Pinkham - Chap 22 - Pulp Therapy for the Primary Dentition Flashcards
Location and characteristics of Odontoblastic layer?
Cells that line the periphery of pulp space
Extend cytoplasmic processes into dentinal tubules
Form Dentin
Size depends on functional activity
Cell Junctions are responsible for communication between odontoblasts and maintain their position relative to one another
Cell Free Zone characteristics?
plexus of unmyelinated nerves and blood capillaries below the odontoblastic layer
dental pulp core chars?
larger blood vessels and nerves surrounded by loose CT below cell free zone
role of IEE and its basement membrane?
IEE presents bioactive molecules(growth factors) that send signals to dental papilla, inducing differentiation and making odontoblasts
where are odontoblast cells derived from?
ectomesenchymal cells of the dental papilla
which dentin is deposited at initiation of dentinogenesis and how is it mineralized?
mantle dentin, thru mediation of matrix vesicles
what dentin is produced by Odontoblasts after mantle dentin?
ODB cells produce matrix dentin
what direction do odontoblast cells move after laying down matrix dentin and what do they leave behind?
pulpally, leave a single cytoplasmic process embedded in a dentinal tubule in the matrix
characteristics of physiologic secondary dentin?
secreted at slower rate throughout life of tooth which is why you get slow reduction of pulp chamber
lifespan of ODB cells?
survive life of the tooth unless subjected to injury
how does pulp-dentin complex(PDC) respond to injury?
forms new hard tissue(tertiary and sometimes sclerotic dentin)
ODB action in a mild injury? discontinuity of tubular structure?
ODB cells that laid down primary dentin may survive and produce reactionary dentin beneath injury site. No disc of tubular structure
ODB action in severe injury? disc of tubular structure?
ODB beneath injury may die and a new generation of ODB like cells may differentiate, secreting reparative dentin. Will be disc of tubular structure with subsequent reduction in permeability
how does PDC respond to caries?
forms sclerotic dentin by apposition of minerals into and b/w tubules and reactionary tertiary dentin is secreted
Deep caries and relation of pulp vessels and inflammatory cells?
blood vessels of pulp dilate and scattered inflammatory cells are present
What happens if deep caries is left in tooth?
becomes an exposure, and chronic pulpitis now becomes acute, abscess may form, pulp undergoes partial necrosis followed by total necrosis
what factor determines whether partial or total necrosis will occur?
drainage. If drainage impeded by food or a restoration, total necrosis will occur
how does PDC respond to operative procedures?
heat, desiccation and cutting of dentin lead to intra and intertubular mineralization resulting in sclerotic dentin followed by tertiary dentin formation
Type of pain and relation to pulp status?
provoked pain, pulp is usually treatable
spontaneous pain - pulp not treatable
internal root resorption indicates what about pulp?
indicates inflammation of vital pulp
external root resorption indicates what about pulp?
indicates non vital pulp with extensive inflammation
hemorrhaging pulp after pulpotomy and 5 mins of cotton pellet pressure indicates?
more extensive inflammation into radicular pulp and indicates a pulpectomy or ext
GI used as a base and liner on pulpal and axial walls because?
dentin is thin and permeable in deep cavities and GI seals the dentin well.
why are resin, GI cements and dentin bonding agents not used with amalgam?
Their insoluble adhesive layer prevents amalgam corrosion products from sealing the gap
indications of Indirect PT and what dentin formation results?
Teeth with deep caries close to pulp with no signs/symptoms of pulp degeneration. tertiary dentin + peritubular/sclerotic dentin
two most common materials used in IPT?
calcium hydroxide and ZOE paste
Success in primary teeth of IPT?
over 90%, so its recommended in pts with no signs/symptoms of pulp degeneration. IPT success reported to be higher than direct pulp capping and pulpotomy for primary molars with caries*
DPT indications
traumatic or mechanical pin pt exposure of pulp, tooth asymptomatic and free of oral contaminants. Generally No DPT in primary teeth unless tooth is 1-2 years from exfoliation. Use DPT in immature permanent teeth with pinpt traumatic/mechanical exposure
what material is used in DPT?
CaOH placed over exposure site to stimulate dentin formation
why is DPT unsuccessful in primary teeth?
due to high cellular content of primary pulp
Pulpotomy contraindications?
swelling, fistula, pathologic mobility, ext/int root resorption, PARL, pulp calcifications, hemorrhaging from chamber
ideal dressing for pulpotomy is ____ and why?
1:5 formocresol, bactericidal, harmless to pulp, allows healing of pulp, doesnt interfere with root resorption, doesnt cause int/ext root resorption(FC can but its not very high)
pulpotomy clinical procedure?
remove pulp horns, remove coronal pulp with excavator or slow round bur, cotton pressure on stumps, then pellet with formocresol for 5 mins, place ZOE, place final restoration(SSC)
after 5 mins of cotton/formocresol pressure, what color should the stumps appear?
dark brown or dark red
Success and controversy with FC?
70-97% success rate. Controversy with how FC affects radicular pulp. Some claim it leads to chronic inflammation while others say partial or total necrosis of radicular pulp. Substitute medicaments are being researched.
Glutaraldehyde?
Glutaraldehyde(less toxic, less penetration, less effect on PA tissues) as substitute for FC in pulpotomy.
Ferric Sulfate?
hemostatic agent, Success rates similar to that of FC but FS has increased rates of internal resorption.
MTA?
Doesn’t cause int root resorption, finding that is seen in FC and FS pulpotomys. MTA results in more pulp canal obliteration compared to FC
Pulpectomy and root filling for primary teeth indications/contraindications?
indicated in chronic inflammation or necrosis in radicular pulp. Contraindicated in teeth with gross loss of tooth stx, advanced int/ext root resorption, or PARL involving crypt of succedaneous tooth. Often done in primary 2nd molars when 1st perm molar hasn’t erupted yet.
Filling materials for pulpectomy/root filling of primary teeth?
ZOE, Iodoform paste, CaOH
ZOE chars as filler for pulpectomy?
most common. Its rate of resorption differs from that of tooth and overfilling can cause mild foreign body rxn from body.
Iodoform paste(KRI) as filler for pulpectomy chars?
resorbs rapidly, no undesirable efx on succedaneous tooth, if overfilled it is rapidly replaced with normal tissue
CaOH by itself and Vitapex as pulpectomy filler?
CaOH not used by itself in primary teeth. Used when combined with iodoform(Vitapex).
Vitapex chars as pulpectomy filler?
resorb rate slightly faster than roots, no toxic efx on succedaneous teeth, and radiopaque. Ideal primary tooth pulpectomy filler.
criteria for clinical success of root treatments?
When there is no pathologic resorption associated with RL. Also considered successful are pulp treated primary teeth with minimal RL or pathologic root resorption in the absence of clinical signs/symptoms.
