pulp therapy

Question 1

anatomical differences

Answer 1

1) primary
- ribbon like, extensions into accessory canals
- programmed to resorb

Question 2

pathologic bone resorption

Answer 2

1) pulpal necrosis
2) furcation and molars
3) PA radiolucency
4) external root resorption
5) internal root resorption
- from pulp
6)

Question 3

examination of soft tissue

Answer 3

1) extraoral swelling
- peri-orbital swelling
- swelling below the inferior border of the mandible
- ludwigs angina
2) cellulitis
- deep inflammation of subcutaneous tissue

Question 4

diagnostic parameters

Answer 4

1) mobility
- radiographic change
2) percussion
- inflammation in PDL
3) pulp testing
- use in permanent

Question 5

sinus tract infection

Answer 5

1) draining

Question 6

direct pulp caps

Answer 6

1) pinpoint trauma
- prognosis is not great
2) carious pulp exposure
- pulpotomy instead
3) MTA
- pulp healing and reparative tertiary dentin formation

Question 7

MTA

Answer 7

1) highly biocompatible
2) tricalcium silicate
3) induces hard tissue formation

Question 8

indirect pulp cap

Answer 8

1) normal pulp, asymptomatic with deep caries
2) leave a little caries over pulp and seal and arrest deep decay
3) higher success rate over pulpotomy and direct pulp cap
4) Ca(OH)2, activa, limelite, GI

Question 9

pulpotomy contraindications

Answer 9

1) contraindications
- immunocompromised
- spontaneous pain hx
- swelling
- excessive bleeding, dark color blood (pulpectomy or extraction)
- necrotic or absent radicular pulp

Question 10

pulpotomy technique

Answer 10

1) local anesthesia and rubber dam isolation
2) access pulp chamber
- feel the drop and widen the outline form
3) sterile water
4) GI base over MTA
5) Place SSC

Question 11

pulpectomy indications

Answer 11

1) necrotic pulp
2) radicular pulp bleeding cannot be controlled
3) radiographic indication of necrosisp

Question 12

pulpectomy contraindication

Answer 12

1) immunocompromised

Question 13

pulpectoy technique

Answer 13

1) LA and access pulp
2) remove necrotic tissue
2) endodontic irrigant and antimicrobial agent
4) biocompatible and non irritating
5) caution sodium hypochlorite
6) shape the canals to get 2 mm below the apex
7) dry the canals and fill with medicament (ZOE or vitapex)
8) apply apical pressure and condense cotton pellet
9) place SSC

Question 14

ZOE vs vitapex

Answer 14

1) both good
2) vitapex is resorbable

Question 15

apexification

Answer 15

1) removal of infected coronal and radicular pulp tissue
- create an apical stop to fill with GP
2) non vital pulp of immature permanent teeth, but helps retain the tooth
3) same steps of pulpectomy
- then add apical collagen matrix, MTA, after 24hrs, reopen and check MTA
- place GP
- need pre op and post op radiography
- 6 mo recall check

Calcium hydroxide takes a long time to set, MTA in 4-8 hours

Question 16

pulpal regeneration

Answer 16

1) replacement for apexification
2) discontinued development of immature permanent tooth
- reestablish vital tissue in radicular canal space

Question 17

pulpal regeneration technicque

Answer 17

1) access pulp, sodium hypochlorite
2) inject bi-Ab past (ciprofloxacin and metronidazole or Ca(OH)2)
3) seal tooth and have patient return in 1 month
4) use an endo file and stimulate the bleeding