vital pulp therapy

Question 1

what to do before any tx

Answer 1

sensitivity testing

Question 2

vital pulp therapy

Answer 2

tx aimed at preserving/ maintaining the pulp that has been compromised by trauma, restorations, or caries

Question 3

indirect pulp cap

Answer 3

material placed on the dentin when near the pulp
dentin must be caries free

Question 4

indriect pulp cap without complete caries removal

Answer 4

will result in failure

Question 5

pulp exposure

Answer 5

opening in dentin that uncovers the pulp

Question 6

carious pulp expsoure

Answer 6

due to progressive destruction due to acids/enzymes of microbe activity
underlying pulp is inflammed due to progression of caries

Question 7

mechanical exposure, will pulp always be inflamed when this occurs?

Answer 7

esposure due to operator/instrumentation
if in a sterile environment pulp usually not inflammed

Question 8

traumatic exposure

Answer 8

due to fx

Question 9

pulp cap (direct)

Answer 9

tx of exposed vital pulp by sealing wound with dental material such as CaOH or mineral trioxide
will facilitate the formation of tertiary dentin

Question 10

what is used at UMKC for pulp exposures

Answer 10

dycal

Question 11

UMKC clinical pulp exposure procedure

Answer 11

5. contact endo faculty

Question 12

pulpotomy

Answer 12

removal of coronal portion of vital pulp, radiuclar portion maintained

Question 13

partial pulpotomy

Answer 13

removal of a small portion of the vital coronal pulp

Question 14

flow chart for pulpal exposures

Answer 14

Question 15

bleeding time importance

Answer 15

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)

Question 16

bacterial invasion into tertiary dentin

Answer 16

can allow pulp to remain vital and bac/dentin can be removed

Question 17

what cells produce tertiary dentin

Answer 17

fibroblasts

Question 18

when is pulp expsoure likely

Answer 18

when exccavation occurs in the dentin near the pulp
does not imply that necrosis has occured

Question 19

when can pulp capping be performed (pulpotomy not needed)

Answer 19

only when there is sound dentin (not infected) and no signs of infection (controlled bleeding)

Question 20

what color should normal pulp be? bleeding time WNL?

Answer 20

bright red
1-3min

Question 21

brown/yellow pulp indication for/of?

Answer 21

indicative of necrosis, no pulp caps should have pulpectomy

Question 22

when do you stop remvoing tissue in pulpotomy

Answer 22

when bleeding time is WNL (1-3)

Question 23

how should carious pulp exposure be managed?

Answer 23

pulpotomy not capping

Question 24

Direct Pulp Cap with MTA method

Answer 24

▪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

Question 25

MTA vs CaOH

Answer 25

at three months MTA formed dentin bridge and had minimal inflammation whereas the CaOH had no bridge, inflammtion and zones of necrosis

Question 26

bur?

when perfroming a partial pulpotomy how much tissue do you remove?

Answer 26

change to sterile bur when entering pulp
remove tissue until bleeding response is normal

Question 27

succes rate of partial pulpotomy

Answer 27

very high (98%)

Question 28

calcification of pulpal tisse following pulpotomy

Answer 28

only tissue in direct contact with the material should calcify, if more this indicates bac leakage

Question 29

if only calicifed pulp tissue is present and there is no bleeding, what is indicated?

Answer 29

pulpectomy