Vital Pulp Therapy

Question 1

What is reversible pulpitis?

Answer 1

Pulp tissues are inflamed due to a particular stimulus and usually the inflammation resolves after
suitable management.

Question 2

What is irreversible pulpitis?

Answer 2

Pulp tissues are severely inflamed due to a limit that will not heal.

Question 3

What does VPT aim to do?

Answer 3

retain the pulp vitality after removing part or all of the pulp that has been impaired due to trauma or caries

Question 4

What is VPT mainly indicated for?

Answer 4

reversible pulpitis

Question 5

What are the procedures of VPT?

Answer 5

direct pulp capping
indirect pulp capping
complete pulpotomy
partial pulpotomy

Question 6

What are the steps of VPT?

Answer 6

isolation
caries removal
coronal pulp amputation if needed
haemostasis and disinfection
therapeutic agent (bioactive material)
coronal seal

Question 7

Why is isolation important?

Answer 7

prevents sepsis of the tooth
prevents aspiration of files

Question 8

Why do we completely remove caries?

Answer 8

➢Infected tissues
➢Complete elimination of chronic inflammatory infiltrates
➢Visualize
➢Better adhesion

Question 9

What is direct pulp capping used for

Answer 9

Actual exposure of pulp tissues during cavity preparation or after complete caries removal

Question 10

When is a partial pulpotomy indicated?

Answer 10

Indicated in reversible pulpitis/irreversible pulpitis/ traumatic exposure

hamemostasis with 5 minutes

Question 11

How much is removed with partial pulpotomy?

Answer 11

1-3mm of coronal pulp tissues

Question 12

When is a complete pulpotomy indicated?

Answer 12

reversible/irreversible pulpitis

haemostasis within 10 minutes

Question 13

What is used for haemostasis and disinfection?

Answer 13

sodium hypochlorite

Question 14

In addition to haemostasis and disinfection, what does sodium hyochloride do?

Answer 14

removes biofilm
clears dentine chips
less cytotoxic effect on dentinal pulp stem cells

Question 15

What qualities should therapeutic agents have?

Answer 15

Sealing
Solubility
Radio-opacity
Antimicrobial
Anti-inflammatory
Setting time
Non-cytotoxic
Handling properties
Application

Question 16

What are examples of therapeutic agents (bioceramics)?

Answer 16

MTA
biodentine
bioceramic putty
dycal

Question 17

When needs to occur for the permanent material to be used?

Answer 17

odontoblasts should be stimulated creating a dentine bridge

Question 18

Are clinical symptoms indicative of the severity of the pathology?

Answer 18

There is no correlation between the histopathological status of inflamed pulp tissues and clinical symptoms

Question 19

Irreversiblle pulpitis > Partial Pulpotomy > Haemostasis achieved within 5 minutes with NaOCl

Answer 19

Bioceramic + restoration

Question 20

Irreversiblle pulpitis > Partial Pulpotomy > No haemostasis achieved within 5 minutes with NaOCl

Answer 20

complete pulpotomy

Question 21

Irreversiblle pulpitis > Complete Pulpotomy > Haemostasis achieved within 10 minutes with NaOCl

Answer 21

bioceramic + restoration

Question 22

Irreversiblle pulpitis > Complete Pulpotomy > No haemostasis achieved within 10 minutes with NaOCl

Answer 22

RCT

Question 23

What should the outcomes of VPT be?

Answer 23

✓ Sensibility tests within normal limits
✓With complete pulpotomy? under-responsive as pulp horns have been removed from crown
✓ Free of pain
✓ Absence of apical periodontitis
✓ Absence of swelling
✓ Absence of root resorption
✓ Formation of dentinal bridge (DPC)
✓ In immature teeth, complete formation and maturation of roots

Question 24

What are indictaions of VPT?

Answer 24

▪ Signs & symptoms of reversible pulpitis
▪ Signs & symptoms of irreversible pulpitis
▪ Incomplete root formation
▪ Carious exposure
▪ Traumatic exposure
▪ Controlled bleeding within 10 mins

Question 25

What are the contraindications of VPT?

Answer 25

▪ Uncontrolled bleeding (>10 mins)
▪ Pulp necrosis/ negative to EPT & Cold tests
▪ Previous attempt of VPT
▪ Presence of swelling, pus, sinus tract, or fistula
▪ Lack of experience & armamentarium