTA
Pulpotomy: _______ success similar to FS
Likely due to Antimicrobial/Antibacterial effect of NaOCL
NaOCL
What is the other, newer material along with MTA for sealing a pulpotomy?
Bioceramics (Endosequence)