pulp therapy for primary teeth Flashcards
what are the techniques we can use for pulp therapy in primary teeth
indirect pulp therapy
pulpotomy
pulpectomy
what is the difference between primary and permanent teeth
much larger pulp chambers
larger pulp horns
wider dentinal tubules
porous pulp floors with accessory canals
why should we restore primary teeth
tooth ache
abscess
what can form if we leave the caries
a turner tooth
what is a turner tooth
local hypoplasia due to chronic infection of primary predecessor
what is the issue with turner tooth
early loss can lead to ortho problems and damage to the permanent successor
what do we need to consider when thinking when to treat a tooth
the quality of the tooth
presence of the successor
age of patient-close to exfoliation
presence of infection and degree of tooth
what do we need to consider with the MH
shouldn’t carry out tx in immunocomprosed teeth or cardiac disease or haemophilic disorders
what are the indications for tooth retention
medical factors-
risk of XTA
risk of GA
what are some treatment options
indirect pulp therapy
pulpotomy
pulpectomy
what is a indirect pulp therapy
tooth is vital and we need to have a good plural seal
what is pulpotomy
vital tooth and removal of some pulp
what is a pulpectomy
non vital and remove all the pulp
do we carry out pulp capping
contra indicated in inflamed primary teeth
how do we carry out indirect pulp therapy
we are going to arrest the caries process and allow for healing
indications for indirect pulp therapy
Tooth with deep carious lesions
No signs or symptoms of pulpal pathosis
More than 90% clinical success after 3 year follow up
indications for pulpotomy
asymptomatic tooth
carious or mechanical exposure of vital coronal pulp
technique of a pulpotomy
- Pre op radiograph
- LA + rubber dam
- Caries removal
- Access cavity
- Remove the coronal pulp
- Control of haemorrhage
- Application of medicament
Some are
Formocresol
Ferric sulphate - cheaper much more available
MTA- bit expensive
Calcium hydroxide
Electrosurgery
Ledermix - Restoration of pulp chamber
- Stainless steel crown
- Follow up
what are some medicaments used in pulpotomies
formocresol ferric sulphate MTA CaOH electrosurgery ledermix
describe ferric sulphate 15.5%
used for pulpotomy in primary molars
promotes pulp haemostats
success rate is greater than 90% at 2 years
describe MTA
mineral trioxide aggregate
release of cytokines from fibroblasts
cytokines stimulate hard tissue formation
more expensive
steps of a pulpotomy
Control the haemorrhage:
Cotton wool soaked in saline
And control the haemorrhage with gentle pressure for 30s-1min if not consider pulpectomy
Application of ferric sulphate for 15-20s
Restore of pulp:
Do not wash pulp out
With zinc oxide eugenol cement
And pack well
Top with a stainless steel crown
Follow up
Review clinically
Review radiographically - we want to see the zinc eugenol cement go into the pulp canals
indications of a pulpectomy
Tooth diagnosed as having irreversible pulpitis on symptoms and clinical findings Non vital radicular pulp without/without infection Good pt compliance Mobility Spontaneous pain Furcation pathology Uncontrollable pulp haemorrhage Necrotic pulp Sinus/abscess
AIMS OF THE pulpectomy
Access to root canals
Remove as much infected material as possible
