Pulp Therapy Flashcards
What are the disadvantages of early primary tooth loss
- Loss of space with an increased risk of malocclusion
- Decreased masticatory function
- Speech impedance
- Psychological disturbance
- Trauma from anaesthesia/surgery
- If a C is lost unilaterally, you may get a centreline shift
- If an E is lost before 6 you can get bodily movement of the 6 and therefore space loss
How are primary molars different to permanent in terms of caries progression
- Rapid caries progression
- Thin enamel and thin dentine
- Broad contact points
- Small teeth with relatively large pulp chambers
- Irreversible pathological changes before pulp exposure
- Early radicular pulp involvement
-Primary teeth show pulpal inflammation much earlier than in permanent dentition particularly if caries is inter-proximal
Where is on the tooth is caries susceptible to pulpal involvement
- Primary teeth show pulpal inflammation much earlier than in permanent dentition particularly if caries is inter-proximal
- But remember pulp can heal
Considerations for doing an endo on primary tooth
- Root morph and number
- Coronal structure remaining
- Root canal pattern
- Patient fear
- Secondary dentine
- Porous plural floor with accessory canals
- Physiological resorption
- Risk of damage to permanent successor
- Small mouths- restricted access
- Restorability and carious severity
- Frank L
What are the stages before diagnosing in pulpal therapy
History
Clinical examination
Radiographs
Difference between irreversible and reversible pulpits and examples of what may suggest each
IRREVERSIBLE
- Inflamed pulp is incapable of healing
- Spontaneous unprovoked pain
- Sinus tract
- Soft tissue inflammation not resulting from gingivitis or periodontitis
- Excessive mobility not associated with trauma or exfoliation
- Furcation involvement
- Radiographic evidence of internal/external resorption
REVERSIBLE
- Pulp is capable of healing
- Provoked pain of short duration relieved by OTC analgesia, by brushing, or upon removal of stimulus and without signs or symptoms of irreversible pulpitis
What are three pulp treatment techniques available for primary teeth and what does it depend on
-Depending on severity of caries:
- Indirect pulp cap
- Pulpotomy
- Pulpectomy
Similarity between IPC and pulpotomy
-Material or medicament used has to be put close or direct contact with living pulp tissue
Most common materials for IPC
- Calcium hydroxide
- MTA
- Adhesive
Most common materials for pulptoomy
- Ferric sulphate
- Calcium hydroxide
- MTA
What is important to remember when doing a pulpectomy of a primary tooth
- Material has to be placed in the space created by pulp removal
- Material should not prevent resorption of primary tooth’s root
- To allow proper evolution of permanent tooth
Indications for pulp treatment
Good co-operation
-Regular attender
MH precludes extraction
-Haematological condition eg haemophilia
Missing permanent successor
-Second premolar
Over-riding necessity to preserve the tooth
-Space maintainer
Developmental state of tooth
Contra-Indications for pulpal treatment
- Poor cooperation
- Poor dental attendance
- MH eg cardiac arrest
- Multiple carious teeth
- Advanced root resorption
- Severe recurrent pain
- Close to exfoliation (>2/3rds root resorption)
- Extensive internal root resorption
- Cellulitis
- Pus in pulp chamber
- Gross bone loss
Classify pulp therapies
Vital Pulp Therapy
- Direct pulp aping NOT recommended for primary molars
- IPC
- Vital pulpotomy
Non-Vital Pulp Therapy
-Pulpectomy
Rationale for IPC
- Arrest carious process and provide conditions conducive to the formation of reactionary dentine beneath the stained dentine and remineralisation of remaining carious dentine
- Promote pulpal healing and preserve/maintain vitality of pulp tissue
Indications for IPC
-Tooth with. deep carious lesion and no signs or symptoms indicative of pulpal pathosis
Procedure for IPC
- LA and rubber dam
- Removal of all caries at EDJ
- Removal of soft deep carious dentine overlying the pulp region with care to avoid a pulpal exposure
- Placement of lining material such as RMGIC or CaOH
- Definitive restoration to achieve optimum external coronal seal idealy a PMC
When would u do a vital pulpotomy
-Carious or traumatic exposure of a bleeding pulp
In basic terms what happens during vital pulpotomy
- Coronal pulp removed
- Radicular pulp preserved
- Tooth exfoliation as normal
Clinical indicators for pulpotomy
- Pulp minimally inflamed/reversible pulpits
- Caries extending more than 2/3rds into dentine on rx
- Any doubt that pulp is exposed
Procedure for vital pulptomy
- LA
- Rubber dam
- Remove caries
- Remove roof of pulp chamber
- Remove coronal pulp with sterile excavator or slow hand piece
- Ferric sulphate for 15-30 seconds and check bleedingg
- Zinc oxide eugenol in pulp chamber
- Restore with PMC
Technique for a vital pulptoomy
Access
- Caries
- Roof of pulpal chamber
Amputation
- Remove coronal pulp (sterile excavator/large round steel bur)
- Haemorrhage control
- Evaluate pulp stumps
- Place ferric sulphate over root stumps for 15s followed by thorough rinsing and drying
- Evalute root stumps
Restore
- Cover stumps with reinforced ZOE paste
- Place a GIC core
- PMC with optimum external coronal seal
How to judge between and inflamed pulp and abnormal pulp when doing the procedure
- Normal bleeding is an uninformed pulp
- Bright red colour
- good haemostats
- Abnormal bleeding is inflamed pulp
- Crimson deep
- Continued bleeding after pressure
Different materials that can be used in pulpotomy and explanation
Ferric sulphate
- 15% solution
- Haemostatic
CaOH
- Clasically associated with internal resorption
- Powder is promising
MTA
-Expensive
Odontopaste should be used in emergencies only
