Pulp Therapy

Question 1

Name some pulpotomy medicaments (other than Formocresol)

Answer 1

Coagulants - Ferric Sulfate
Mineralizing/Bacterialstatic agents - CaOH
Other - electro-surg, laser, pressure, MTA

Question 2

How does Ferric Sulphate work? What is it used for?

Answer 2

1. Used as a coagulation and he static agent (blood proteins react with ferric and sulphate ions with acidic pH solution)
2. Agglutinate do proteins form plugs that occlude capillary orifices
3. No concerns about toxicity or harmful effects
4. Not an antibacterial

Ferric sulphate is used for pulpotomy treatment

Question 3

What is MTA? What is it used for?

Answer 3

MTA is Mineral Trioxide Aggregate (MTA)

Made of:

• tricalcium silicate
• dicalcium silicate
• tricalium aluminate
• calcium sulfate dihydrate
• bismuth oxide

Hardens in dampness or blood. It is an anti-microbial to facultative bacteria. Causes dentin bridge formation with less inflammation and less pulp all necrosis than CaOH. It is not hemostatic

Question 4

What induced formation of dentin at a faster rate - CaOH or MTA?

Answer 4

MTA and it produces more complete dentin bridges

MTA has a very high success rate but it is expensive, technique sensitive, and has difficult handling properties

Question 5

What is the difference in patient results between Formocresol and Ferric sulfate?

Answer 5

There is no difference

Question 6

Which is better for a pulpotomy procedure? CaOH or Formocresol?

Answer 6

Formocresol is a much better option

Question 7

What is better for pulpotomy? Sodium hypochlorite or Formocresol?

Answer 7

No difference but if there is internal resorption it is most likely due to failure in hypochlorite

Question 8

What is better in a pulpotomy procedure – Formocresol or MTA?

Answer 8

MTA proved to have a lower failure rate with less occurrence of internal root resorption

Question 9

What is the restoration of choice for primary teeth after a pulpotomy or pulpectomy?

Answer 9

SCC

Question 10

How is timing important to preventing failure of restoration? (SCC and pulp treatment)

Answer 10

SCC with finished pulp at the same visit has a higher chance of success (82%) than if don’t at a later visit.

SCC with indirect pulp at same visit success rate is 93%

Question 11

Where can signs of failure for pulptomy’s be seen first?

Answer 11

Radiographically before they are expressed clinically

Question 12

Which pulp therapy treatment has a higher success rate – Pulpotomy or Indirect?

Answer 12

Indirect

Question 13

What do we do if the pulp of a tooth is necrotic or hyperemic but we need the tooth?

Answer 13

Pulpectomy

Question 14

What is used on incisors and molars respectively for pulpectomys?

Answer 14

Incisors and canines - broach is used to remove pulpal tissue

Molars - endodontic files used to remove pulpal tissue

Question 15

What are some resort able materials used for pulpectomys?

Answer 15

ZOE paste

Kri-1 paste – iodoform paste

CaOH

Question 16

What are some indications for pulpectomys?

Answer 16

1. Chronic inflammation - canals are necrotic or hyperemic
2. Fisutla, mild mobility
3. Behavior management
4. Finances

Question 17

What are some contraindications for pulpectomies?

Answer 17

1. Non-restorable - gross loss of tooth structure
2. If radiographically we see:
   - Advanced internal root resorption
   - External root resorption
   - Periodical infection involving crypt of the succedaneous tooth
   - pathological loss of bone or PDL
3. Mechanical or various perforation of the floor of the chamber

Question 18

How far should you fill the pulp chamber with ZOE for pulpectomies?

Answer 18

Filled to or slightly short of apex

Question 19

Name some criteria for failure in pulpectomies

Answer 19

Erythema
Swelling
Chronic paroles
Fistula us tract
Missing restoration
Mobility (sustained
Percussion sensitivity

Radiographically:

• Interradicular pathology
• Recurrent caries
• Widened PDL space
• Pathologic root resorption

Question 20

What is Formocresol?

Answer 20

Buckley’s Formula (1:5)

3 parts glycerine - 90ml
1 part water - 30ml
1 part Buckleys - 30ml

Question 21

When does the pulp experience irreversible inflammation in regards to caries

Answer 21

When there is progression to 0.5mm into the pulp

Question 22

How does spontaneous pain occur in pulp all inflammation?

Answer 22

The temperature of our own body can produce nerve firings

Question 23

How does discoloration of tooth structure (observed with luxation injuries) occur?

Answer 23

It is as a result of “leaking” blood components from injured pulp blood vessels and movement of this blood into the dentin all tubules

Question 24

Pulpal necrosis from trauma depends on which two important factors?

Answer 24

1. The type of injury

2. Development of the tooth (open or closed apex)