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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
Indirect pulp capping technqiue? (5)
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
26
Indirect pulp capping removal of caries? (2)
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
27
Indirect pulp capping placement of cavity base?
1. In the case of calcium hydroxide, we will wait until it hardens 2. Glass ionomer will be light cured
28
Indirect pulp capping removal?
In primary dention, the indirect pulp capping will not be removed on a second appointment.
29
What is a pulpotomy?
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
30
Pulpotomy indications? (2)
- 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)
31
Pulpotomy contraindications?
``` 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 ```
32
Pulpotomy objectives?
Keep vital the radicular pulp, letting a correct dental exfoliation when its normal time comes.
33
Pulpotomy materials? (7)
- 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
Pulpotomy formocresol? (5)
* Most used medicine * 19% formaldehyde, 35% cresol, 15% glycerine (vehicle) and water * Clinic success:70-100%
35
Pulpotomy formocresol has the capacity to ____ tissues
mummify
36
Pulpotomy formocresol proteins?
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
Why has the use of formocresol been questioned? (3)
• 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
Pulpotomy glutaraldehyde? (5)
• 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
Pulpotomy glutaraldehyde disadvantages? (2)
• - 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
Pulpotomy ferric sulphate? (3)
15,5% • Hemostatic • Similar short-term success rate as formocresol, both clinically and radiographically (74-99%)
41
Pulpotomy ferric sulphate advantages? (2)
* Work time: 15 seconds | * Economic
42
Pulpotomty MTA? (3)
• 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
Pulpotomy MTA disadvantages? (3)
* Grey MTA may stain the tooth * The work time is 15 minutes * Very expensive
44
Pulpotomy biodentine? (3)
- 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
Pulpotomy biodentine disadvantages? (2)
- Work time: 12m between modelling and hardening | - Expensive
46
Pulpotomy step 1?
Topical and local anesthesia
47
Pulpotomy step 2?
Rubberdam isolation
48
Pulpotomy step 3?
- 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
Pulpotomy step 4?
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
Pulpotomy step 5?
Removal of the cameral pulp with a round tungsten low speed bur or with a sharp excavator
51
Pulpotomy step 6?
Control of the bleeding (hemostasia) with cotton pellets
52
Pulpotomy: What do we do when there is excessive bleeding persisting?
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
Pulpotomy step 7? (5)
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
Pulpotomy step 8?
Removal of the cotton pellet in case of formocresol or ferric sulphate pulpotomies and chek the hemostasia of the radicular pulp stumps
55
Pulpotomy step 9? (2)
- 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
Pulpotomy step 10? (3)
Final obturation of the tooth. • Posterior teeth: Preformed crown • Anterior teeth: Glass ionomer type III+ composite
57
Pulpectomy definition?
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
Pulpectomy objective?
Keep the dental structure until the exfoliation of the primary tooth
59
Pulpectomy indictions?
- Irreversible pulpitis or pulp necrosis. | - Radicular pulp affected
60
Pulpectomy contrindications? (3)
•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
Pulpectomy special considerations? (3)
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
Pulpectomy materials? (4)
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
Pulpectomy: What is the pulp chamber obturated with?
ZOE
64
How many steps are in a pulpectomy?
12
65
Pulpectomy step 1?
Previous X-ray
66
Pulpectomy step 2?
Topical anesthesia and local anesthesia
67
Pulpectomy step 3?
Rubberdam isolation
68
Pulpectomy step 4?
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
Pulpectomy step 5?
Opening of the pulp chamber (removal of the pulp chamber roof) and removal of the cameral pulp.
70
Pulpectomy step 6?
Evaluate the bleeding
71
Pulpectomy step 7? (4)
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
Pulpectomy step 8?
Dry with paper points
73
Pulpectomy step 9?
Obturate the rot Canals with reabsorbable and antiseptic material (with a lentule or syringe being carful not to pass the apex
74
Pulpectomy step 10?
Obturate the pulp chamber with ZOE
75
Pulpectomy step 11?
Control X-ray
76
Pulpectomy step 12
Final reconstruction (composite on anterior teeth and preformed crowns on posterior)
77
Pulpectomy follow up?
* Resolution of the infectious process * Development of the permanent germ * Radicular reabsorption * No signs or symptoms of infection * No internal or external reabsorptions
78
Extraction indications? (3)
- 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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