Pulp Therapy Flashcards
T or F. For a primary tooth that has received a pulpotomy, an annual bitewing radiograph that shows the interradicular area, but not periapical area is sufficient.
True.
“Radiographic evaluation of primary tooth pulpotomies should occur at least annually because the success rate of pulpotomies diminishes over time. Bitewing radiographs obtained as part of the patient’s periodic comprehensive examinations may suffice. If a bitewing radiograph does not display the interradicular area, a periapical image is indicated.”
Not as concerned with apex in primary teeth but Dr. Ball likes to err on the side of caution and take the PA unless something like behavior management does not permit doing so
External resorption is more common at the apex and furcation - need to discern if normal or pathologic
Internal resorption is more common under pulpotomy fill - if observed, monitor
A radiograph should be obtained immediately following a primary tooth pulpotomy. A radiograph should be obtained immediately following a primary tooth pulpectomy.
1 First statement is true, second statement is false
2 First statement is false, second statement is true.
3 Both statements are true
4 Both statements are false
2 First statement is false, second statement is true.
“A radiograph of a primary tooth pulpectomy should be obtained immediately following the procedure to document the quality of the fill and to help determine the tooth’s prognosis. Radiographic evaluation of primary tooth pulpotomies should occur at least annually because the success rate of pulpotomies diminishes over time.”
In the OR, many providers do not take post-op radiograph of pulpectomy because they are aware of their skill and can “feel” the fill is good
Which of the following is NOT recommended as liner in primary teeth?
1 Calcium Hydroxide 2 Glass Ionomer 3 RMGI 4 ZOE 5 Bonding Agent 6 All are adequate liners
6 All are adequate liners
“Placement of a thin protective liner such as calcium hydroxide, dentin bonding agent, or glass ionomer cement is at the discretion of the clinician.” “A radiopaque liner such as a dentin bonding agent, resin modified glass ionomer, calcium hydroxide, zinc oxide/eugenol, or glass ionomer cement is placed over the remaining carious dentin to stimulate healing and repair.”
First quote found under protective liner section and second quote found under IPT section
Interesting that RMGI (ex: Vitrebond) was not listed as a liner in the protective liner section
DIscussed ZOE - was taught in dental school that the eugenol decreases bonding strength so need to cover it with something but Gordon Christensen has stated he has not found this to be true.
Indirect pulp capping has been shown to have a higher success rate than pulpotomy in long term studies. Indirect pulp treatment is preferable to a pulpotomy when the pulp is normal or has a diagnosis of reversible pulpitis.
1 First statement is true, second statement is false
2 First statement is false, second statement is true.
3 Both statements are true
4 Both statements are false
3 Both statements are true
“Indirect pulp capping has been shown to have a higher success rate than pulpotomy in long term studies. It also allows for a normal exfoliation time. Therefore, indirect pulp treatment is preferable to a pulpotomy when the pulp is normal or has a diagnosis of reversible pulpitis.”
Not often done in OR - teeth are pre-pulp stage or past-pulp stage, also providers tend to be more aggressive because they don’t want to have to bring patients back and chose to do pulpotomy as a “definitive” treatment (open pulp to see if hyperemic or necrotic, may consider to be more “reliable”)
When would be the INCORRECT time to do a MTA or CaOH direct pulp cap on a primary tooth?
1 Pinpoint mechanical exposure
2 Traumatic injury
3 Carious exposure
4 All the above – you don’t do DPC on primary teeth!
3 Carious exposure
“This procedure is indicated in a primary tooth with a normal pulp following a small mechanical or traumatic exposure when conditions for a favorable response are optimal. Direct pulp capping of a carious pulp exposure in a primary tooth is not recommended”
Can do DPC for small carious exposure in permanent teeth
You finish the pulpotomy of #T on your eight-year-old patient. What is the correct restoration?
1 Stainless Steel Crown (SSC)
2 Amalgam
3 Composite
4 All of the above would be clinically acceptable
1 Stainless Steel Crown (SSC)
“The most effective long-term restoration has been shown to be a stainless-steel crown. However, if there is sufficient supporting enamel remaining, amalgam or composite resin can provide a functional alternative when the primary tooth has a life span of two years or less.”
The eruption time of Mandibular 2nd Pre-molars is age 11-13
It was noted that to do amalgam or composite, only one surface must be affected but if 2+ surfaces, then SSC is recommended (should it actually be “full coverage restoration” since there are zirconia crowns?)
You are performing a pulpotomy and there appears to be uncontrolled hemorrhage of the pulp chamber after five minutes of leaving your cotton pellet in. What do you do next?
1 Proceed as regular 2 Perform pulpectomy 3 Extract 4 Temporize and bring back in a week to finish treatment 5 None of the above
2 Perform pulpectomy
“A pulpectomy is indicated in a primary tooth with irreversible pulpitis or necrosis or a tooth treatment planned for pulpotomy in which the radicular pulp exhibits clinical signs of irreversible pulpitis (e.g., excessive hemorrhage that is not controlled with a damp cotton pellet applied for several minutes) or pulp necrosis (e.g., suppuration, purulence). The roots should exhibit minimal or no resorption.”
Amount of time is subjective, Dr. Ball said he usually does 3-5 minutes but in these situations, he likes to do deeper pulpotomies with high speed and diamond football bur for a clean amputation of pulp compared to carbide or slow speed (which can sometimes tug pulp)
T or F. For an immature permanent tooth that you are considering an indirect pulp cap, the “two-step” or “step-wise” has recently been shown to be more successful than the single appointment or “one-step” indirect pulp cap.
False.
“The decision to use a one-appointment caries excavation or a step-wise technique should be based on the individual patient circumstances since the research available is inconclusive on which approach is the most successful over time.”
Prefer doing as much as possible in one visit, especially if behavior is a problem
T or F. For Cvek pulpotomy, neither time between the accident and treatment nor size of exposure is critical if the inflamed superficial pulp tissue is amputated to healthy pulp.
True.
“Neither time between the accident and treatment nor size of exposure is critical if the inflamed superficial pulp tissue is amputated to healthy pulp.”
Try to do as soon as possible but if unable to, patient likely won’t wait long to get treatment done
It is okay to cover pulp to prevent further contamination but okay to leave as is and have patient show up for treatment the next day
T or F. MTA and Formocresol are the recommended materials for use in both IPT and pulpotomies.
False.
“The panel strongly recommends the use of MTA [and Formocresol] in vital primary teeth with deep caries lesions treated with pulpotomy due to pulp exposure during carious dentin removal.”
“The panel found that the success of IPT in vital primary teeth with deep caries lesions is independent of the type of medicament used, and therefore conditionally recommends that clinicians choose the medicament based on individual preferences.”
Formo was never specified as an IPT medicament, and likely not meant as an option as it is a fixative agent (good for pulpotomy)
When using formocresol as a pulpotomy medicament, how long is the application time?
- Application time does not determine success
- 1 minute
- 5 minutes
- More than one answer is correct
- More than one answer is correct
Buckley’s full-strength FC recommends a 5 minute application, but according to evidence a 1 minute application has equivalent success.
pg 140 handbook
Out of the following medicaments, which one could lead to accelerated exfoliation of primary teeth?
1 NaOCl
2 Ferric Sulfate
3 Formocresol
4 Calcium Silicate
3 formocresol
pg 140 handbook
I tried to find a good reason why that is? There is a case report called: “Premature exfoliation of primary molars related to the use of formocresol in a multivisit pulpotomy technique: a case report.” Here, they really didn’t give any great evidence why. They said it could be bc of inadequate technique, residual infection or using too much formo. In McD&A pg 239, It states that “Occasionally a pulpally treated tooth will loosen or exfoliate prematurely for no apparent reason. Such conditions result from low-grade chronic, asymptomatic, localized infection.”
- *formocresol causes external resorption
- *ferric sulfate causes internal resorption
What is considered the gold standard for pulp capping on permanent teeth?
1 MTA
2 Biodentine
3 Ca(OH)2
4 GI/RMGH
3 Ca(OH)2
Pg 152 handbook
Although MTA has shown similar results to Ca(OH)2, Ca(OH)2 has remained the gold standard as it has the longest track record of clinical success.
Pg 145 handbook
IPT: MTA has higher success rates than Ca(OH)2 (60-100% for CaOH2 and 98% MTA)
For revascularization to be successful, which of these are required? (this one is tricky)
i. Carious vital tooth
ii. Carious non-vital tooth
iii. Traumatized vital tooth
iv. Traumatized non-vital tooth
v. Open apices of at least 1mm
vi. Open apices of 2mm
vii. Healthy 6yo child
viii. Healthy 17yo child
ix. Healthy 7yo child
a. i, vi, ix
b. iii, v, viii
c. iv, vi, ix
d. iii, vi, vii
e. iv, v, ix
c. iv, vi, ix
pg 151 handbook
Criteria: 1.1mm open apex, patient in good health and in age between 7-16yrs old. Blake commented that there are case reports for carious non-vital tooth as well. Should only be attempted if tooth is not suitable for RCT, after apexogenesis, apexification, or partial pulpotomy tx have already been attempted and have prognosis.
T or F. Revascularization, partial pulpotomy, and apexogenesis are all under the umbrella of regenerative endodontics.
True.
