Pinkham - Chap 33 - Pulp Therapy for the Young Permanent Dentition Flashcards
Tertiary dentin is classified as either?
Reactionary dentin - secreted by new ODB like cells differentiated after death of original cells
Reparative Dentin - involves progenitor cell recruitment and differentiation prior to matrix secretion at injury site
Whats the most significant factor that determines secretion of reactionary dentin?
Residual dentin thickness
Restorative material choice also influences secretion of reactionary dentin?
CaOH>resin>resin modified GI>ZOE
R/O what when dx clinical and pulpal dx of young permanent dentition?
During eruption of 6yr molars, r/o biting on operculum and pericoronitis
Pericoronitis?
acute infxn of partially erupted/impacted tooth causing swelling/inflammation
Best protective liners used in deep cavities?
GI or CaOH
affected dentin chars?
demineralized dentin
IPT objective ?
Objective is to maintain vitality of teeth with reversibile pulp injury
IPT rationale?
postmitotic odontoblasts can upregulate secretory activities when bacterial challenges are reduced, results in tertiary dentin and sclerotic dentin deposition which reduces dentin permeability
what material is used for DPT and how does it work?
CaOH. When mixed with water, causes liquefaction necrosis. Tissue close to wound loses its architecture, becomes calcified and forms a hard tissue bridge
What other material has been suggested for DPT?
dentin bonding agents bc hybridization creates a better seal
Another material for DPT?
MTA- similar antibacterial efx as CaOH but has a biologically active substrate for cell attachment, thus preventing microleakage. After MTA, place vitrebond(GI cement), and then perm restoration
Partial or Cvek pulpotomy indications?
In immature teeth suffering from trauma or carious exposure. Inflammation extends a few mm into the pulp for teeth suffering trauma, so remove only coronal tissue with profuse bleeding or judged to be inflamed/infected
Clinical procedure for Cvek/partial pulpotomy?
Use 330 carbide or diamond, remove superficial portion of coronal pulp, cleanse with saline and use NaOHCl to control hemorrhage and dry/control hemmorhage with cotton pellets. If hemmorhage exists, amputate pulp to a more apical level. Achieve hemostasis, place CaOH or MTA followed by ZOE or GI cement
Indications for a cervical pulpotomy?
Done in mature permanent teeth as ER tx for which a RCT must follow. Done in immature permanent teeth with assumed healthy radicular pulp tissue with potential for continued root development.
What is essential after performing a cervical pulpotomy?
place a perm restoration to prevent leakage and clinical and radiographic f/u to ensure to pulpal/periapical pathosis is developing
Apexogenesis aka
calcium hydroxide or vital pulpotomy
Apexogenesis indications
young immature permanent teeth when part of pulp remains vital and uninflamed. Can be regarded as very deep pulpotomy. Usually performed in carious exposure or in some trauma situations in which pulp exposure occurred and tx was delayed
Apexogenesis clinical technique?
remove coronal pulp, place CaOH over vital pulp stumps after hemostasis is established
Apexogenesis goal?
retain vitality of radicular pulp to allow normal apical development
Essential to perform what after apexogensis procedure?
clinical/radiographic f/u. If barrier is not observed then apexification should follow
Apexification?
Tx for immature permanent teeth in which root growth/development has ceased due to necrosis.
Apexification goal?
form an apical barrier so RCT can be performed
Apexification indiciations?
incisors with lost vitality following trauma, non vital immature teeth following carious exposure
Apexification technique?
total pulp debridement, place CaOH(or MTA) in canal to apex. Requires multiple visits and could take 1+year to achieve apical barrier
Why does an apexification procedure take a long time to complete?
It takes a long time for dentin bridge formation(closure of apex) and because CaOH washes out and must be replaced every several months until you get apical closure(usually 6 months to 1 year)
what about CaOH keeps its antibacterial efx for a long time?
high pH and low solubility
what material can be used in an apexification procedure to speed up tx time?
Place MTA at apex, acts as apical plug/seal
