Restorative Dentistry and Pulp Therapy Flashcards
What ate the 2 primary objectives in pulp therapy for baby teeth?
1- eradicate infection
2-maintain the integrity and heath of the teeth and supporting tissures
8 reasons why we don’t just pull baby teeth
1- prevent space loss and malocclusion
2- aid in mastication
3- preserve the primary tooth in case of hypodontia
4 - Prevent possible speech problems
5- Maintain esthetics
6- Prevent aberrant tongue habits
7- Prevent potentially damaging psychosocial effects
8-Maintain normal eruption patterns and timing
If a primary tooth is removed, and space is not maintained, what can happen with the premolars?
1st premolar can come in ectopically and resorb roots of 2nd premolar
what are the 5 pulpal therapies offered in pediatric dentistry?
1- protective liner 2- indirect pulp cap 3- direct pulp cap 4- pulpotomy 5- pulpectmy
T/F In relation to crowns, the pulp in primary teeth are smaller than in the permanent dentition
False
Which pulp horn is closest to the outer surface of the tooth?
Mesial pulp horns
**makes it more readily exposed to caries or trauma
T/F Pulp horns under each cusp are longer than suggested by external anatomy?
true
Which arch has molars with bigger pulp chambers?
Mandibular
where do accessory canals in primary teeth lead?
directly to the intra radicular furcation
Describe how roots compare to crown size in primary teeth
Longer and more slender than permanent teeth
Describe primary tooth canals
long, ribbon like, tortuous
T/F primary teeth are wider mesiodistally
False- they are narrower
proper identification and diagnosis requires what 4 things?
1-History
2-symptoms
3- radiographic eval
4- clinical eval
Do you need consent from parents?
yes. Duh.
- *or Legal guardian
- *Get documentation of concent
- *answer all questions
What pulpal therapy is indicated if you have normal pulp, all caries are removed for a restoration?
Protective Liner
what are the 3 purposes of a protective liner?
1- minimize injury to pulp
2- promote pulp tissue healing
3- minimize post-op sensitivity
- *Place in deep spots
- a good seal is more important than the actual material type that is placed
What are the 4 objectives for a protective liner?
1- preserve tooth vitality
2- promote pulp tissue healing
3- promote tertiary dentin formation
4- minimize bacteria microleakage
**Should prevent post-op sensitivity, pain, swelling
5 protective liner materials
1- GLUMA 2- calcium hydroxide 3- bonding agents 4- glass ionomers 5- RMGI
What makes up gluma ?
5% glutaraldehyde
35% HEMA (hydroxyethyl methacrylate in water)
What 4 things does GLUMA do?
1- Desensitizer
2- cavity disinfectant
3- rewetting agent
4- adhesion promoter
what are 2 indications to use an indirect pulp cap?
1- no pulpitis or irriversible pulpitis
2- deepest caries are NOT removed to avoid pulp exposure
The pulp is judged by what 2 things to determine if tooth is vital and able to heal from the carious insult?
1- radiograph
2- clinical criteria
7 Steps to indirect pulp cap
1- prep tooth for restoration 2-caries free margins 3- remove gross caries and infected dentin 4- don't hit the pulp 5- leave affected dentin 6- place radiopaque base 7- restore
5 objectives of indirect pulp cap
1-seal involved dentin 2- preserve tooth vitality 3- no post-op symptoms 4- no evidence of root resportpion or path. changes 5- no harm to perm. tooth
5 indirect pulp cap materials
1- Calcium hydroxide 2- ZOE 3- resin modified glass ionomer 4- mineral trioxide aggregate (MTA) 5- glass ionomer cement
what should be placed over CaOH?
glass ionomer or ZOE to provide seal
CaOH has high or low solubility?
high
CaOH has good or poor seal?
poor
**one of the reasons it needs to be reinforced
CaOH has high or low compressive strength
low
2- indication for direct pulp cap
1- normal pulp following small exposure
2-favorable conditions to heal
T/F direct pulp cap of carious pulp exposure is recommended
false
3 basic steps of direct pulp exposure
1-mechanical or traumatic pulp exposure
2- place radiopaque base
3- restore and seal
2 main objectives if direct pulp cap
1-mainain tooth vitality
2- no post-op symptoms
what should result from direct pulp cap?
pulp healing and reparative dentin formation
2 materials for direct pulp cap
1- CaOH
2- MTA
what should be placed as a seal in direct pulp cap to prevent microleakage?
Glass ionomer, RMGI or reinforced ZOE
**CaOH have high solubility, poor seal, low compressive stregnth
2 indication for pulpotomy
1- pulp exposure from caries removal with normal pulp
2- reversible pulpitis from traumatic pulp exposre
9 pulpotomy basic steps
1- prep tooth for full coverage 2- remove caires 3- unroof pulp chamber 4- remove coronal pulp (#4, 6, spoon) 5- stop bleeding with pressure 6- apply medicaments 7- dry with cotton pellets 8- seal 9- place crown
3 objectives of pulpotomy
1- radicular pulp should remain asymptomatic
2- no post op root resorption
3- internal resorption should be stable and self limiting
**might need to remove tooth in perf. causes loss of supportive bone
5 pulpotmy materials
*material (purpose)
1- Formocresol - 1:5 dilution, bactericidal, 65-95% success
*(devitalization/fixation)
2- Ferric sulfate- mask pulp signs (preservation)
3- Chlorhexidine (preservation)
4-MTA (regeneration)
5- ZOE (IRM) is the gold stanard for sealing and filling coronal pulp chamber
In class hint regarding pulpotmy materials
***it doesn’t really matter what product you use as long as you SEAL THE TOOTH
3- pulpectomy indications
1- irreversible pulpitis or necrosis
2- planned for pulpotomy but you see radicular pulp is bad
3- roots have minimal or no resorptions
**you’ll know you need to go to pulpetomy if there is excessive bleeding
11 basic steps for pulpectomy
**steps 5-9 are different from pulpotomy
1- prep tooth
2- remove caries
3- unroof pulp chamber
4- remove coronal pulp
5- extiprate radicular pulp with broaches
6- short fine for radiographic apex (<35)
7- instrument only to point of resistance
8-dry with paper points
9-obturate with ZOE or iodoform past
10- seal
11- place crown
3 pulpectomy objectives
1- radiographic infection should resolve
2- clinical signs should resolve
3- tx will allow for primary tooth resorption and allow perm. tooth to erupt
how long after pulpectomy will radiographic evidence go away?
6 month
how long after pulpectomy will clinical pre-tx go away?
few weeks
4 pulpectomy materials
1- ZOE
2-CaOH
3-MTA
4- Iodoform paste (bactericidal, resorbable)
4 keys to success of any pulp therapy?
1- diagnose
2- isolate
3- technique
4- seal
4- Contraindications to pulp therapy in primary teeth
1-close to exfoliation 2-PA abscess with swelling and drainage 3- unrestorable 4- medically complex
Crown options for primary teeth
1- stainless steel crown
2- veneered stainless steal crowns
3- zirconium crowns
what three pulp therapies are the same for primary and perm. teeth?
1- protective liner
2- indirect pulp cap
3- direct pulp cap
How does a pulpotomy in a primary tooth differ in a permanent tooth?
more conservative pulp access. uses reparative materials like CaOH and MTA
How does a pulpectomy in a primary tooth differ in a permanent tooth?
endo referal
same as pulupotomy: more conservative pulp access. uses reparative materials like CaOH and MTA
