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pulpotomies > pulpotomy theory > Flashcards

pulpotomy theory Flashcards

1
Q

What is a pulpotomy?

A

Removal of carious or infected CORONAL pulp and maintenance of healthy RADICULAR pulp.

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2
Q

What is the aim of a pulpotomy?

A

To maintain pulp vitality until exfoliation.

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3
Q

What is the success rate for pulpotomies using MTA or Biodentine?

A

70-90%

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4
Q

7 contraindications for a pulpotomy:

A
  1. Resorption
  2. Furcation perforation
  3. Insufficient root structure
  4. Unrestorable tooth
  5. Periradicular pathology
  6. Immunocompromised child
  7. Child unable to accept LA and rubber dam placement
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5
Q

When managing an occlusal carious lesion, what type of bur should be used to access?

A

High speed diamond bur.

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6
Q

What type of radiograph is imperative to have before starting?

A

BW (provides optimal view of the crown)
or
PA (indicated to exclude PA pathology if the history doesn’t)

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7
Q

What is the aim of the preparation?

A

To access roof of the pulp chamber and its full width..

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8
Q

In a pulpotomy, where would we expect the carious process to have infected?

A

Coronal pulp with healthy radicular pulp.

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9
Q

What type of bur can be used following caries removal by high speed diamond burs?

A

Endo-Z Bur

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10
Q

What instrument can be used to access the pulp?

A

An Excavator

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11
Q

What kind of pulpal tissue would be expected at the point of excavation?

A

Red, haemorrhagic, infected pulpal tissue.

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12
Q

After excavating the pulpal tissue, what should be placed into the cavity?

A

A sterile cotton wool pellet soaked in saline.

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13
Q

What is the aim of inserting a cotton wool pellet into the cavity?

A

To achieve haemostasis.

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14
Q

How should the cotton wool pellet be applied?

A

With gentle pressure over 3-5 minutes.

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15
Q

What signs would indicate that a pulp is still infected after trying to achieve haemostasis?

A

If it is still haemorrhagic and bright red when removing the pellet.

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16
Q

If the pulp has not achieved haemostasis, what further action could be taken?

A
  1. Remove more pulp
  2. Decide that the pulpotomy procedure is no longer indicated.
17
Q

Direct Evaluation:
signs of a non-inflamed pulp.

A
  1. Normal bleeding.
  2. Bright red colour.
  3. Good haemostasis.
18
Q

Direct Evaluation:
signs of an inflamed pulp.

A
  1. Abnormal bleeding.
  2. Deep crimson.
  3. Continued bleeding despite pressure.
19
Q

When can a pulpotomy be continued?

A

Once a stage has been reached where the radicular pulp is healthy and haemostasis has been achieved.

20
Q

What should be used to remove moisture from the cavity?

A

A dry cotton wool pellet.

21
Q

What are the 2 medication choices for a pulpotomy?

A

MTA or Biodentine

22
Q

Properties of MTA

A
  • Creates a bridge of dentine.
  • Biocompatible.
  • Excellent sealing.
  • High pH.
  • Bone morphogenic properties.
  • Growth factors act through their osteogenic potential to repair pulp.
  • Better than previous materials.
23
Q

What does biodentine contain?

A

Tricalcium Silicate

24
Q

Properties of Biodentine

A
  • Biocompatible and bioactive (induces hard tissue gen).
  • Forms a dentine bridge.
  • Excellent sealing and handling properties.
  • High pH so antimicrobial.
  • More readily available in primary care than MTA.
25
Q

How do Biodentine and MTA induce reparative dentine?

A

Through the modulation of transforming growth factor-b1 secretion by pulp cells.

26
Q

MTA vs Biodentine: pulp-dentine response.

A

Both have similar pulp-dentine complex responses to vital pulp therapy.

27
Q

In what ways is biodentine better than MTA?

A

Better Handling Properties -

Reduced setting time and porosity, enhanced compressive and push-out bond strength and increased microhardness.

28
Q

Why should the biodentine capsule be tapped before mixing?

A

Ensures all the powder is at the correct end of the capsule.

29
Q

How many drops should be added to the biodentine capsule?

A

5 drops

30
Q

How long should biodentine be mixed for?

A

30 seconds

31
Q

What is the ideal consistency of Biodentine?

A

Looks like wet sand.

32
Q

What instrument can be used to dispense the Biodentine into the cavity?

A

Amalgam Packer

33
Q

Why is it a good idea to pack the biodentine?

A

To make an optimal biocompatible seal.

34
Q

What should be used following the pulpotomy to ensure a good coronal seal?

A

PMC

35
Q

When following up, what should be seen in the radicular pulp?

A

Should remain asymptomatic without adverse clinical signs

36
Q

Upon follow up, what should be present radiographically?

A

No postop radiographic evidence of external root resorption.

37
Q

When following up, what should be expected of internal root resorption?

A

Self-limited and stable.

this should be monitored

38
Q

What should be done if resorption causes perforation / loss of supporting bone or clinical signs of infection and inflammation?

A

Extraction

39
Q

When might a tooth be extracted following a pulpotomy?

A
  • Resorption causes perforation.
  • Loss of supportive bone.
  • Clinical signs of infection and inflammation.

pulpotomies (8 decks)

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