Restorative procedures for the child 2: pulp treatment of primary teeth Flashcards
What can cause deciduous teeth to have pulp involvement?
- smaller sized teeth, larger pulp chamber in relation to size
- pulp horns are closer to tooth surface
- failure to diagnose caries early or treat caries early
- caries can progress very rapidly
What are the causes for pulp exposure?
- caries
- iatrogenic
- dental trauma
What are the causes for devitalisation?
- heavily restored tooth
- undiagnosed pulpal exposure
- dental trauma/wear
What are vital tooth restoration techniques?
- indirect pulp capping
- direct pulp capping
- vital pulpotomy
what are non-vital tooth restoration techniques?
- non-vital pulpotomy
- non-vital pulpectomy (dentist only!!)
What are the steps in an indirect pulp cap restoration?
1- LA given, tooth isolated (rubber dam, cotton wool)
2- Caries is removed, some carious dentine is left over pulp
3- cavity lines with MTA (mineral trioxide aggregate) or calcium hydroxide (Dycal/Life)
4- GIC restoration placed on top
What are the steps in a direct pulp cap restoration?
1- LA give, tooth isolated (rubber dam, cotton wool)
2- cover exposure with MTA (mineral trioxide aggregate) or calcium hydroxide (Dycal / Life)
3-GIC restoration placed on top
When is a vital pulpotomy carried out?
What does it involve?
used for large carious/traumatic exposures of vital pulp with no previous symptoms.
Ideally only transient pain, no irreversible pulpitis and no clinical/radiographic signs of infection.
It involves removal of the coronal pulp (under the crown) but leaving the radicular pulp (within the root canals). This allows the apical part of the pulp to remain vital and ensures the tooth can grow and develop normally.
What are the steps in a vital pulptomy restoration?
1- LA given, tooth isolated (rubber dam)
2-occlusal access using high speed handpiece.
3-Remove peripheral caries at ADJ with slow speed handpiece
4- access to pulp chamber through the roof using a slow speed handpiece. Open up entire occlusal surface.
5-Remove coronal pulp using excavator.
6-irrigate with saline and press on wet cotton wool pledglet
7- Remove CWP and replace with one soaked in ferric sulphate (haemostatic agent) for 15 seconds. Repeat this process until is appears brown: has stopped bleeding
8- remove CWP, irrigate gently, dry.
Then place ONE of the following three:
-MTA (mineral trioxide aggregate)
-ZOE (zinc oxide eugenol)
-hard setting calcium hydroxide
-8 Restore with definitive restoration
When is a direct pulp cap carried out?
What is its’ purpose?
- Only used when there is a accidental/small exposure. The exposure must be non-carious. It can be iatrogenic or caused by trauma.
- to maintain pulp vitality.
when is an indirect pulp cap carried out?
what is it’s purpose?
- When there is carious tooth tissue that has almost extended to the pulp
- arrests caries and promotes pulpal healing.
What is a pulpectomy?
can DHTs do this?
it is the complete removal of the coronal pulp tissue and radicular pulp tissue.
Only dentists can carry out this treatment
