pulp therapy in primary teeth Flashcards
3 medicaments used in pulpotomy of primary teeth
- MTA: mineral trioxide aggregate
- formocresol
- ferric sulfate
explain the properties of MTA, pros and cons
- MTA is a tricalcium silicate cement
- biocompatible & promotes tissue healing
- Sets upon moisture, releases CaOH –> highly alkaline env and bactericidal
- Forms HAP when setting –> promotes dentine bridge formation
- success rates similar / better than formocresol
Cons:
- expensive
- discolors tooth
describe properties, pros and cons of Formocresol as pulpotomy medicament
- made up of formaldehyde and cresol
- a fixative and bactericidal medicament
- causes tissue fixation of remaining radicular pulp
- causes coagulation necrosis of infected pulp tissue
- reduces PA & furcal RL
- high success rates
cons:
- concerns of cytotoxicity, carcinogenicity
- formaldehyde toxicity
- diffusion into systenmic system
hence we need to use 1/5 dilution
describe pros and cons of ferric sulfate as medicament
- a hemostatic agent
- ferric complex ion seals the cut BV in pulp, achieving hemostasis
- success rate similar to formocresol
cons:
- not bactericidal , only hemostatic agent
- very acidic
is CaOH used in pulpotomy of primary teeth? why or why not?
no
higher prevalence of internal resorption + tends to wash out after a while
has inferior success. but we use it for DPC instead.
indications for pulpotomy in primary teeth
- carious exposure of primary teeth
- traumatic/mechanical exposure (greater than pinpoint exposure)
- in normal/ reversible pulpitis
- when inflammation deemed to be confined to coronal pulp and radicular pulp still vital –> check when see whether can achieve hemostasis
how to tell if radicular pulp healthy or not during pulpotomy procedure?
check bleeding after amputation of coronal pulp
- healthy red –> can achieve hemostasis –> healthy so do pulpotomy
- dark red/ purple –> unable to achieve hemostasis –> pulpectomy
tx for carious exposure of primary teeth
pulpotomy if radicular pulp still vital
dont do DPC due to lower success rate <75% vs >90%
possible complications of pulpotomy
- premature exfoliation of baby teeth
- pulp calcification
- enamel defects of successor (turners hypoplasia)
- internal resorption of pri teeth
indications for DPC in primary teeth
- pinpoint <1mm pulp exposure FOR MECHANICAL/ TRAUMA EXPOSURE
- vital tooth
NOT FOR CARIOUS EXPOSURE!!!!!
indications for indirect pulp cap in pri teeth
- deep caries adjacent to pulp , vital asymptomatic tooth
- numerous open cavities
how to do indirect pulp cap
- after caries free
- place biocompatible RO base over thin residual layer of affected dentine
- material should stimulate healing & repair
- restore w material to protect against microleakage (CR/ GIC)
aims of direct pulp cap in primary teeth
- promote dentine barrier formation at exposed site
- promote tissue repair & regenration
to maintain vitality of pulp
procedure for DPC
- base line xray
- caries free
- biocompatible RO base over exposed pulp tissue site
- restore w material that seals against microleakage
what we look for during follow up after pulp capping?
- absence of s/s
- tooth remains vital
- no radiographic pathology
- no harm to permanet successor
- must monitor and recall tooth until it exfoliates
how often to recall for DPC
3/12
6/12: take xray to check pulp status, presence of hard tissue formation and root development
what is the indication for intermin therapeutic restorations? (ITR)
- conventional resto not feasible (uncooperative, partially erupted, special needs)
- carious teeth w reverisble pulpitis/ normal pulp
- caries control for multiple open carious lesions
how is ITR done?
interin therapeutic restoration
- selective caries removal: make sure periphery caries free
- can leave behind infected dentine, careful dont expose pulp
- make sure enough space to hold material
- restore w GIC
- monitor for s/s , follow up and decide on need to replace w conventional resto
describe ITR
interim therapeutic restoration
- temp resto placed to train child to handle permanent resto
- similar to IPC, but not complete caries free
options for non vital pulp therapy in baby teeth
- lesion sterilization
- pulpectomy
explain lesion sterilization
indications & procedure
indications:
- tooth has to be maintained for <12m
- root resorption making it hard to do RCT
procedure:
similar to pulpect, except no instrumentations of canals
- canal orifice slightly widneed w round bur
- walls of pulp chamber cleaned w phosphoric acid, rinsed and dried
- AB paste (Clindamycin, metro, cipro) applied onto enlarged canal orifice and pulp floor
- restore w GIC base and SS crown
indications for pulpectomy
- pulp necrosis/ irreversible pulpitis
possible complications pulpectomy
- root resorption
- premature exfoliation
- delayed exfoliation/ over-retention
- enamel defects on permanent successor: turners hypoplasia
- possible flare up –> redo rct if got s/s
important to monitor & recall : ensure it exfoliates normally bc nonvital may delay exfoliation; roots may not resorb normally
considerations during pulpectomy/ nvpt
non vital pulp therapy
- restorability
- variable & complex root morphology
- thin canal walls & pulp floor
- ongoing physiological root resorption
- close proximity to developing perm tooth –> ensure dont damage
- internal root resorption
- advanced root resorption
- cystic lesion
