Summer Final Flashcards
What is the percent chance that an uncomplicated crown fracture will progress to pulpal necrosis? And how do you treat an uncomplicated crown fracture?
This involves enamel and dentin and has a 1-7% chance. You treat it by applying CaOH cement or VitraBond to exposed dentin and then you can restore it if it less than 1/2mm of dentine, and reattach separated tooth fragment with bonding agent.
What is a complicated crown fracture? What are the factors involved? And how do you treat it?
It involves enamel, dentin, and pulp. The factors are the extent of the fracture, stage of root development, and length of time since fracture, and restorative treatment plan. Immature roots need pulp to develop. You can treat it by pulp capping with CaOH if within 1st 30 hours, otherwise do a partial or pull pulpotomy, or a pulpectomy.
Inflammation increases success for vital pulp therapy. True or False?
False
What are the characteristics of MTA?
- Has high pH
- bacteria tight seal, creates its own seal, works the best
- hardens
- acts as a base for permanent restoration
- needs moisture to cure-two appointments
- grey can’t be used in anterior teeth
- expensive
- It comes in grey and white and white can also discolor while the temporary is on.
What are the two things you can mix CaOH with?
Saline or anesthesia, turns into thick paste.
During Cvek Pulpotomy, what does placing the CaOH after the pulpotomy help with?
Starting the healing process/inflammation response to pulp.
When should you splint a root fracture and when should you not worry about it yet?
Splint if fracture on cervical or middle 1/3, and don’t do anything if apical 1/3.
Is a concussed tooth percussion sensitive?
Yes, but no displacement or mobility. No treatment.
What is subluxation?
No displacement, but mobile and percussion sensitive with sulcular bleeding, not treatment.
How do you treat an extrusive tooth?
Reposition on splint for 2-4 weeks, and RCT later if needed.
How do you treat an intrusive tooth?
-Treatment of intrusive luxation injuries depends on root maturity. If the tooth is incompletely formed with an open apex, it may reposition spontaneously. If it is fully developed, active extrusion will be necessary soon after the injury, either orthodontically or surgically. Root canal treatment is indicated for intruded teeth with the exception of those with immature roots, in which case the pulp may revascularize.
How do you treat a laterally displaced tooth?
Reposition with splint for 2-4 weeks, RCT later if needed.
What is the overall prognosis of PDL, root, etc of an avulsed tooth?
-If a tooth has been out of the alveolar socket for more than 1 hour (and not kept moist in a suitable medium), periodontal ligament cells and fibers will not survive, regardless of the stage of root development. Replacement resorption (ankylosis) will probably be the eventual sequela after replantation. Therefore, treatment efforts before replantation include treating the root surface with fluoride to slow the resorptive process. -When mature avulsed teeth are replanted, they cannot be expected to reestablish pulpal blood supply.37 Revas- cularization may occur in immature teeth with wide-open apexes, but it is unpredictable and must be monitored carefully. These teeth must be monitored radiographi- cally over a period of time to watch for evidence of pulp necrosis. In the mature replanted tooth, root canal treatment is definitely indicated and should ideally be started 7 to 10 days after replantation. The splint may remain during treatment for stability. The use of calcium hydroxide as an antimicrobial intracanal interappointment medica- ment may be helpful.43,45 It is particularly beneficial if the root canal is infected, a condition that would be likely to occur when root canal treatment is delayed more than a few weeks after replantation.
How do you treat a tooth that has been out of socket for less than 60 minutes, both closed and open apex?
Closed, put in saline, milk, or saliva, irrivate socket, reimplant and splint for 2 weeks, use antibiotics, than do a RCT after one week, and CaOH 2 weeks. Open, saline to clean, doxycycline for 5 minutes, reimplant with flexible splint, use antibiotics, and follow for vitality after 2, 6, and 12 months.
How do you treat a tooth that has been out of socket for greater than 60 minutes, both closed and open apex?
Closed, Soak in 2% NaF for 20 minutes, and do RCT in NaF soaked guaze in hand. Replant and splint for 4 weeks. It will probably ankylose. Open, May not reimplant due to very high incidence of ankylosis, but do RCT out of mouth as well.
What is apexogenesis and what are some options for doing it?
It is vital pulp therapy to encourage continued physiologic development and formation of root end, maintaining pulp vitality. You could do a Cvek pulpotomy, cervical pulpotomy, control bleeding, rinse with NaOCl diluted to 1.25%, MTA or CaOH.
What is apexification? And what do you do?
Pulp vitality is not attainable so we introduce a calcific barrier across open apex with pulpal necrosis. You do irrigation with NaOCl 1.25%, get WL short of apex with gentle filing, use CaOH paste to stimulate inflammatory response, use MTA for barrier that is permanent at apex, and you can also do Regendo.
Is deep or superficial dentin more porous?
Deep dentin
Why can pulp testing be inconclusive with immature teeth?
Sensory innervation to pulp does not mature until later stages of root formation. Thermal testing may be more reliable.
What are characteristics about primary teeth morphology?
Smaller in all dimensions, primary crowns are wider M-D relative to crown length. Primary have have narrower and longer roots and are more slender. More constricted at DEJ. Enamel and dentin are thinner.
Which pulp test is most reliable with primary teeth?
Thermal - CO2 testing specifically.
What are the main four vital pulp therapies?
- Indirect pulp therapy
- Hall technique (stainless crown with no caries removal)
- Direct pulp capping (Only with small mechanical or traumatic exposures, but not with caries exposure)
- Pulpotomy (Use formacresol, glutaraldehyde, ferric sulfate, or MTA)
How do you perform pulpal therapy on a Non-vital tooth?
Use rubber dam, get WL 2-3 mm short of radiographic length, use NiTi instruments, don’t perforate, and obturate with ZOE, iodoform paste, or CaOH, which are all resorbable, which is the key!!
What are the steps of a pulpotomy?
Remove coronal pulp, and then you can do one of three things. 1) place diluted solution of formocresol for 5 minutes which produces partial tissue fixation, and then place ZOE and an intracoronal restoration over pulp stumps. 2. Place 15% ferric sulfate solution for 15 seconds which produces mechanical blockage of open cappilaries, and then place intracoronal restoration. 3. Place MTA over pulp stumps and then a intracoronal restoration.
Difference between Pulpectomy and RCT?
On slide, they placed ZOE down the canals instead of gutta percha.
What are the 3 requirements for Regendo?
- Stem cells (pulpal mesenchymal stem cells located in cell-rich zone of Hohl. Stem cells of apical papilla SCAP)
- Growth factors/Morphogens
- Scaffold (collagen or glycosaminoglycans)
What are the four case requirements for Regendo?
- Necrotic pulp 2. Immature root apex (young patient) 3. Pulp space not to be utilized by a post or any restorative purposes 4. Coronal seal
What are the main steps of the Regendo Technique?
Anesthetize, isolate, access, debridement of necrotic tissue, WL, irrigate with NaOCl diluted, dry, medicament with CaOH or Triple Antibiotic paste 1:1:1 mixture of cipro, metro, mino (which can stain). Visit in 2-4 weeks, repeat if still infected, anesthetize with 3% Mepivacaine w/o vasoconstrictore, isolate, access, irrigate NaOCL and then 17% EDTA to remove medicament, dry, then use #10 or #15 file out of apex to stimulate bleeding, place collagen matrix (colla-plug) to serve as matrix for white MTA seal, then put on permanent restoration.
