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Pediatric Dentistry Boards > Pulp Therapy > Flashcards

Pulp Therapy Flashcards

1
Q

Histologically pulp of primary teeth compared to young/permanent teeth

A
  • Primary teeth are histologically similar to the pulp of young permanent teeth, cell rich and vascular; primary teeth exhibit a more typical inflammatory response than permanent teeth in adults
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2
Q

Morphology of primary teeth compared to permanent teeth

A
  • Increased number of accessory canals especially in the pulpal floor
  • Greater curvature of molar roots
  • Flat, ribbon shaped canals, apices more open
  • Relatively longer, more slender roots in molars
  • Pulp horns closer to outer surface of tooth
  • apical resorption
  • Proximity of premolars
  • Larger pulp relative to crown size
  • Mesial pulp horns closer to surface than distal; pulp horns longer than external anatomy suggests
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3
Q

Symptoms suggestive of vital pulp therapy. Examples of vital pulp therapy

A

A normal pulp (no pain) or reversible pulpitis (thermal, chemical, intermittent pain)

  1. Protective base/liner
  2. Indirect Pulp tx
  3. Direct pulp caping
  4. Pulpotomy
  5. Partial Pulpotomy (permanent teeth)
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4
Q

Protective Base (Liner)

  • What are the indications for this treatment?
  • Objectives?
  • *Differences between primary and permanent teeth?
A
  1. Indications:
    - normal pulp
    - dentin tubules exposed by cavity preparation
    - Minimize injury to the pulp
    - Promote pulp healing
    - Minimize post operative sensitivity
  2. Objective:
    - Preserve pulpal vitality
    - promote pulpal healing
    - promote tertiary (reparative) dentin formation–up to 3.5 microns/day; more extensive response in primary than permanent teeth
    - minimize microleakage/post treatment sensitivity
    * *Same for permanent and primary teeth
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5
Q

Indirect Pulp Therapy

  • What are the indications for this treatment?
  • Objectives?
  • *Differences between primary and permanent teeth?
A
  1. Indications:
    - deep carious lesions
    - reversible pulpitis
    - incomplete caries removal
    - no pulp exposure
    - pulp vital
  2. Objectives: Complete seal, preserve vitality, no post-treatment symptoms, no harm to succedaneous teeth, continued root development in permanent teeth
    - Technique: apply Ca(OH)s, if planning to re-enter, wait 6-8 weeks to restore, most practitioners do not re-enter
    - Success rate : ~90%
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6
Q

Indirect pulp therapy w/GI vs FMC pulpotomies in primary teeth?

A

IPT w/GI showed a higher overall success rate (93%) than FMC pulpotomies (75%) in tx deep caries in primary teeth (Farooq 2000)

  • IPT success rates higher than FMC pulpotomies over 4 yr period; treatment of deep dentinal lesions w/caries control procedures prior to IPT or pulpotomy improved the success both txs
  • IPT success rate in primary molars was 95% in a retrospective study (al-zayer 2003)
  • Carious lesion undergoes mineral gain when sealed in indirect pulp tx (oliveira)
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7
Q

Direct Pulp cap:

  • What are the indications for this treatment?
  • Objectives?
  • *Differences between primary and permanent teeth?
A
  1. Indications:
    - Small mechanical or traumatic exposure in primary teeth w/normal pulp
    - Small carious or mechanical exposure in permanent teeth w/normal pulp
    - Contraindicated for carious exposure in primary teeth
  2. Objectives:
    - preserve vitality, no post tx sign/symptoms, pulp healing, tertiary dentin, no pathologic changes (in/external root resorption), for primary teeth: no harm to succedaneous teeth; for permanent teeth: continued apexogenesis for immature teeth
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8
Q

Direct pulp capping and bleeding–important to keep in mind/ increase success?

A
  • Success inversely related to bleeding at DPC
  • Remove debris, irrigate w/saline or LA, keep pulp moist
  • Do not allow clot to form; prevents contact of DPC material w/healthy pulp; may release products that attract bacteria
  • Success rate up to 80-90% but 50% if pulp is inflamed
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9
Q

Partial Pulpotomy

  • What are the indications for this treatment?
  • Objectives?
  • *Differences between primary and permanent teeth?
A
  1. Indications :
    - no pain or recent pain of short duration that subsided w/analgesics, no rxn to percussion, no swelling, no mobility
    - no in/external root resorption, no pathologic changes in PDL or surrounding bone
    - Pulp exposure during caries removal not exceeding 1-2 mm in diameter, with bleeding that stopped within 1-2 mins
    - inflammation and penetration of microorgs limited to superficial site, only superficial tissue removed at exposure site
  2. Objective: vitality, continued apexogenesis in immature teeth
    * ** If carious exposure in primary teeth, full pulputomy
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10
Q

Technique for Partial pulpotomy

A

A Cvek:
Enlarge exposure
partial extirpation (1-3 mm or deeper) or coronal pulp w/sterile round diamond bur
- place pulp capping material (CaOHs currently material of choice w/GIC or CaOH2 if composite restoration to be placed
- Total etch technique w/dentin bonding agents is gaining in popularity

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11
Q

Advantages of a partial pulpotomy over a full cervical pulpotomy?

A
  • Removes inflamed, infected pulp, but preserves cell-rich coronal pulp
  • Facilitates washing away carious debris
  • Allows better contact w/more material; increases healing potential
  • Physiologic apposition of cervical dentin
  • obviates need for RCT
  • natural color and translucency preserved
  • maintains vitalometer response
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12
Q

Pulpotomy in primary teeth

  • What are the indications for this treatment?
  • Objectives?
  • *Differences between primary and permanent teeth?
A
  1. Indications:
    - deep lesion adjacent to pulp that is normal or reversibly inflamed or
    - pulp exposed by trauma
    - coronal tissue can be amputated
    - remaining radicular tissue vital (clinically and radiographically)
    - absence of spontaneous pain, swelling
  2. Objectives:
    - Preserve vitality of radicular pulp
    - no adverse signs or symptoms
    - no radiographic pathology
    - -Technique: prep for SSC, excavate caries, unroof pulp chamber, amputate coronal pulp, hemostasis, treat remaining pulp w/medicament/pressure, neutralize, seal/restore
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13
Q

What are the clinical and radiographic contraindications to pulpotomy in primary teeth?

A
  • Hx of unprovoked pain
  • Presence of fistula or swelling
  • Uncontrolled pulpal hemorrhage
  • Periapical or bifurcation radiolucency
  • Pathologic resorption of pulp
  • Dystrophic calcification
  • more than 1/3 external root resorption; internal resorption
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14
Q

What are each of these made of?

  • Vitapex
  • Maisto’s paste
  • Ledermix
A
  1. Vitapex: iodoform, CaOH2
  2. Maisto’s Paste: iodoform, parachlorophenol, camphor-menthol
  3. Ledermix used to be popular (now its not): dimethylchlorotetracycline, triamcinolone
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15
Q

Formocresol:

  • composition? dilution? method of action? caveats?
  • success?
A
  • Composition: 20% formaldehyde, 35% cresol 15% glycerin. Dilution: 1-5% is sufficient, there is no significant different between 100%.
  • Fixation w/progressive fibrosis: acidophilic zone (fixation), pale staining zone (atrophy), broad zone of inflammatory cells, linear calcifications seen in longer term studies
  • Bactericidal–~most important mech of axn
  • No dentinal bridge, but calcific changes occur
  • Fixation: preserves cells, inhibits autolytic changes and bacterial growth, coagulates protoplasm rendering it insoluble
  • -Success 60-100% depending
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16
Q

Glutaraldehyde: what is it? method of axn?

A

Also a powerful fixing agent

  • antibacterial
  • large molecule
  • minimal systemic distribution
  • tx conc 2-5%
17
Q

Ferric Sulfate: what is it, mech of axn? compared to FMC?

A
  1. Forms protein complex, occludes capillaries, no antibacterial action
  2. Similar radiographic/clinical success to FMC (Loh, 2004)
    - Meta-analysis: overall clinical success of FS: 78-100% similar to that of FMC (Peng 2007)
18
Q

MTA: what is it? benefcits? compared to FMC?

A
  1. Tricalcium silicate, dicalcium silicate, tricalcium aluminate, calcium sulfate dehydrate, bismuth oxide, etc
  2. hydrophilic particles set in the presence of moisture w/in 3-4 hours; working time is 5 minutes
  3. Compressive strength equal to that of IRM
  4. Sealing ability greater than amalgam
    - -Significantly more teeth w/root resorption FMC non in MTA (Aeinehchi 2007), No significant diff in radiographic success (Noorollahian 2008), meta analysis (Peng 2007) states higher clinical and radiographic success, MTA significantly superior to FMC
19
Q

Sodium Hypochlorite: compared to Ferric sulfate?

A

Compared to ferric sulfate:

  • 12 months
  • NaOCl: 100% clinical success (80% radiographic success; FS a little lower but not significantly significant difference
20
Q

Electrosugery : advantages? disadvantages?

A
  1. Advantages: quick, self limiting, hemostasis
  2. Disadvantages: heat tissue destruction, persistent inflammation, coagulation current can result in superficial zone of coagulation necrosis, energy cannot be isolated to surface, incites pathologic root resorption and periapical/furcal pathology and acute/chronic inflammation, edema, fibrosis, diffuse necrosis
    - -results in reparative dentin formation
    - -high success rates (80-95%
21
Q

Huth et al 2005 RCT of primary tooth pulpotmy techniques

A

Prospective randomized control teeth of 175 teeth (impressive):

  • FMC, Er:Yag laser, 50 CaOH2, 50 ferric sulfate
  • Everything was successful at 12 months
  • at 24 months: FMC, Laser, Ferric Sulfate 80% or greater survival. CaOH2 at 50% significantly worse
22
Q

Pulpotomy in permanent teeth:

  • What are the indications for this treatment?
  • Objectives?
  • *Differences between primary and permanent teeth?
A
  1. Indications: pulp exposure, but all infected/affected coronal tissue can be removed
    - Undertaken when time/money prevent immediate conventional RTC (closed apex)
23
Q

Apexogenesis:

- objectives, indications

A
  • encourage continued root formation
  • promote tertiary dentin formation
  • no evidence of inflammatory resorption
  • no evidence of root resorption and periradicular pathosis
24
Q

Indications for non-vital pulp therapy in primary teeth

A
  • Irreversible pulpitis, necrosis; tooth planned for pulpotomy with excessive hemorrhage from radicular pulp
25
Q

Nonvital pulp therapy for primary teeth: treatment options? indications

A

Pulpectomy

  • necrotic pulp, irreversible inflammation
  • Abscessed-in very limited instances–strategic importance of tooth is major consideration
  • adequate root remaining
  • cooperative patient
  • limit to incisors and second molars
26
Q

ZOE vs Vitapex: (Mortazavi 2004) Describe the study: overall success?

A

More short fills for ZOE, overfills w/Vitapex

  • Overall success 10-16 mo: Vitapex 100%, ZOE 78% statistically significant
  • Pulpectomy success rates in molars and incisors
  • likely not just due to material (ZOE consistently had more short fills)

Pediatric Dentistry Boards (23 decks)

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