Pinkham - Chap 33 - Pulp Therapy for the Young Permanent Dentition

Question 1

Tertiary dentin is classified as either?

Answer 1

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

Question 2

Whats the most significant factor that determines secretion of reactionary dentin?

Answer 2

Residual dentin thickness

Question 3

Restorative material choice also influences secretion of reactionary dentin?

Answer 3

CaOH>resin>resin modified GI>ZOE

Question 4

R/O what when dx clinical and pulpal dx of young permanent dentition?

Answer 4

During eruption of 6yr molars, r/o biting on operculum and pericoronitis

Question 5

Pericoronitis?

Answer 5

acute infxn of partially erupted/impacted tooth causing swelling/inflammation

Question 6

Best protective liners used in deep cavities?

Answer 6

GI or CaOH

Question 7

affected dentin chars?

Answer 7

demineralized dentin

Question 8

IPT objective ?

Answer 8

Objective is to maintain vitality of teeth with reversibile pulp injury

Question 9

IPT rationale?

Answer 9

postmitotic odontoblasts can upregulate secretory activities when bacterial challenges are reduced, results in tertiary dentin and sclerotic dentin deposition which reduces dentin permeability

Question 10

what material is used for DPT and how does it work?

Answer 10

CaOH. When mixed with water, causes liquefaction necrosis. Tissue close to wound loses its architecture, becomes calcified and forms a hard tissue bridge

Question 11

What other material has been suggested for DPT?

Answer 11

dentin bonding agents bc hybridization creates a better seal

Question 12

Another material for DPT?

Answer 12

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

Question 13

Partial or Cvek pulpotomy indications?

Answer 13

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

Question 14

Clinical procedure for Cvek/partial pulpotomy?

Answer 14

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

Question 15

Indications for a cervical pulpotomy?

Answer 15

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.

Question 16

What is essential after performing a cervical pulpotomy?

Answer 16

place a perm restoration to prevent leakage and clinical and radiographic f/u to ensure to pulpal/periapical pathosis is developing

Question 17

Apexogenesis aka

Answer 17

calcium hydroxide or vital pulpotomy

Question 18

Apexogenesis indications

Answer 18

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

Question 19

Apexogenesis clinical technique?

Answer 19

remove coronal pulp, place CaOH over vital pulp stumps after hemostasis is established

Question 20

Apexogenesis goal?

Answer 20

retain vitality of radicular pulp to allow normal apical development

Question 21

Essential to perform what after apexogensis procedure?

Answer 21

clinical/radiographic f/u. If barrier is not observed then apexification should follow

Question 22

Apexification?

Answer 22

Tx for immature permanent teeth in which root growth/development has ceased due to necrosis.

Question 23

Apexification goal?

Answer 23

form an apical barrier so RCT can be performed

Question 24

Apexification indiciations?

Answer 24

incisors with lost vitality following trauma, non vital immature teeth following carious exposure

Question 25

Apexification technique?

Answer 25

total pulp debridement, place CaOH(or MTA) in canal to apex. Requires multiple visits and could take 1+year to achieve apical barrier

Question 26

Why does an apexification procedure take a long time to complete?

Answer 26

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)

Question 27

what about CaOH keeps its antibacterial efx for a long time?

Answer 27

high pH and low solubility

Question 28

what material can be used in an apexification procedure to speed up tx time?

Answer 28

Place MTA at apex, acts as apical plug/seal