Pulp Protection Part II Flashcards
Define pulp capping
an endodontic treatment designed to maintain the vitality of the endodontium (or the pulp-dentin complex)
What factors for each patient must be considered for pulp capping
- tooth must have a vital pulp and no history of spontaneous pain
- pain elicited during pulp testing with a hot/cold stimulus shouldn’t linger when stimulus is removed
- PA X-ray should show no evidence of a periradicular lesion
- Bacteria must be excluded from a site by the restoration
Which forms more tertiary (reparative) dentin small/slowly progressive lesions or large/rapid progressing lesions
small/slow
Which forms more reactionary dentin, (old/young) teeth and why
young because the pulp is more vital.
What is tubular sclerosis
it is a defense reaction of the pulp- it is the process in which mineral is deposited within the dentinal tubules reducing the permeability to bacteria and toxins
what cells are responsible for secreting reactionary dentin
primary odontoblasts
when is reactionary dentin synthesized
then the pulp has been injured or in response to irritants (like caries and trauma)- but not so injured that the odontoblasts don’t survive
Describe the morphology of reactionary dentin
resembles primary dentin matrix and has a tubular pattern
Where does tertiary/ reparative dentin form
at the pulp-dentin interface
The distribution of tertiary dentin is limited to where
area beneath the stimulus
How does the tertiary dentin provide extra protection to the pulp
by increased the distance between them and injurious stimuli
What is direct pulp capping (DPC)
Procedure in which small exposure of the pulp occurs during cavity preparation or injury (due to caries) with a sound surrounding dentin, is dressed with an appropriate biocompatible radiopaque base in contact with the exposed pulp tissue prior to placing a final restoration
What are the objectives of DPC
- maintain the pulps vitality and function**
- Normal responsiveness to electrical and thermal pulp tests
- Formation of secondary/reparative dentin
- No prolonged post operative pain or swelling
- No pathological changes
What are the indications for direct pulp capping (DPC)
- light red bleeding from the exposure site that can be controlled by cotton
- Traumatic exposures in a dry, clean field, which are reported to dental clinic within 24 hrs
- Small pin-point exposure surrounded by sound dentin during mechanical prep of the cavity
Contraindications for DPC
- Systemic diseases (i.e diabetes and cancer)
- Primary teeth with root resorption
- Pre operative tooth sensitivity
- large pulp exposure
- X-ray changes
- Uncontrolled bleeding
- Non-restorable tooth or restorable with low prognosis
- Tooth mobility
- Swelling and fistula
What is the clinical procedure for DPC
- Anesthetic and rubber dam
- complete removal of decay
- Pin point exposure of pulp
- Control the bleeding with cotton soaked in saline, chlorhexidine, or hydrogen peroxide
- Dry the cavity
- Place calcium hydroxide on the exposed pulp directly
- Place GIC (glass ionomer) liner over Ca(OH)2
- Restore the tooth with composite or amalgam
- Follow up 6 weeks after with X-ray
What should you see on the X-ray and clinically you take 6 weeks after pulp capping
reparative dentin formation and no post operative pain/swelling
What are the differences between affected and infected dentin
Affected
- Inner layer
- Few bacteria
- Reminerizable
- Vital
- Sensitive
- Useful
- Can be left unexcavated
Infected
- Outer (superficial) layer
- Bacterial invasion
- Non-reminerizable
- Dead – lacks sensation
- Without sensation
- Not useful– deteriorated collagen fibers
- Should be excavated
What is indirect pulp capping (IPC)
Procedure where small amounts of carious dentin is retained in deep areas of the cavity to avoid exposure to the pulp followed by the placement of suitable medication and restorative material that seals off the carious dentin and encourages pulp recovery
What are the objectives of IPC
- The restorative material should completely seal the involved dentin from the oral fluids
- Vitality of the tooth should be preserved
- No post operative pain and swelling
- The tertiary or reparative dentin should be evident on X-rays after 6-12 weeks after treatment
- No evidence of internal resorption
What are the indications of IPC
- When pulpal inflammation is minimal and complete removal of caries would cause pulp exposure
- Mild pain associated with eating
- Negative history of spontaneous extreme pain
- no mobility
- no periodical radiolucency
What are the contraindications of IPC
- Signs of pulpal or periapical pathology
- Soft leathery dentin covering all area of cavity
- Pain lingering after removal of stimulus
- Mobility
- Discoloration
Describe the clinical procedure for IPC (single visit)
- Anesthetic and RD
- Cavity outline with high speed
- Remove superficial debris and majority of soft necrotic dentin
- Hard, leathery and infected dentin is left behind
- Rinse cavity with saline and dry
- Ca(OH)2 is placed in the deepest portion of the prep and covered with GIC
- Final restoration with composite or amalgam
- X-ray after 6 weeks and check for presence of reparative dentin
Describe the clinical procedure of IPC (multiple visits)
- Place Ca(OH)2 liner and GIC cement
- Restore cavity with interim material
- 6 weeks look for reparative dentin formation on X-ray
- Re-enter cavity and remove interim material
- Place final restoration
What are the different pulp capping materials available
- Zinc oxide eugenol
- Calcium hydroxide
- Mineral trioxide aggregate (MTA)
- Glass ionomer/ Resin modified glass ionomer
- Adhesive systems
What are the properties of Zinc oxide eugenol
- Germicidal effect
- Palliative effect
- Excellent initial seal
- Arrests the carious process
What are the indications for Calcium hydroxide use in capping
- gold standard
- initially bactericidal then bacteriostatic
- stimulates the reparative dentin
- stops internal resorption
- low cytotoxicity
What are the contraindications of using Ca(OH)2 for capping
-Doesn’t bond to tooth
0Degrades acid etching
-Doesn’t have mechanical strength with standard condensation pressure under an amalgam restoration
-Dissolves in oral builds.
What are the indications of Mineral trioxide aggregate (MTA)
- Adheres to tooth structure
- Stimulates the reparative dentin better and faster than Ca(OH)2
- Biocompatible
- Low cytotoxicity
- Better marginal seal
- Good mechanical strength
- Antibacterial
What are the contraindications of mineral trioxide aggregate (MTA)
- Gray in color
- Long setting time (2-4 hrs)
- Expensive
- Highly soluble
What are the properties of a glass ionomer cement
- provides bacterial seal
- fluoride release
- chemically bonds to tooth structure and resin cement
What are the properties of adhesive systems
- complete marginal seal
- prevents bacterial invasion
- Allows pulp repair
What the videos at the end of the slides
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