Pee Dos Flashcards
How do we determine vitality of Primary teeth?
- 4 tests
- unreliable in Primaries
Thermal
Percussion
Palpation
Mobility
How do we determine vitality of Immature Permanent Teeth?
*useful to establish baseline in trauma
Electric
Thermal
Percussion
Palpation
Mobility
How do we determine viability of Permanent Teeth?
Electric
Thermal
Percussion
Palpation
Mobility
Feel changes in alveolus/furcation/mobility
Infection leads to Resorption leads to Mobility
True
T/F
Never base Tx decisions on sensibility tests/feedback
True
Tx exposes pulp, how determine Pulp Status?
*2 options
Purulent/profuse bleeding - Irreversible Pulpitis
Bright red/arrests 5 min. - Reversible Pulpitis
12/24 month (general) Success Rate: MTA
FS:
FMC:
Laser:
ZOE:
CaOH
100 98
86 86
96 85
93 78
92 68
86 53
What is the best filler for Pulpotomy?
MTA
4 reasons MTA best filler for Pulpotomy:
Bioactive glass/ceramic
biocompatible (non-toxic)
Minimal inflammatory response
HA forms dentin and filling material
What is a dentinal bridge?
Reparative Dentin laid down after Pulpotomy
*MTA
3 Protective Liner Meds (Primary and Permanent)
GI (Vitrebond/Fuji IX)
CaOH
Dentin Bonding Agent
4 Direct Pulp Cap Meds (Primary/Permanent)
MTA (Mineral trioxide aggregate)
BIO
CaOH
RMGI/GI
What 2 products would you NEVER USE for Pulpotomy for Permanent teeth?
What 2 products are ok to use?
FMC or FS
MTA or CaOH
6 Pulpotomy meds:
*that can be used on Primary teeth
Formocresol (FMC)
Ferric Sulfate
MTA
Electrosurgery/Laser
TempIt (ZOE)
NaOCl (bleach)
Primary Pulpotomy Meds: FMC ___ application, is _____
Ferric Sulfate ____ application, is _______
MTA/Endosequence, ________
Electrosurgery/Laser, careful of…
ZOE, aka…
NaOCl, similar success rate to ______
5 minute, bactericidal
15 second, coagulant
leave it in
exces heat/energy
TempIt
FMC
4 Indirect Pulp Tx Meds (Primary/Permanent)
GI
RMGI
CaOH
ZOE/IRM
3 Pulpectomy Meds to never use with Primary teeth:
Why?
IRM, MTA, Gutta Percha
non resorbing
IRM, MTA, GP never used for Pulpectomy on Primary teeth (non resorbing), what do you use instead?
Vitapex
followed by ZOE/GI
*flush canals w/ NaOCl 1%
there is a tendency to ______ Vitapex and ______ ZOE
*primary pulpectomy
overfill Vitapex
underfill Zoe
What are the steps for Immature Permanent Apexification?
(like pulpectomy) Irrigate NaOCl
CaOH 2 wks for disinfection
Apical collagen as needed
MTA (moist pellet 24 hrs)
check MTA after 24 hrs, Place GP
***MTA/composite fill for reinforcement of immature root (this is apexification)
What is used for Apexification?
MTA/composite fill to reinforce immature root
What are the filling (obturating) materials for the chamber?
ZOE (IRM)
FMC has similar success to FS and Bleach
True
If the Pulp is Vital, what procedures can you do?
Direct Pulp Cap
Pulpotomy
Indirect Pulp Cap
Revascularization
If the Pulp is Non-Vital, what procedures can you do?
Pulpectomy
Use a Protective Liner in Normal Pulp for what?
Dentinal tubules exposed by prep
A Protective Liner is only used when what 2 conditions are met?
All decay removed
no pulp exposure
When can you use a Direct Pulp Cap?
2 conditions
Vital
Small/pinpoint exposure (less than 1mm)
A Direct Pulp Cap is NOT recommended for a Primary tooth when?
if carious exposure
*internal resorption
Pulpotomy on a Primary, do when the Tooth is Vital, or ______ pulpitis
And the tooth is restorable
Reversible Pulpitis
3 options if you have a Vital tooth and a Large exposure due to caries on a Permanent tooth:
Direct pulp cap
Partial pulpotomy
Pulpotomy
Direct Pulp Cap, Partial Pulpotomy, and Pulpotomy for large carious exposure, vital tooth absence of _______, no radiographic pathology
And what?
spontaneous pain
open apex
For an Indirect Pulp Tx on Primary you must remove what?
Re-enter?
Caries should be __ mm from the pulp
All caries that would potentially expose pulp
no
1 mm
When would you do a Pulpectomy on a Primary?
Non vital
Strategic
Resorable
Adequate root
Immature Permanent Apexification:
RCT
Vital Pulp Tissue
Dentin pulp complex free of bacteria
Creation of new pulp for Apexogenesis
Revascularization
Procedure that addresses the shortcomings involved with capping the inflamed dental pulp of an incompletely developed (immature) permanent tooth. The goal is the preservation of vital pulp tissue so that continued root development with apical closure may occur on its own naturally
Apexogenesis
Achieving artificial closure of the Apex, pulp is non vital in immature permanent teeth, tooth discontinues its natural maturation process and can be weakened
Apexification
Primary Pulpectomy, can’t use what 2 products?
Use what instead?
MTA/IRM
Vitapex
Which medications/Tx are not used in Permanent Pulpotomies?
*why?
FS/FMC
*don’t want existing vital pulp inert/leave clot
In what scenario do we not perform a direct pulp cap?
why?
Carious pulp exposure, Primary teeth
mesenchymal cells differentiating into odontoclasts and resorbing the pulp internally
How do we promote apexogenesis in pulpally involved teeth?
Vital
no RCT, pulpectomy, apexificatoin
vital pulp therapy options instead
Where would a Primary Pulpectomy be a good Tx option?
Where do we NOT do them?
necrotic, strategic, restorable
primary 1st Molars
Apexogenesis is used…
Apexification is used…
normal natural closure of root for Immature Permanent
artificial closure (RCT)
***vital vs non-vital
When would you remove a tooth instead of doing a Pulp Therapy?
infection uncontrolled
Bony support can’t be regained
inadequate tooth structure
excessive root resorption
not strategically important
Good pain often sharp
Bad pain often throb
True
True
What is the most reliable pulp test?
Electric, Thermal, Percusssion/palpation/mobility
Percussion/Palpation/Mobility
Never base Tx on sensibility tests alone. They are only one possible indication of pulp vitality
True
2 indications, Irreversible Pulpitis:
2 indications, Reversible Pulpitis:
Profuse Bleeding, purulent exudate
bright red, 5 min arrested
What isn’t recommended in a Primary Tooth with Carious Exposure?
Direct Pulp Cap
Primary tooth w/ Carious Exposure, no Direct Pulp Cap
What instead?
Pulpotomy
Biocompatibility is a function of…
Microleakage
IPT (indirect pulp treatment) is better than what?
__% at 3 years
Formocresol
94%
ITR (Interim Therapeutic Restoration) will successfully diagnose treateable vital pulp therapy teeth ___% of the time
98%
Early tooth extraction may decrease the length of stay in the hospital
True
ABCDE: missing E:
Missing D:
Missing E on both sides:
Missing D on both sides
distal shoe
banded loop
Nance/Transpalatal Arch
Two banded loops (or Transpalatal Arch)
ONMLK: Missing K
Missing L (after 1st molars in)
LLHA
Do nothing
Most reliable pulp test for Primaries:
Percussion
Mobility
Palpation
When evaluating Primary for pulp Vitallity, what x-rays are the most helpful:
BW
PA
8 y/o, tooth 30, deep lesion, vital, all decay removed, moderate sized pulp exposure:
What meds?
Pulpotomy
MTA
6 y/o, tooth K, deep lesion, all decay removed, no exposure:
Meds:
Liner
GI
10 y/o, tooth 3, deep lesion, vital, potential for pulp exposure:
Meds:
Indirect pulp therapy
RMGI
5 y/o, tooth D, deep lesion, non-vital, moderate sized pulp exposure, pulpal necrosis/purulence
Extraction
T/F
A tooth cannot be fractured without having had an associated displacement injury
True
Prognosis of crown fracture: depends upon ______ to PDL
concomitant injury
Age of pulp exposure, extent of dentin exposed, stage of root development at the time of injury secondarily affect the tooth’s prognosis
True
Crown/root fractures: When the primary tooth can’t be restored, entire tooth removed unless?
Retrieval apical fragments might damage Succedaneous Tooth
Root fracture involves what?
dentin, cementum, pulp
Reduce/reposition a root fracture and space in a ______ splint for ______
rinse with what?
Prognosis:
In the event that the pulp becomes necrotic…
If necrotic part removed:
non rigid, 4 weeks
CHX, antibiiotics
improves w/ fracture closer to Apex
radiolucency at fracture site
apical segment continues to develop/calcify
T/F
It is typical for slight root resorption to occur at the fracture site early in the healing process
True
Follow up timeline for a fracture: 4 week splint removal
4 month splint:
4 weeks splint removal:
2 week splint removal:
apical third and mid root fractures
root fracture near cervical area
lateral luxation, alveolar involvement
intrusion alveolar fracture
Splinting should be non-ridig, passive atraumatic, with small diameter ortho wire measuring:
.014 - .015
or monofilament fishing line + composite
Splinting involves 2 non-affected teeth on either side and must allow movement, otherwise…
risk ankyloses
4 things requiring 2 week splint:
3 things requiring 4 week splint:
subluxation, extrusion, intrusion, avulsion
lateral luxation, delayed avulsion, root fracture
ECC, presence of ____ decayed/missing/filled in any primary tooth in a child ____ months or younger
1+
71 months
Severe ECC any smooth surface lesions in a child younger than…
3 y/o
From ages 3-5, one or more cavitated/missing/filled smooth surface where?
or…
Primary Mx Anterior
decayed/missing/filled score
What meds do we Never use on a Permanent tooth?
What do we use instead?
FMC/FS
MTA/CaOH
4 options for Vital Pulp therapy:
Liner
Indirect Pulp Cap
Direct Pulp Cap
Pulpotomy
Never do a Direct Pulp cap if there is what?
***Primary tooth
Carious lesion
3 meds suitable for a Direct Pulp Cap:
DiCal, MTA, CaOH
FMC, time…
FS, time…
5 minutes
15 seconds
Depth of a Partial Pulpotomy in a Permanent tooth:
1-3 mm
Primary Pulpectomy, never use…
Instead use…
MTA, IRM
Vitapex, ZOE
IRM is reinforced ______
Therefore, you can’t use IRM in a Primary Pulpectomy, but you can use…
ZOE
Apexification:
Collagen plug, GP
Revascularization, make the canal ______, then do what?
Sterile
puncture alveolus, bleed, creates scaffolding that creates new pulp
Pulp vitality in Primary teeth: (3 things)
Also what?
percussion, mobility, palpation
Hx
4 y/o, tooth T, deep lesion, no exposure:
Liner
5 y/o S and L extracted, what is space management?
LLHA or Band/Loop
- **in this case, go with 2 Band/Loop
- **if M also gone, LLHA (but warn about linguals)
Primary pulpectomy, don’t use IRM or MTA why?
don’t resorb
Why would we do a Pulpectomy in a Primary tooth?
non vital
root intact
Anterior Teeth
2nd Primary Molars
Apexogenesis:
Apexification:
natural growth of the root
collagen Plug (non-vital, immature)
PERRLA:
Pupils equal, Round, Responsive to Light, Accommodation
4 types of Displacement Injuries:
Concussion
Subluxation
Luxation (3 subtypes)
Avulsion
3 types of Luxation:
Extrusion
Lateral
Intrusion
Injury to tooth-supporting structures without abnormal loosening or displacement of the tooth
Concussion
Prognosis for Primary Concussion:
53% discolor
PRIMARY/Permanent Concussion Tx: ____ radiograph
Pulp sensibility tests:
Observation ____ diet
____ week follow up
_____ week follow up w/ radiograph
Follow for ______ and signs of necrosis
1 occlusal
don’t do (perm: should be negative)
soft
1 week (perm: 4 weeks)
6-8 week
1 year
Radiographic evidence Pulp Necrosis:
Inflammatory resorption:
Replacement resorption:
2 weeks
3 weeks
6 weeks
Injury to tooth-supporting structures with Loosening but no displacement
Subluxation
Subluxation will get bleeding from where?
because PDL is _____
Radiographs show no ______ and minimal PDL thickening
sulcus
torn
displacement
PRIMARY Subluxation Tx: ____ radiograph
sensibility tests?
Observation and ____ diet
____ week follow up
_____ week follow up w/ radiograph
Prognosis:
1 occlusal
no
soft
1
6-8 week
possible discoloration, can lead to pulp canal obliteration
Permanent Subluxation Tx: 1 occlusal radiograph, Splint for ______ weeks
___week follow up
______ week follow up w/ radiograph
Follow for ___ signs necrosis
Prognosis open apex:
Prognosis Closed apex:
2 weeks
4 week
6-8 week
1 year
minimal risk necrosis
slight risk necrosis (15%)
While Splinting, _____ is required ____ times/day
CHX
2x
Displacement of the tooth axially
PDL partially/totally separated
- tooth appears elongated
- negative pulp tests
Extrusion Luxation
Extrusion Luxation, reposition/splint Primary tooth is less than ___ mm extrusion
Extract if….
3 mm
greater than 3 mm
How long to splint Extrusion Luxation?
2 weeks
The need to Splint Extrusively luxated Primary Tooth is likely an indication for what?
Extraction
Permanent Extrusion Luxation Tx: splint:
Follow ups at:
Prognosis for Open Apex
Prognosis for Closed Apex:
2 weeks
1, 2, 4, 8 weeks, 6 months, 1 year, follow annually 5 yrs
best
necrosis/obliteration common Ankylosis
Lateral Luxation Primary Tx, if Crown displaced labially:
follow ups:
Prognosis:
Extract
1 week, 2-3 weeks (splint), 6-8 weeks (radiographs)
if repositioned, pulp necrosis increases
Lateral Luxation Permanent Tx: when reposition?
follow ups:
Prognosis Open Apex
Prognosis Closed Apex:
immediately
2, 4, 6-8 weeks, 6 months, 1 yr, annually 5 yrs
best
necrosis/obliteration common
Lateral Luxation in Permanent tooth has ___% chance of necrosis:
75%
Primary Apical Luxation Tx: displaced labially:
displaced lingually:
if extract?
re-eruption
extraction
radiograph every yr until permanent erupts
___% of intruded teeth will re-erupt spontaneously
90%
Intrusion Luxation Permanent Tx: remove splint when?
If Immature:
If mature:
2 weeks
spontaneous eruption (ortho after 3 wks)
reposition ASAP surgically
Intrusion: if Apex is Open, when allow spontaneous eruption?
When ortho/surgical
If Apex Closed, when allow spontaneous eruption?
When ortho/surgical?
up to 7 mm
more than 7 mm
up to 3 mm
ortho 3-7, surgical more than 7
Most complicated luxation injury
Ankylosis
Avulsion for Primary Teeth:
Never Replant
Avulsion Tx permanent:
put back in right away
Avulsion Tx, if less than 60 minutes:
if more:
replant
will Ankylose and fail - replant for esthetic, delayed resorption
Any immature tooth out for less than 1 hour is worth replanting
True
Mature Apex (closed) tooth Avulsion, pulpectomy when?
within 7-10 days
*before removal of splint
Avulsion: Mature apex replant?
don’t replant?
less than 1 hr
more than 1 hr
Partial pulpotomy removes 1-3 mm and is called what?
What is goal?
Cvek
apexogenesis
If a fracture is near the cervical area the Splint should be kept in how long?
4 months
In order, the best transport medium for teeth:
never:
put in socket, hanks, milk, saliva
water
