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Pulp III Flashcards

1
Q

General characteristics of young permanent teeth? (6)

A
  • Big pulp chamber
  • Marked pulp horns
  • Big apical foramen
  • Thin tooth walls
  • Slow apical closure (3-4 years)
  • Great regeneration capacity of the pulp
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2
Q

Objectives of the pulp treatment in young permanent teeth? (2)

A
  • Keep, if possible, the pulp vitality
  • Reach the normal radicular development and apical closure:
    correct corono-radicular proportions
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3
Q

Factors to take into account to decide the treatment of the young permanent teeth? (8)

A
  • Level of pulp affectation (gravity of the process)
  • Level of maturity and pulp age (open or closed apex)
  • Possibility to restore the tooth
  • Kind of restoration we are going to do
  • Child´s collaboration
  • Economic cost of the treatment
  • Duration of the treatment
  • Implications for the occlusal development of the tooth
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4
Q

Treatments that keep pulp vitality? (4)

A
  • Cavity base
  • Indirect pulp capping
  • Direct pulp capping
  • Apexogenesis (pulpotomy)
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5
Q

Treatments that do not keep pulp vitality? (2)

A
  • Apexification

* Revascularization

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6
Q

Direct pulp capping definition?

A

Application of a medicine over an exposed pulp

exposed during the removal of the last portions of caries or as a consequence of a trauma

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7
Q

Direct pulp capping indications?

A

There must be a minimum or inexistent inflammation
of the pulp (It is indicated small mechanical or traumatic
exposure).

  • Clinically and radiographicaly asymptomatic tooth.
    • Mechanical exposure caused by iatrogenia (excessive cavity
    preparation)
    • Small pulp exposure by caries surrounded by healthy dentin
    • Traumatic lesion
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8
Q

Direct pulp capping requirements? (3)

A
  • Size of exposure <1 mm
  • Controllable bleeding on the site of exposure
  • Time of pulp exposure (<24 hours)
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9
Q

Direct pulp capping objective?

A

Induce the sound young pulp to form a bridge of
dentin, trying to cover the site of exposure and conserve the
pulpar vitality.

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10
Q

Direct pulp capping materials?(2)

A
  • Calcium hydroxide

* MTA

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11
Q

How many steps are there in the direct pulp capping technique?

A

7

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12
Q

Direct pulp capping step 1?

A

Topical and local anesthesia

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13
Q

Direct pulp capping step 2?

A

Rubber dam isolation

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14
Q

Direct pulp capping step 3?

A

Remove ALL the caries (starting on the walls far away from the pulp chamber and finishing on the closest wall of the pulp) and make a pulp exposure <1mm.

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15
Q

Direct pulp capping step 4?

A

Cleansing (saline solution) and drying of the area

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16
Q

Direct pulp capping step 5?

A

Placement of calcium hydroxide or MTA on the área

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17
Q

Direct pulp capping step 6?

A

Final obturation of the cavity

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18
Q

Direct pulp capping step 7?

A

Radiographic control of formation of dentin bridge (3-6 weeks later)

WE do not remove it on a second session

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19
Q

Apexogenisis other name?

A

vital pulpotomy

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20
Q

Apexogenesis definition?

A

Removal of the coronal pulp with preservation of the vitality
of the root pulp)

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21
Q

Apexogenesis objective?

A

It will permit the final physiological development of the root

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22
Q

Apexogenesis indications and requirements to preform it? (4)

A

• Size of exposure ( > 1 mm )
• Time of exposure( > 24 horas)
• Inflammation of the cameral pulp
• Healthy radicular pulp (no signs of inflammation, incuding
correct hemostasia of the radicular stumps)

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23
Q

Apexogenesis materials?

A
  • Calcium hydroxide
  • MTA may be used on those case where we know the radicular pulp is
    completely healthy, because once the MTA is hard, it is very hard to remove it on a posterior sesion.
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24
Q

How many steps are in the apexogenesis technique?

A

10

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25
Apexogenesis step 1?
Topical and local anesthesia
26
Apexogenesis step 2?
Rubber dam isolation
27
Apexogenesis step 3?
Remove ALL the caries (starting on the walls far away from the pulp chamber and finishing on the closest wall of the pulp) and make a pulp exposure <1mm.
28
Apexogenesis step 4?
Removal of the pulp chamber roof (endo-z bur)
29
Apexogenesis step 5?
Removal of the cameral pulp (With round low-speed bur or sharp excavator, careful not to extirpate the pulp)
30
Apexogenesis step 6?
Cleansing of the cavity with saline solution
31
Apexogenesis step 7?
Hemostasia with cotton pellets
32
Apexogenesis step 8?
Placement of calcium hydroxide on the pulp chamber floor
33
Apexogenesis step 9?
Obturation of the pulp chamber with ZOE
34
Apexogenesis step 10?
Final restoration with composite or preformed crown
35
Apexogenesis radiographics follow up?
The ápex must close and there must be a dentin bridge at the pulp chamber floor (entrance of the root canals)
36
Apexogenesis check pulpotomy?
- Partial pulpotomy On teeth with pulp exposure due to trauma we may do a partial pulpotomy: • We only remove the swollen cameral pulp (1-3mm) and achieve hemostasia after irrigation with sodium hypoclorite or clorhexidine. • We will place a layer of calium hydroxide or MTA on top of the pulp stump. • On top of the MTA or calcium hydroxide we place glass ionomer and a composite. • Make follow-ups to chek there is a physiological apical closure.
37
Apexification definition?
Removal of all of the radicular pulp to stimulate with | biocompatible materials the closure of the foramen.
38
Apexification indications? (2)
* Necrotic pulp | * Irreversible pulpitis
39
Apexification objectives? (2)
* Control of the infection | * Closure of the apex
40
Apexification materials? (2)
* Calcium hydroxide | * MTA
41
How many apexification steps exist?
8
42
Apexification step 1?
Topical and local anesthesia
43
Apexification step 2?
Rubber dam isolation
44
Apexification step 3?
Removal of the caries and the pulp chamber roof
45
Apexification step 4?
Removal of the pulp (with files)
46
Apexification step 5?
Irrigation with sodium hypochlorite or clorhexidine
47
Apexification step 6?
Careful instrumenta/on of the walls to scrape the adhered pulp (using the correct work length)
48
Apexification step 7?
Dry the conducts with paper points
49
Apexification step 8?
Placement of the material for apexification
50
Apexification step 8 materials?
Calcium hydroxide | MTA
51
Apexification material calcium hydroxide?
- Fill up the root canal with calcium hydroxide using lentules, syringes,… - Control X-ray to check it is correctly filled - Temporary obturation (ZOE) - Control and change of the calcium hydroxide every 3 months
52
Apexification material calcium hydroxide followup?
• Clinic and radiographical check-ups every 3 months • Closure process: 3 months - 3 years • Once the apical closure is finished---------Root canal treatment • The most frequent complication is the root fracture (big pulp and thin walls)
53
Apexification material MTA?
We place the Mta at the apical área, with a damp cotton pellet on top and place a provisional obturation A few days laterà root canal treatment If necrosis or severe inflammationà Previous calcium hydroxide
54
Revascularization definition?
Technique based on the capacity of the clot from | the periapical área to produce calcified tissue.
55
Revascularization indications?
Permanent tooth with open apex and pulp necrosis
56
Revascularization objectives? (2)
* Control the infection | * Reach an apical closure
57
Revascularization materials?
Triantibiotic paste: • Ciprofloxacin 200 mg • Metronidazole 500 mg • Minocycline 100 mg
58
Revascularization first session step 1?
Topical and local anesthesia
59
Revascularization first session step 2?
Rubber dam isolation
60
Revascularization first session step 3?
Removal of the caries and pulp chamber roof
61
Revascularization first session step 4?
Removal of the pulp with files (up to work-length)
62
Revascularization first session step 5?
Irrigation with sodium hypochlorite
63
Revascularization first session step 6
Application of triantibiotic paste inside the conduct
64
Revascularization first session step 7
Provisional closure with a cotton pellet and provisional | obturation (cavit or ZOE)
65
Revascularization second session step 1? (2)
- 14-30 days after | - Topical and local anesthesia
66
Revascularization second session step 2?
Rubber dam isolation
67
Revascularization second session step 3?
Removal of the provisional obturation and cotton pellet
68
Revascularization second session step 4?
Irrigation of the conduct with sodium hypochlorite 5,25% and dry the conduct with paper points
69
Revascularization second session step 5?
After the desinfection of the root canal, it is proveked the bleeding of the surrounding periodontal tissue
70
Revascularization second session step 6?
Placement of MTA at the entrance of the root canals
71
Revascularization second session step 7?
Composite restoration or preformed crown
72
Revascularization second session step 8?
Control x-ray at 3, 6, 12 and 18 months

Peds II (11 decks)

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