Pulpotomy, SSC and Hall's technique Flashcards
Explain what a light red and dark red haemorrhage signify
- Light red, limited haemorrhage = less inflammation
* Dark red, profuse haemorrhage = more inflammation, probably extending into radicular pulp
List the 3 types of pulp therapy medicaments available
- Preservation of radicular pulp: aim is to preserve vitality of radicular pulp without induction of a dentine reparative bridge
- Devitalization of the radicular pulp
- Regeneration/remineralisation (aim to induce formation of a dentine barrier)
Explain ferric sulphate and state what type of medicament it is
- Preservation medicament
- Causes agglutination of blood proteins without the presence of a blood clot
- The agglutination of blood proteins results from the reaction with ferric and sulphate ions to form a ferric-ion-protein complex
- This ferric-ion-protein complex mechanically seals the cut blood vessel and produces haemostasis
- By forming plugs that occlude capillary orifices, the protein complex also prevents the formation of blood clots , thereby minimises chances for inflammation and internal resorption
- The action of ferric sulfate is purely haemostatic, rather than bactericidal or fixative
Explain formocresol and state what type of medicament it is
- Devitalisation medicament • Research has shown that even teeth deemed not suitable for pulpotomy could remain clinically viable following a formocresol pulpotomy
- Success rate ranged from 70 – 90%
List and explain the three major concerns surrounding formacresol
Carcinogenicity:
• Formaldehyde causes nasopharyngeal cancer (Limited evidence that it causes nasal sinus carcinoma
• May cause leukemia in humans
Systemic Distribution:
• Several animal studies have demonstrated systemic absorption following pulpotomy
Mutagenic:
• Formaldehyde is mutagenic in some bacteria
• Long studies with animals have found that prolonged contact with formaldehyde can give rise to precancerous and cancerous states in epithelium
• Inhalation of formaldehyde was found to cause squamous cell tumors of the nasal cavities in rats
• In vitro studies have shown mutations and chromosomal aberrations
Explain glutaraldehyde and state what type of medicament it is
- Devitalisation medicament
- Rates of clinical success are generally similar to those of formocresol
- However later work found that glutaraldehyde is only slightly less toxic than formocresol
- With similar toxic effects and no strong evidence of improvement there is very little rationale for considering glutaraldehyde a replacement for formocresol
Explain calcium hydroxide and state what type of medicament it is
- Regeneration medicament
- Calcium hydroxide has not compared favorably when compared against other pulpotomy techniques and radiographic success rates have rarely been shown to exceed 60%
- The most frequent complication reported is excessive internal resorption following from chronic inflammation
- This is due to blood clot intervening between the pulp and the material itself
Explain mineral trioxide aggregate (MTA) and state what type of medicament it is
- A powder composed of 80% Portland cement and 20% Bismuth Oxide
- The powder undergoes a setting reaction in contact with water, initially forming a highly alkaline paste
- Paste is applied following haemostasis
- MTA has similar clinical success to formacresol and ferric sulphate
- However, it is very expensive and hard to store
Explain electrosurgery and state what type of medicament it is
- Devitalisation medicament
- Non pharmacological devitalisation requiring an electrosurgery unit to produce deep tissue burns
- Carbonises and denatures the pulp and bacterial contamination
- In theory it produces a layer of coagulative necrosis which acts as a barrier between the base material above and the healthy radicular tissue beneath
- There are limited studies and evidence of tissue repair, however, success rate is between 70 – 94%
Explain laser and state what type of medicament it is
- Prevention medicament
- Removal of tissue by ablation through conversion of the laser energy to heat
- Advantages are: haemostatic, antimicrobial and cell-stimulating effects
- Some studies have demonstrated potential to increase healing, stimulate dentinogenesis and preserve the vitality of the dental pulp
- To date there has been limited research and the results have been conflicting
- Cost may be a significant factor limiting the use of lasers
Define Hall’s technique
- A method of managing carious primary molars with a crown and GIC but without the use of LA, caries removal or tooth preparation”
- Sealing infected dentine deprives microorganisms of substrates, reduces bacterial diversity and allowing pulp-dentine complex to lay down tertiary dentine and arrests decay
List the 3 advantages of Hall technique
- No LA
- Minimal failures
- Time
List the 4 indications for Hall’s technique
- Proximal (Class II) cavitated or not
- Occlusal (Class I) non cavitated lesion and patient unable to accept conventional restoration
- Occlusal (Class I) cavitated lesion and patient unable to accept conventional restoration
- Hypomineralised and hypoplastic primary molars
List the 5 contraindications for Hall’s technique
- Signs and symptoms of irreversible pulpits
- Radiographic or clinical signs of pulpal or periradicular pathology
- Severely broken down crowns
- Patient co-operation and clinician not confident crown can be seated without endangering airway
- Risk of bacterial endocarditis
Explain the steps taken when applying a crown
- Protect airway, seat patient upright
- Do not fit Hall crowns on opposing teeth at the same appointment, but either side of the same arch and diagonally opposite teeth acceptable
- Seat crown on tight contact first, if you experience any difficulty remove immediately before the cement sets
- Patients to reviewed on a normal recall schedule with a radiographic examination
