Paeds S3

Question 1

What does survival of the pulp depend on?

Answer 1

• associated periodontal ligament injury
• extent of exposed dentine
• age of the patient (open verses closed apex)

Question 2

When is the prognosis better?

Answer 2

when there is no luxation (displacement) injury

Question 3

What is a pulp cap and when is it used?

Answer 3

apply calcium hydroxide directly to exposure site
small exposure, less than 24 hours old

Question 4

What is a pulpotomy and when is it used?

Answer 4

– maintains the vitality of the remaining (non-infected pulp)
– root formation can continue
Larger exposure, delay in Rx

Question 5

What is a pulpectomy and when is it used?

Answer 5

removal of the entire necrotic nerve from root canal
used when nerve has become entirely non-vital
(uses temporary root filling instead of permanent such as in RCT)

Question 6

What is the process for direct pulp capping?

Answer 6

• arrest haemorrhage with pressure (moistened cotton wool)
• calcium hydoxide placed over the exposure site
• dress with GIC and restore with composite

Question 7

What is apexigenesis?

Answer 7

vital tissue within the tooth is maintained to facilitate continued development of the immature root.

Question 8

What is used to form an apical barrier?

Answer 8

MTA used to provide apical barrier against which to condense root canal filling

Question 9

What material is used for the root canal filling?

Answer 9

gutta percha

Question 10

What does long term use of calcium hydroxide use do?

Answer 10

Marginal breakdown (soluble, does not bond)
High alkalinity can cause demineralisation of dentine (over exposure)

Question 11

How is apical barrier formation using MTA carried out?

Answer 11

• at least 5mm of MTA placed at apical end of root
• placement aided by use of microscope
• placement carried out using disposable MTA carriers and pluggers
• once MTA dry, obturate with heated GP system

Question 12

What are the types of MTA?

Answer 12

• MTA angelus white (sets 10-15mins)
• pro root MTA (sets 24 hours)

Question 13

What are benefits of calcium hydroxide?

Answer 13

• high pH (alkaline) decreases microbial load
• induces a calcific barrier
• reduces inflammatory resorption to an avulsed reimplanted tooth

Question 14

When is calcium hydroxide used?

Answer 14

• pulpotomy
• endodontic inter-visit dressing (4-6 weeks)

Question 15

What are the two types of calcium hydroxide?

Answer 15

“ultracal” - non setting
“dycal” - setting

Question 16

What are instructions for avulsed permanent teeth first aid?

Answer 16

• store in fresh cold milk or saliva asap
• do not allow to dry out
• can wash for 10s under cold water which holding only the crown if obvious debris
• do not handle the root
• re-implant quickly
• flexible splint for 2 weeks
• start RCT after 2 weeks unless open apex replanted within 30-45 mins

Question 17

What is the splinting time for avulsion and extrusion?

Answer 17

2 weeks

Question 18

When should the splint be kept on for 4 weeks?

Answer 18

• luxation
• apical and middle 3rd root fractures
• dento-alveolar fracture

Question 19

When should the splint be kept on for a further 4 weeks?

Answer 19

if there is breakdown/fracture of the marginal bone

Question 20

When should the splint be kept on for 4 weeks-4 months?

Answer 20

there is cervical 1/3 of the root fracture

Question 21

What are the types of splints?

What one is most commonly used?

Answer 21

• composite wire
• acrylic wire
• vacuum formed splint
• acrylic (upper removable appliance) splint
• orthodontic brackets

composite most commonly used

Question 22

Why is a gumshield splint not good?

Answer 22

oral hygiene is often very poor

Question 23

What are the steps for splinting a re-implanted tooth?

Answer 23

Cut and bend 0.6mm stainless steel wire.
Apply composite resin to traumatised tooth and those adjacent.
Sink the contoured, passive wire into the composite.
Shape and cure composite.
Smooth rough composite and wire ends.

Question 24

How is a provisional partial pulpotomy carried out?

Answer 24

• Access pulp
• Remove 2-4mm of pulp tissue
• Arrest haemorrhage with cotton wool and acheive haemostasis
• Dress pulp with calcium hydroxide
• Dress with intermediate restoration material (GIC) vitrebond
• Apply restoration (composite bandage)