Vital Pulp Therapy Flashcards
What is reversible pulpitis?
Pulp tissues are inflamed due to a particular stimulus and usually the inflammation resolves after
suitable management.
What is irreversible pulpitis?
Pulp tissues are severely inflamed due to a limit that will not heal.
What does VPT aim to do?
retain the pulp vitality after removing part or all of the pulp that has been impaired due to trauma or caries
What is VPT mainly indicated for?
reversible pulpitis
What are the procedures of VPT?
direct pulp capping
indirect pulp capping
complete pulpotomy
partial pulpotomy
What are the steps of VPT?
isolation
caries removal
coronal pulp amputation if needed
haemostasis and disinfection
therapeutic agent (bioactive material)
coronal seal
Why is isolation important?
prevents sepsis of the tooth
prevents aspiration of files
Why do we completely remove caries?
➢Infected tissues
➢Complete elimination of chronic inflammatory infiltrates
➢Visualize
➢Better adhesion
What is direct pulp capping used for
Actual exposure of pulp tissues during cavity preparation or after complete caries removal
When is a partial pulpotomy indicated?
Indicated in reversible pulpitis/irreversible pulpitis/ traumatic exposure
hamemostasis with 5 minutes
How much is removed with partial pulpotomy?
1-3mm of coronal pulp tissues
When is a complete pulpotomy indicated?
reversible/irreversible pulpitis
haemostasis within 10 minutes
What is used for haemostasis and disinfection?
sodium hypochlorite
In addition to haemostasis and disinfection, what does sodium hyochloride do?
removes biofilm
clears dentine chips
less cytotoxic effect on dentinal pulp stem cells
What qualities should therapeutic agents have?
Sealing
Solubility
Radio-opacity
Antimicrobial
Anti-inflammatory
Setting time
Non-cytotoxic
Handling properties
Application
What are examples of therapeutic agents (bioceramics)?
MTA
biodentine
bioceramic putty
When needs to occur for the permanent material to be used?
odontoblasts should be stimulated creating a dentine bridge
Are clinical symptoms indicative of the severity of the pathology?
There is no correlation between the histopathological status of inflamed pulp tissues and clinical symptoms
Irreversiblle pulpitis > Partial Pulpotomy > Haemostasis achieved within 5 minutes with NaOCl
Bioceramic + restoration
Irreversiblle pulpitis > Partial Pulpotomy > No haemostasis achieved within 5 minutes with NaOCl
complete pulpotomy
Irreversiblle pulpitis > Complete Pulpotomy > Haemostasis achieved within 10 minutes with NaOCl
bioceramic + restoration
Irreversiblle pulpitis > Complete Pulpotomy > No haemostasis achieved within 10 minutes with NaOCl
RCT
What should the outcomes of VPT be?
✓ 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
What are indictaions of VPT?
▪ Signs & symptoms of reversible pulpitis
▪ Signs & symptoms of irreversible pulpitis
▪ Incomplete root formation
▪ Carious exposure
▪ Traumatic exposure
▪ Controlled bleeding within 10 mins
What are the contraindications of VPT?
▪ 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
