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Peds II > Pulp II > Flashcards

Pulp II Flashcards

1
Q

Characteristics of primary dentition: Teeth size

A

smaller in all dimensions

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2
Q

Characteristics of primary dentition: thickness?

A

Less thickness of enamel and dentin

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3
Q

Characteristics of primary dentition: pulp chambers? (3)

A
  • Big
  • closer to external surface
  • more accentuated horns
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4
Q

Characteristics of primary dentition: roots? (4)

A
  • Long
  • Thin
  • Curved roots
  • narrower canals with apical ramifications
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5
Q

Characteristics of primary dentition: pulp chamber floor? (3)

A
  • Thin
  • Porous
  • Presence of accessory conducts
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6
Q

Characteristics of primary dentition: Reabsorptions

A
  • External: Caused by root reabsorption

- Internal: Caused by aggressions to the pulp

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7
Q

What causes more chances of the caries reaching the pulp? (2)

A
  • High index of caries during childhood

- Morphological characteristics of the primary teeth

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8
Q

Why do primary teeth have less sensitivity?

A
  • Nerve fibers usually end among the odontoblasts / predentin
  • In permanent nerve fibers pass through the odontoblastic zone becoming free of nerve terminations
  • Root resorption= degeneration of nerve fibers: Nervous tissue is the last to mature and first to degenerate
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9
Q

Treatments that preserve pulp vitality? (4)

A

On teeth with no pulp affectation or reversible pulpitis
• Cavity base
• Indirect pulp capping
• Pulpotomy

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10
Q

Radical treatments (do not preserve the pulp vitality)? (3)

A

On teeth with irreversible pulpitis or pulp necrosis
• Pulpectomy
• Extraction

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11
Q

What is a cavity base?

A

Protective liner is a thinly-applied liquid placed on the pulpal surface of a deep cavity preparation, covering exposed dentin tubules, to
act as a protective barrier between the restorative material or cement and
the pulp.

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12
Q

Indication for cavity base?

A

In a tooth with a normal pulp, when all caries is removed for a restoration, a protective liner may be placed in the deep areas of the
preparation to minimize injury to the pulp, promote pulp tissue healing, and/or minimize post-operative sensitivity

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13
Q

Objectives for a cavity base?

A

Preserve the tooth’s vitality, promote pulp tissue healing and
tertiary dentin formation, and minimize bacterial microleakage

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14
Q

Materials for cavity bases? (2)

A
  • Calcium hydroxide

* Glass ionomer type III

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15
Q

Properties of calcium hydroxide? (3)

A
  • Low termal conductivity
  • It stimulates the formation of tertiary dentin (2)
  • Bactericide capacity
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16
Q

Limitations of calcium hydroxide? (2)

A
  • Little resistance to forces

* Soluble, it disappears with time

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17
Q

Glass ionomer properties? (4)

A 
• It liberates fluoride
• Light-cured
• Bactericide capacity
• Contraction of polymerization similar to
the composite
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18
Q

Glass ionomer limitations?

A

It does not stimulate the creation of tertiary dentin

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19
Q

Cavity base technique? (5)

A
  1. Topical and local anesthesia
  2. Rubber dam isolation
  3. Removal of ALL the caries
  4. Placement of the cavity base with a Pitch instrument
  5. Composite restoration following the normal technique for it.
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20
Q

Cavity base technique: placement of cavity base with a pitch instrument? (2)

A
  1. In the case of calcium hydroxide, we will wait until it hardens
  2. Glass ionomer will be light cured
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21
Q

What is indirect pulp capping?

A

Protective liner is a thinly-applied liquid placed on the pulpal surface of a deep cavity preparation, covering exposed dentin tubules, to
act as a protective barrier between the restorative material or cement and
the pulp. The last layer of caries is NOT removed

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22
Q

Indirect pulp capping indications?

A

Indirect pulp treatment is indicated in a primary tooth with no pulpitis or with reversible pulpitis when the deepest carious dentin is
not removed to avoid a pulp exposure. The pulp is judged by clinical and
radiographic criteria to be vital and able to heal from the carious insult.

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23
Q

Indirect pulp capping objectives?

A

Preserve the tooth’s vitality, promote pulp tissue healing and tertiary dentin formation, and minimize bacterial microleakage

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24
Q

Indirect pulp capping materials? (2)

A
  • Calcium hydroxide

* Glass ionomer type III

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25
Q

Indirect pulp capping technqiue? (5)

A
  1. Topical and local anesthesia
  2. Rubberdam isolation
  3. Removal of the caries until there is risk of pulp exposure
  4. Placement of the cavity base with a Pitch instrument
  5. Composite restoration following the normal technique for it
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26
Q

Indirect pulp capping removal of caries? (2)

A
  1. Start at the walls that are further away from the pulp chamber and clean
    them completely.
  2. Remove the caries closest to the pulp trying to avoid a pulp exposure with
    both excavators and/or low speed burs
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27
Q

Indirect pulp capping placement of cavity base?

A
  1. In the case of calcium hydroxide, we will wait until it hardens
  2. Glass ionomer will be light cured
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28
Q

Indirect pulp capping removal?

A

In primary dention, the indirect pulp capping will not be removed on a second appointment.

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29
Q

What is a pulpotomy?

A

Pulp treatment where the coronal pulp is amputated, and the remaining vital radicular pulp tissue surface is treated with a long-term clinically-successful medicament

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30
Q

Pulpotomy indications? (2)

A
  • Primary teeth with cameral pulp affected but the radicular
    pulp is vital, with no clinical or radiographical signs of inflammation (reversible pulpitis).
  • Furthermore, the tootha has to be restorable and have at least 2/3 of the
    root length (tooths functional life)
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31
Q

Pulpotomy contraindications?

A 
All those situations that make us suspect the radicular pulp is already affected:
• Spontaneous pain
• Pain to percussion
• Abnormal mobility
• Fistulas
• Internal reabsorptions
• Pulp calcifications
• External pathological reabsorptions
• Periapical or interradicular
radiolucency
• Excessive bleeding
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32
Q

Pulpotomy objectives?

A

Keep vital the radicular pulp, letting a correct dental exfoliation when its normal time comes.

33
Q

Pulpotomy materials? (7)

A
  • A material will be used to preserve the radicular pulp vital. We may choose
    among different options: entre varias opciones:
  • The pulp chamber will be obturated with zinc oxide eugenol
    Formocresol
    • Ferric sulphate
    • Glutaraldehyde
    • MTA
    • Biodentine
    • Other techniques:
    Laser,
    electrocoagulation
34
Q

Pulpotomy formocresol? (5)

A
  • Most used medicine
  • 19% formaldehyde, 35% cresol, 15% glycerine (vehicle) and water
  • Clinic success:70-100%
35
Q

Pulpotomy formocresol has the capacity to ____ tissues

A

mummify

36
Q

Pulpotomy formocresol proteins?

A

Denaturalizes the proteins that are situated most proximately to the pulp chamber and diffuses towards the apical pulp, creating a bigger or
smaller mummification

37
Q

Why has the use of formocresol been questioned? (3)

A

• 1. The mummification of the pulp treats the symptom but does not
produce cicatrization or healing
• 2. Toxicity: It may diffuse fast, producing lesions at the periodontal and
apical tissues
• 3. Systemic toxicity and immunologic, mutagenic and carcinogenic
potential

38
Q

Pulpotomy glutaraldehyde? (5)

A

• 2 - 4% solution
• Standard fixative for electronic microscope
• Powerful fixative and antiseptic
• Does not diffuse through the pup up to the apex. Smaller systemic
distribution. It is eliminated of the organism in 3 days
• Similar to formocresol in short term success rate. Clinic studies have
demonstrated higher long-term failures

39
Q

Pulpotomy glutaraldehyde disadvantages? (2)

A

• - The pureness, preparation, stability and storage conditions have to be very meticulous. If
not, the solution will loose effectiveness
• - No commercial formula is sold. It has to be obtained through magistral formula

40
Q

Pulpotomy ferric sulphate? (3)

A

15,5%
• Hemostatic
• Similar short-term success rate as formocresol, both clinically and radiographically
(74-99%)

41
Q

Pulpotomy ferric sulphate advantages? (2)

A
  • Work time: 15 seconds

* Economic

42
Q

Pulpotomty MTA? (3)

A

• The studies are based on the idea that pulp exposures have the capacity of healing as
long as there is no microfiltration or bacterial contamination
• MTA is biocompatible and able to seal the communications between the pulp
chamber and the exterior
• Clinic and radiographic success

43
Q

Pulpotomy MTA disadvantages? (3)

A
  • Grey MTA may stain the tooth
  • The work time is 15 minutes
  • Very expensive
44
Q

Pulpotomy biodentine? (3)

A
  • Bioactive substitute of the dentine. Tricalcium silicate.
  • Biocompatible, it can seal the communication áreas of the conduct system and the
    external surface.
  • Both clinical and radiographical success in pulpotomies on primary dentition.
45
Q

Pulpotomy biodentine disadvantages? (2)

A
  • Work time: 12m between modelling and hardening

- Expensive

46
Q

Pulpotomy step 1?

A

Topical and local anesthesia

47
Q

Pulpotomy step 2?

A

Rubberdam isolation

48
Q

Pulpotomy step 3?

A
  • Removal of ALL the caries, starting at the walls further away from the caries and cleaning last the closer area to the pulp, making a pulp exposure.
  • Use a 330 high-speed bur.
49
Q

Pulpotomy step 4?

A

Removal of the pulp chamber roof with a 330 high-speed bur. Sometimes may use an Endo-z, being carefull never to touch the pulp chamber floor (even with the noncutting tip)

50
Q

Pulpotomy step 5?

A

Removal of the cameral pulp with a round tungsten low speed bur or with a sharp excavator

51
Q

Pulpotomy step 6?

A

Control of the bleeding (hemostasia) with cotton pellets

52
Q

Pulpotomy: What do we do when there is excessive bleeding persisting?

A

joined with a dark red- Brown color of the pulp tissue; it is indicating the inflammation has reached the radicular pulp. In this case the treatment will be a pulpectomy or extraction of the tooth

53
Q

Pulpotomy step 7? (5)

A

Application of the medecine that will preserve the pulp vitality:
• Formocresol: Cotton pellet damp with formocresol for 5 minutes
• Ferric sulphate: Cotton pellet damp with formocresol for 15 seconds
• MTA: Base of MTA that is left to harfen for 15 minutes
• Biodentine: Base of Biodentine that is mixed and modelled for 6 minutes
and left to harden for other 6 minutes

54
Q

Pulpotomy step 8?

A

Removal of the cotton pellet in case of formocresol or ferric sulphate pulpotomies and chek the hemostasia of the radicular pulp stumps

55
Q

Pulpotomy step 9? (2)

A
  • Obturation of the pulp chamber with zinc oxide eugenol cement.
  • The cement will be mixed on a glass tile with a cement spatula. It will be condensed with an amalgam condenser or a cotton pellet moistened with water.
56
Q

Pulpotomy step 10? (3)

A

Final obturation of the tooth.
• Posterior teeth: Preformed crown
• Anterior teeth: Glass ionomer type III+ composite

57
Q

Pulpectomy definition?

A

Pulp treatment in primary dentition where we remove ALL the pulp, including the radicular pulp, and the conducts are filled up with a reabsorbable material.

58
Q

Pulpectomy objective?

A

Keep the dental structure until the exfoliation of the primary
tooth

59
Q

Pulpectomy indictions?

A
  • Irreversible pulpitis or pulp necrosis.

- Radicular pulp affected

60
Q

Pulpectomy contrindications? (3)

A

•Teeth that cannot be restored
• Internal reabsorption of the roots
• Perforation of the pulp chamber floor
• Absence of bone support and/or root support (at least there has to be
2/3 of the roots)
• Perirradicular radiolucid área that affects the follicle of the perment tooth.
• Dentigerous or folicular cyst

61
Q

Pulpectomy special considerations? (3)

A

Clinic situations where the pulpectomy is indicated eventhough the
prognosis is poor:
• Primary tooth where there is agenesis of the permanent tooth.
• Second primary molars before the first permanent molar has erupted.

62
Q

Pulpectomy materials? (4)

A

We will use a reabsorbable material to fill the root canals. We may use:

  • Zinc oxide eugenol (ZOE)
  • Kri paste (Idoformic paste)
  • Vitapex (Calcium hydroxide+Idoformic paste)
63
Q

Pulpectomy: What is the pulp chamber obturated with?

A

ZOE

64
Q

How many steps are in a pulpectomy?

A

12

65
Q

Pulpectomy step 1?

A

Previous X-ray

66
Q

Pulpectomy step 2?

A

Topical anesthesia and local anesthesia

67
Q

Pulpectomy step 3?

A

Rubberdam isolation

68
Q

Pulpectomy step 4?

A

Removal of ALL the caries, starting at the walls further away from the
caries and cleaning last the closer area to the pulp, making a pulp exposure. We will use a 330 high-speed bur

69
Q

Pulpectomy step 5?

A

Opening of the pulp chamber (removal of the pulp chamber roof) and removal of the cameral pulp.

70
Q

Pulpectomy step 6?

A

Evaluate the bleeding

71
Q

Pulpectomy step 7? (4)

A

Removal of the pulp with files (manual or rotatory) being carefull not to
make them too wide and irrigate with:
• Sodium hypochlorite 1%
• Clorhexidine

Careful not to irrigate outside the ápex, specially with the hypochlorite

72
Q

Pulpectomy step 8?

A

Dry with paper points

73
Q

Pulpectomy step 9?

A

Obturate the rot Canals with reabsorbable and antiseptic material (with a lentule or syringe being carful not to pass the apex

74
Q

Pulpectomy step 10?

A

Obturate the pulp chamber with ZOE

75
Q

Pulpectomy step 11?

A

Control X-ray

76
Q

Pulpectomy step 12

A

Final reconstruction (composite on anterior teeth and preformed crowns on posterior)

77
Q

Pulpectomy follow up?

A
  • Resolution of the infectious process
  • Development of the permanent germ
  • Radicular reabsorption
  • No signs or symptoms of infection
  • No internal or external reabsorptions
78
Q

Extraction indications? (3)

A
  • Osteolysis area: More tan half of the root is affected or it
    connects with the permanent tooth germ ( to avoid the
    lesión of the permanent tooth, such as hipoplasias, deviations
    of its position and expulsive foliculitis))
  • Not restorable
  • Close to exfoliation

Peds II (11 decks)

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