PAEDS PULP THERAPY Flashcards
Why is pulp therapy more difficult in deciduous dentition?
Pulp horns are bigger
Easier to get pulp exposure
Canal are finner, narrower, more branching
Difficult to clean
Canals are less densely innervated
Pain response vague in children
Pulp vitality testing in deciduous teeth?
Inconclusive
Types of pulp therapies?
Vital and non vital therpies
What are the types of vital pulp therpies?
Direct/indirect pulp capping
Pulpotomy
What are the types of non vital therapies?
Pulpectomy
What is the best restorative material following pulp therapy
Stainless steel crown
What is a hyperemic pulp?
Excess bloodflow, continuous bleeding
What teeth should have vital pulp therapy?
Primary teeth diagnosed with reversible pulpitis
For what pulpal diagnosis can you do an indirect pulp cap?
Healthy asymptomatic pulp or reversible pulpitits
Which has a better prognosis: deciduous indirect pulp cap or pulpotomoy?
Indirect pulp cap
Which has a worse prognosis? Direct or indirect pulp cap following carious exposure
Direct pulp cap - never do in deciduous teeth with carious pulp exposure
When doing an indirect pulp cap, do you need complete caries removal?
No, as long as you have a hella good seal.
What material would you use for an indirect pulp cap?
CaOH2
When would you do a direct pulp cap in deciduous teeth?
Only when there is mechanical/trauma pulp exposure
What material should you use for a direct pulp cap?
MTA or CAOH2
What is a pulptomy?
Coronal pulp tissue is removed and radicular pulp tissue is left behind
When is pulpotomy indicated?
Mechanical exposure of primary teeth
Caries involving the coronal pulp with no inflammation in the radicular pulp
No abscess or fistula
History of spontaneous pain
No inter-radicular bone loss in xray
When we remove coronal portion of pulp, should shoud be bright red and controllable.
Contraindications for pulpotomy?
History of tooth symptoms
TTP+ve
When more than 1/3rd of root is resorbed
Large cavities
Uncontrollable haemorrhage
Heart disease and immunocompromised children.
If there are periapical pathosis or pathological resorption involved can you do a pulpotomy?
No
What materials do you use in a pulptomy?
MTA or ferric sulphate
What materials do you use in a pulpotomy?
MTA or ferric sulphate
What materials do you use in a pulpotomy?
MTA or ferric sulphate
What is a pulpectomy?
Complete removal of all coronal and radicular pulp tissue
Indications for pulpectomy?
Diagnosis with irreversible pulpectomy
Tooth still restorable
PA or furcation involvement
Buccal or E/O swelling
Persistent bleeding during pulpotomy
Contraindications for pulpectomy?
Med hx: immunocompromised, heart disease
Tooth unrestorable
Pathologic resorption of >1/3rd of tooth
Internal rot resorption
Mechanical or carious pulpal exposure of floor of pulp chamber
What are the best materials for pulpectomies?
Iodoform (KriTM) paste
Iodoform (KriTM) paste + CAOH2 (Vitapex TM)
Which has better prognosis pulpotomy vs pulpectomy?
Pulpotomy, only do pulpectomy if essential to preseve tooth
Success rate of pulpectomy?
75-95%
How often should you review pulp-treated teeth?
6 monthly
Why cant you use GP for pulpectomies?
GP won’t resorb as the tooth root is resorbing during exfoliation.
What is the clnical procedure for pulpectomies?
- Pre op radiograph (WL 1mm short of apex)
- LA
- Rubber dam
- Remove caries
- Access pulp chamber
- Remove coronal pulp
- Instrument canals with K files < size 30
- Irrigate with NaOCl (2.25-5%) +/- chlorhexidine 0.12%
- Dry canals with paper point
- Obturate canals with syringe or lentulo spiral, place medicament in canals and pulp chamber floor
- Restore coronal cavity - IRM + GIC double seal
- Post op radiograph
- Restore with SSC>
- Review 6 monthly
