pulpotomy Flashcards

1
Q

when is a pulpotomy done?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how is a pulpotomy performed?

A

Coronal pulp is amputated at the entrance of the root canal and the radicular pulp is assessed to be normal and left intact.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are indications for pulpotomy?

A

Carious ,traumatic or mechanical exposure of pulpal tissue in primary teeth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the contraindications for pulpotomies?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are other factors to consider when planning for pulpotomy treatment?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the rationale for performing a pulpotomy?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the very first three things you should do?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

for a formocresol pulptotomy what should you do for occlusal reduction?

A

Occlusal Reduction 1-1.5mm (for stainless steel crown preparation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should you do after occlusal reduction?

A

remove all caries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the three groups of pulpotomy agents?

A

Three groups based on their histological effects on pulpal tissue:
Agents that devitalize pulp tissue:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is formocresol?

A
Buckley’s Formocresol 
19% formaldehyde 
35% cresol
15% glycerine 
31% water
1/5 dilution can be used. But difficult to keep accurate dilution due to evaporation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what’s the histology of formocresol?

A

Formocresol demonstrates unpredictable penetration through pulpal tissue. There is no significant difference between a 5 min or 5 day application in terms of pulpal penetration apically.
Coronal1/3: superficial eosinophilic fixed tissue over pulpstones poor cellular detail (necrosis)
Mid1⁄3:preserved cells tructure, weakly eosinophilic
thrombotic capillaries, endothelial cells and pericytes thickened edema
Apical 1⁄3: (can be vital but mostly non vital)
inflammatory cells (lymphocytes, macrophages, plasma cells)
some edema increased fibrils

Three layers formed (7-14 days) Acidophilic zone (fixation)
Pale staining zone (atrophy) Inflammatory zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what occurs with formocresol pulpotomy?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the controversy with formocresol and is it valid?

A

Controversy:



How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what about mixing formocresol with ZOE paste?

A

Do not mix formocresol into ZOE paste used to cover pulp stumps. No proven benefits shown in literature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is ferric sulfate pulpotomy?

A

Ferric Sulfate Fe2 (SO4)3
Used in 15.5-20% concentration. Fe ions form complexes with
blood proteins which mechanically occlude cut capillaries.
Applied to pulp for 10-15 seconds.
Greater prevalence of internal resorption seen radiographically.

17
Q

what is MTA pulpotomy?

A

Formulation:

18
Q

What are the success rates of the different pulpotomy agents?

A

formocresol - 62-97% - toxic potential

ferric sulfate 77-95% - expensive

MTA - 95-97% - expensive

calcium hydroxide - 31-87% (50%) - internal resorption

ZOE - 57%

Electrosurgery - 84%-96% - heat damages pulp

Laser - 70-95% - not as many studies

USE FORMOCRESOL AND MTA

19
Q

What is the pulpotomy follow-up

20
Q

what is the diagnosis for pulpotomy in immature permanent teeth?

A

Remember that your best clues to pulpal status are history, clinical and radiographic examination.

21
Q

what are the indications for a pulpotomy in immature permanent teeth?

22
Q

what are the contraindications for pulpotomy in immature permanent teeth?

23
Q

What about doing an endodontic fill in immature permanent teeth?

A

Very difficult in immature teeth with open apices to adequately do a conventional gutta percha endodontic fill. Usually requires periapical surgery.
In mature teeth with closed apices, not common to do a calcium hydroxide pulpotomy as may cause pulp canal obliteration. This interferes with access for conventional endodontic treatment. (Defer to Endo Dept)

24
Q

What must you evaluate for pulptotomy in immature permanent teeth?

A

Must evaluate:

25
what are the two types of pulpotomies for immature permanent teeth? and what agents are used?
``` Two types: Partial Pulpotomy Full Coronal Pulpotomy Agents: Calcium Hydroxide Mineral Trioxide Aggregate ```
26
what is a partial pulpotomy?
Removal of part of coronal pulp.
27
what must you watch carefully with partial pulpotomies on immature permanent teeth?
28
what is a full coronal pulpotomy for immature permanent teeth?
29
What do you need to do after the coronal pulp removal for a calcium hydroxide polpotomy in an immature permanent tooth? then how do you do it?
30
For an immature permanent tooth pulpotomy what should happen after you have placed your MTA or calcium hydroxide plus a glass ionomer and permanent restoration?