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Advanced Restorative > Vital Pulp Therapy > Flashcards

Vital Pulp Therapy Flashcards

1
Q

if you’re close to the pulp place:

A

vitrebond

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2
Q

if you’re really close to the pulp place:

A

dycal then vitrebond

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3
Q

if pulp is exposed, place:

A

dycal then vitrebond

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4
Q

what are the two red flags in diagnosis

A
  • deep caries
  • pt presents with pain
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5
Q

what are the considerations with deep caries

A
  • may be symptomatic or asymptomatic
  • must be aware caries could approach pulp
  • make the pt aware of this before prep
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6
Q

what are the considerations with pt presenting with pain

A
  • compare objectives vs subjective findings
  • rule out other possibilities
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7
Q

when do you vitality test

A

before anesthesia

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8
Q

what is the DDX for pain

A
  • sinus pain
  • periapical abscess
  • periodontal origin
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9
Q

what are the considerations with maxillary sinus pain

A
  • does pt have hx of allergies and/or sinus infections?
  • worse when they bend over/lie down/jump up and down?
  • located in general area of maxillary arch on one or both sides?
  • lack of radiographic/clinical evidence of decay
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10
Q

what are the considerations with periodontitis as a DDX for pain

A
  • pain more vague- regional, cant isolate to one tooth
  • pulp vital
  • percussion main symptom
  • deeper pocketing depths usually
  • pain episodic
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11
Q

what do you do with a pain DDX of PDL

A
  • restoration left in hyperocclusion
  • reduce occlusion
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12
Q

what are the considerations with acute periapical abscess as a DDX for pain

A
  • not reversible pulpitis
  • may be painful to percussion, palpation, chewing, to cold - >hot as tooth is dying
  • may have swelling, fever
  • radiographic PA lesion may or may not be present
  • caused by bacteria
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13
Q

what do you do when a tooth tests non vital, necrotic pulp

A

refer to endo

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14
Q

what are the DDXs for PA radiolucency

A
  • periapical abscess
  • cementoma
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15
Q

what are the considerations for chronic periapical abscess as a DDX for PA radiolucency

A
  • NOT reversible pulpitis
  • radiographic periapical lesion
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16
Q

what are the considerations with cementoma as a DDX for PA radiolucency

A
  • not abscess
  • rule out cementoma in radiograph presenting similar to abscess
  • most commonly in lower anterior/premolar region
  • pulp test prior to tx
  • be very suspicious if no caries present
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17
Q

what are the possible causes of pulpal irritation

A
  • mechanical: iatrogenic or pt
  • heat: dentists handpiece
  • chemical: some dental materials
  • bacteria: caries
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18
Q

what subjective data do you gather from the pt

A
  • where is the pain
  • how intense is the pain (1-10 scale)?
  • how long has it hurt
  • how long does the pain last
  • what causes it to hurt
  • does anything make it feel better
  • what have you been taking for the pain
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19
Q

what are the objective tests

A
  • percussion: remember to begin on asymptomatic tooth to get to baseline, use mirror handle or tooth slooth
  • palpation
  • thermal tests
  • transillumination
  • periodontal probing
  • clinical exam
  • radiographs
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20
Q

once it is determined that pain is pulpal in origin:

A

determine the type of pulpitis

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21
Q

what is the response in reversible pulpitis

A
  • mild to moderate pain
  • cold response
  • occasional response to sugar or heat
  • occasional response to biting pressure
  • pulp is still vital
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22
Q

what are the causes of reversible pulpitis

A
  • bacteria - caries
  • trauma
  • exposed dentin
  • new restoration- deep restoration or occlusion is left high
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23
Q

what is the possible tx for reversible pulpitis

A

remove caries and or restoration and attempt to restore

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24
Q

what are the symptoms of irreversible pulpitis

A
  • longer duration: pain lingers several minutes- hours
  • heat sensitivity
  • cold: may have lingering cold sensitivity or cold may alleviate pain
  • spontaneous
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25
Q

what factors must be present to perform vital pulp therapy

A
  • a vital tooth: pulpitis optional - reversible only
  • a rubber dam
  • clean walls of prep
  • pulp capping material
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26
Q

what are the vital pulp therapy materials

A
  • calcium hydroxide
  • glass ionomer/resin modified GI
  • mineral trioxide aggregate
    -BC putty
  • # zinc oxide eugenol
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27
Q

what are the names for calcium hydroxide

A

dycal or life

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28
Q

what is the gold standard for direct pulp cap and why

A
  • calcium hydroxide
  • inexpensive
  • antibacterial
  • evidence- supported
  • stimulates repair
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29
Q

describe the timeline of CaOH

A
  • 2-3 minutes set up time
  • 5-7 minutes to resist condensation forces
  • 3 weeks formation of dentin bridge
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30
Q

glass ionomer/resin modified GI are most ___ cure

A

light

31
Q

what are the advantages and disadvantages to glass ionomer/resin modified GI

A
  • advantages: seals well as indirect pulp cap, good biocompatibility, fluoride release
  • disadvantages: moderate to intense inflammation, no dentin bridge formation
32
Q

what are the newer liners

A

-theracal
-biodentine
- limelight

33
Q

may leave a small amount of ____ dentin to avoid pulp exposure

A

affected

34
Q

when to perform vital pulp therapy - indirect pulp cap

A
  • vital tooth: absolutely necessary, rule out irreversible pulpitis or nonvitality prior to beginning procedure
  • asymptomatic with deep caries
  • reversible pulpitis
  • caries free
35
Q

what are the considerations with indirect pulp cap

A
  • remove all caries, place pulp capping material and final restoration
  • operative: may leave affected dentin to avoid pulp exposure. ideally remaining caries remineralize, pulp not traumatized by exposure
  • endodontics: you cant be 100% sure that affected dentin isnt actually infected - remove all caries
  • better to get pulp exposure and leave no trace of caries
  • 1-2mm remaining dentinal thickness (including liner) is ideal
  • restoration must rest on sound dentin
36
Q

what is are the steps in the indirect procedure

A
  • isolate
  • access
  • carefule debridement
37
Q

what do you need to do in the isolation step for an indirect pulp cap

A
  • use rubber dam
  • keep bacteria far away from pulp in case of exposure
38
Q

when do you perform a direct pulp cap

A
  • vital tooth
  • asymptomatic with deep caries
  • reversible pulpitis
  • and exposed pulp
39
Q

what is the most important determinant of success in direct pulp caps

A

hemostasis

40
Q

what do you do in a direct pulp cap

A
  • achieve hemostasis
  • cover exposure site with thin layer of CaOH
  • begin at sound dentin, lead over exposure with instrument
  • cover with GI/RMGI
  • light cure
  • restore with amalgam or composite resin material
  • if composite is used, etch and bond after liner materials
41
Q

you do VPT on exposed pulp only when:

A

the tooth is vital

42
Q

how do you finish and seal a direct pulp cap

A
  • rinse with water
    -gently dry with air, cotton pellets- do not dessicate
  • place final restoration at same appointment to reduce leakage
  • check occlusion to avoid premature occlusion
  • restoration should be perfectly sealed
  • avoid placing etch near pulp - always etch after vitrebond has been placed, focus on enamel
43
Q

what is the most crtitical issue in insuring success of VPT when pulp is exposed

A

controlling hemorrhage

44
Q

hemostasis achieved in ____ minutes is ideal

A

2-3 minutes

45
Q

why is hemostasis achieved in 2-3 minutes ideal

A

longer= pulp already inflamed- will not respond well to therapy

46
Q

how can you stop hemostasis

A

hold cotton soaked with NaOCl to exposure site for 30 seconds to stop bleeding

47
Q

why bevel

A
  • reduce miroleakage - particularly at cervical box in class II resin
  • better results from etching - exposes underlying prismatic enamel
48
Q

where is bond strength the highest in enamel

A

occlusal third of tooth

49
Q

where is bond strength the lowest in enamel and why

A
  • lowest to cervical third of tooth
  • fewer enamel tags
  • shorter enamel tags
  • prismless enamel found here
50
Q

when would you not bevel

A

when a bevel would remove all enamel

51
Q

describe the etch surface

A
  • increased surface area and surface energy
  • allows wetting by hydrophobic adhesive resin
  • enamel has minimal water- 3%
52
Q

describe enamel bonding

A
  • resin tags interlock
  • micromechanical bonding
  • enamel- adhesive composite bond- 20-25mPA
53
Q

describe dentin bonding

A
  • dentin compositiion- heterogenous
  • dentin tubules
  • intertubular dentin- less mineralized, hybrid layer is collagen fibrils and resin intermingled
  • acid etched dentin- partial or total smear layer removal and demineralizes collagen
54
Q

less intertubular dentin where?

A

closer to pulp

55
Q

rubber dam helps counteract some issues with:

A

dentin bonding

56
Q

in dentin bonding it is crucial to get:

A

hybrid layer formation

57
Q

what are potential problems with forming hybrid layer

A
  • overdrying - collapses colalgen
  • overetching- demineralized zone is too thick and primer cannot fully penetrate
  • underdrying- excess water leads to poor hybrid layer formation
58
Q

what are advantages to total etch

A
  • hybrid layer thicker
  • larger resin tags
59
Q

what are the disadvantages to total etch

A
  • more steps
  • possibility of collagen collapse
  • can etch too deeply
  • possibility of post op sensitivity
60
Q

what are sealants

A
  • resin material placed on grooves of non carious teeth
61
Q

sealants seal surfaces to prevent caries formation on:

A

grooves and fissures

62
Q

what are the most common type of sealants

A

resin based sealnts

63
Q

what is the sealant placement process

A
  • tooth must be cleaned with pumice
  • optional enameloplasty
  • etch grooves 15-20 seconds rinse
  • place sealant material
  • light cure
  • check occlusion
64
Q

when is a PRR done

A
  • when inital caries are present
65
Q

what is the PRR process

A
  • remove caries- anesthetic not needed
  • etch for 15-20 sec and rinse
  • bond
  • place flowable resin
  • check and adjust occlusion
66
Q

what brand do we use for resin infiltration

A

ICON

67
Q

what is resin infiltration used for

A

white spot lesions usually after ortho tx or initial lesions in interproximal surfaces

68
Q

what is the process of resin infiltration

A
  • etch surface
  • infiltrate using icon resin
69
Q

what are the indications for SDF

A
  • rampant caries that cannot be definitively treated in a timely manner
  • pt with behavioral concerns
  • medically compromised patients
  • carious lesions determined un restorable or complicated to restore and pt dsires or requires to avoid conventional tx
70
Q

what are the contraindications to SDF

A
  • pt desires esthetic tx in the area
  • silver allergy
  • ulcerative gingivitis, stomatitis
71
Q

what is low risk in CAMBRA

A
  • no disease indicators, less than 2 risk factors and has protectice factors
72
Q

what is moderate risk in CAMBRA

A

no disease indicators, more than 2 risk factors but no caries

73
Q

what is high risk in cambra

A

cavitated lesions/disease indicatros or more than 3 risk factors

74
Q
A

Advanced Restorative (17 decks)

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