vital pulp therapy Flashcards
what to do before any tx
sensitivity testing
vital pulp therapy
tx aimed at preserving/ maintaining the pulp that has been compromised by trauma, restorations, or caries
indirect pulp cap
material placed on the dentin when near the pulp
dentin must be caries free
indriect pulp cap without complete caries removal
will result in failure
pulp exposure
opening in dentin that uncovers the pulp
carious pulp expsoure
due to progressive destruction due to acids/enzymes of microbe activity
underlying pulp is inflammed due to progression of caries
mechanical exposure, will pulp always be inflamed when this occurs?
esposure due to operator/instrumentation
if in a sterile environment pulp usually not inflammed
traumatic exposure
due to fx
pulp cap (direct)
tx of exposed vital pulp by sealing wound with dental material such as CaOH or mineral trioxide
will facilitate the formation of tertiary dentin
what is used at UMKC for pulp exposures
dycal
UMKC clinical pulp exposure procedure
- contact endo faculty
pulpotomy
removal of coronal portion of vital pulp, radiuclar portion maintained
partial pulpotomy
removal of a small portion of the vital coronal pulp
flow chart for pulpal exposures
bleeding time importance
if prolonged (longer than 2 min) indication for continued tissue removal
example: pulp exposure but controlled=direct cap
exposure but no control= pulpotomy (if bleeding progressed= pulpectomy)
bacterial invasion into tertiary dentin
can allow pulp to remain vital and bac/dentin can be removed
what cells produce tertiary dentin
fibroblasts
when is pulp expsoure likely
when exccavation occurs in the dentin near the pulp
does not imply that necrosis has occured
when can pulp capping be performed (pulpotomy not needed)
only when there is sound dentin (not infected) and no signs of infection (controlled bleeding)
what color should normal pulp be? bleeding time WNL?
bright red
1-3min
brown/yellow pulp indication for/of?
indicative of necrosis, no pulp caps should have pulpectomy
when do you stop remvoing tissue in pulpotomy
when bleeding time is WNL (1-3)
how should carious pulp exposure be managed?
pulpotomy not capping
Direct Pulp Cap with MTA method
▪Deliver MTA with amalgam carrier or MTA carrier instrument (Dentsply); do not use plugger!
▪Blot excess moisture from MTA with dry cotton ball/forcepts; carve MTA 1.0mm past exposure site
▪Restore
MTA vs CaOH
at three months MTA formed dentin bridge and had minimal inflammation whereas the CaOH had no bridge, inflammtion and zones of necrosis
bur?
when perfroming a partial pulpotomy how much tissue do you remove?
change to sterile bur when entering pulp
remove tissue until bleeding response is normal
succes rate of partial pulpotomy
very high (98%)
calcification of pulpal tisse following pulpotomy
only tissue in direct contact with the material should calcify, if more this indicates bac leakage
if only calicifed pulp tissue is present and there is no bleeding, what is indicated?
pulpectomy
