Pulp Therapy In Young Permanent Teeth

Question 1

What is the aim of vital pulp therapy in young permanent teeth

Answer 1

Maintain vitality of young permanent teeth, to allow for continued physiologic development —> lay down dentine, apexogenesis

Question 2

Pulp capping and pulpotomy have high success rate in young permanent teeth due to

Answer 2

Good blood supply though open apices

Question 3

When do you do a partial pulpotomy

Answer 3

Pulp exposure in young permanent teeth where not suitable for direct pulp capping as exposed pulp area not healthy any more

Inflamed pulp 1-3mm in depth, removed to reach healthy pulp tissues

Pulp hemorrhage is controlled after removal of superficial inflamed tissue

Question 4

What to do if pulp is healthy/unhealthy in partial pulpotomy

Answer 4

If remaining pulp tissue healthy, bleeding can be controlled. Hemostasis achieved, place caoh2/MTA over remaining healthy pulp tissue

If hyperaemia, cannot achieve hemostasis —> prepare access cavity and amputate entire pulp

Question 5

Follow up for partial pulpotomy

Answer 5

1 week
1 month - sensibility testing, x ray for apical pathology
3 months - x ray for root development
6 monthly review for at least 3 years

Once apex formation complete, routine elective rct, or observe and do rct when signs and symptoms of pathosis/radicular calcification/final restoration is post crown

Question 6

Problems with doing rct in non vital immature permanent teeth

Answer 6

Lack of apical stop to condense gutta percha

Blunderbuss apex difficult to obturation

Thin walls of immature root may fracture during instrumentation/apiceoectomy

Question 7

Aim of pulp therapy on non vital immature permanent teeth

Answer 7

Promote formation of hard tissue barrier at apex to allow placement of root filling

Revascularisation

Question 8

How to perform apical closure

Answer 8

Apical closure used for pulp therapy in non vital immature permanent teeth.

Cns —> fill canal with non setting caoh2 an seal with td
After 2-4 months remove td and wash out caoh2. Keep on replacing caoh2 every3 months (wash out liquid comes out clear each time)

CaOH2 must go down to apex

Once apical barrier formed (6-18 months), fill with gp/mta

Question 9

How to perform apical plug for non vital immature permanent tooth

Answer 9

Remove caoh2 dressing from canal at one week review. Wash out. If no exudate, place mta plug at apical region (3-5mm thick). Seal in wet sponge/paper point to allow MTA to set

Question 10

When do you do revascularisation for non vital permanent tooth

Answer 10

MTA plug and apical closure poor prognosis eg very short root, need to revascularise and have continued root development or eg very open apex or eg very thin walls

Question 11

What is used for revasculariation pulp therapy

Answer 11

Metronidazole + ciprofloxacin