Vital Pulp Therapy

Question 1

what is vital pulp therapy

Answer 1

treatment aimed at preserving and maintaining pulp tissue that has been compromised by trauma, caries, or restorative procedures in a healthy state

Question 2

complete caries removal is essential to eliminate:

Answer 2

infected tissues

Question 3

residual caries compromises:

Answer 3

necessary observations of pulpal inflammation levels and areas of potential necrosis

Question 4

what is carious pulp exposure

Answer 4

a pulp exposure resulting from the progressive destruction of tooth structure by acids and proteolytic enzymes elaborated through microbial activity
- underlying pulp is inflammed to a varying and unknown extent, due to the progression of dental caries

Question 5

what is mechanical pulp exposure

Answer 5

• an accidental exposure of the pulp by hand or engine driven dental instruments in the absence of dental caries
• if aseptic conditions are maintained the underlying pulp is usually not inflamed

Question 6

what is a traumatic pulp exposure

Answer 6

a pulp exposure due to fracture of a tooth

Question 7

what is a pulp cap

Answer 7

treatment of an exposed vital pulp by sealing the pulpal wound with a dental material such as calcium hydroxide or mineral trioxide aggregate to facilitate the formation of reparative dentin and maintenance of a virtal pulp

Question 8

what is a direct pulp cap

Answer 8

a dental material placed directly on a mechanical or traumatic vital pulp exposure

Question 9

what is an indirect pulp cap

Answer 9

a procedure in which a material is placed on a thin partition of remaining carious dentin that, if removed, might expose the pulp in immature permanent teeth

Question 10

what is the protocol for a pulp exposure on a vital pulp

Answer 10

• isolate the tooth
• remove all remaining caries
• irrigate with 8.3% NaOCl to achieve homeostasis
• gently place dycal in the pulp exposure and a temporary restoration - IRM, PARACORE
• after you have filled out forms and taken radiographs contact endo faculty at a later time via email to review paperwork and get the patient referrred or scheduled in clinic

Question 11

what is a pulpotomy

Answer 11

the removal of the coronal portion of the vital pulp as a means of preserving the vitality of the remaining radicular portion
- may be performed as an emergency procedure for temporary relief of symptoms or therapeutic measure as in the instance of a Cvek pulpotomy

Question 12

what is a partial pulpotomy

Answer 12

• the removal of a small portion of the vital coronal pulp as a means of preserving the remaining coronal and radicular pulp tissues

Question 13

when do you do a cavity restoration without bases

Answer 13

• reversible pulpitis
• no pulp exposure
• sound dentin at bottom of cavity

Question 14

when do you do direct pulp cap

Answer 14

• reversible pulpitis
• pulp exposure
• sound dentin around exposure
• continuous blood filled pulp
• bleeding controlled within 2 mins
• no dentin chips displaced

Question 15

when do you do a pulpotomy

Answer 15

• irreversible pulpitis: pulp exposure, continuous pulp tissue, bleeding controlled in 2 mins
• reversible pulpitis: pulp exposure, not sound dentin around exposure, not continuous blood filled pulp, bleeding not controlled in 2 mins, dentin chips displaced

Question 16

when do you do a pulpectomy

Answer 16

• irreversible pulpitis
• pulp exopsure
• not continuous pulp tissue
• bleeding not controlled in 2 mins

Question 17

how should we manage carious pulp exposure

Answer 17

• direct pulp capping
• pulpotomy
• teeth must have reversible pulpitis
• need a microscope
• not calcium hydroxide

Question 18

where do bacteria live in the dentin

Answer 18

in the tubules

Question 19

no wound healing will take place in the presence of:

Answer 19

bacteria

Question 20

if the infection invades tertiary dentin:

Answer 20

infectde dentin is removed and a hermetic restoration is provided
- pulp vitality is maintained

Question 21

what is another name for pulpotomy

Answer 21

pulp removal

Question 22

what is another name for partial pulpotomy

Answer 22

-shallow pulpotomy
- Cvek pulpotomy

Question 23

what treatment is main clinical proceure with highest success rate

Answer 23

partial pulpotomy

Question 24

what procedures are reported to have lower success rates

Answer 24

complete pulpotomy and direct pulp capping

Question 25

describe pulp histology at 3 months after using CaOH

Answer 25

• no dentin bridge
• pulpal inflammatino
• zone of necrosis present

Question 26

describe pulp histology at 3 months using mineral trioxide aggreate

Answer 26

dentin bridge formation