vital pulp therapy (2)

Question 1

Indications for vital pulp therapy:

Answer 1

Vital pulp therapy would appear to be better treatment option as compared to routine endodontic treatment in the following cases:
1- Teeth with incomplete apical development.
2- Primary teeth: Various types of vital pulp therapy are suggested to retain primary teeth until the normal time of shedding.
3- Teeth involved in simple restorations: If a pulp exposure does occur in a tooth that is surrounded by sound adjacent teeth, vital pulp therapy may be performed knowing that the consequences of failure would not jeopardize a complex prosthesis.

Question 2

Contra indications for vital pulp therapy:

Answer 2

1- Teeth involved in complex prosthesis:
2- Teeth in which the root canal space is needed to hold a post and core.
3- Teeth involved in complex periodontal therapy

Question 3

universal standard for vital pulp therapy materials.

Answer 3

Calcium Hydroxide

Question 4

•Desirable characteristics of CH include an

Answer 4

 initial high alkaline pH, which is responsible for stimulating fibroblasts and enzyme systems.
 It neutralizes the low pH of acids, shows antibacterial properties, a promotes pulp tissue defense mechanisms and repair.
When calcium hydroxide is applied directly to the pulp tissue (direct pulp capping) it causes necrosis of the adjacent pulp tissue and a dentin bridge is formed at the junction of the necrotic tissue and the underlying vital inflamed tissues.

Question 5

The drawbacks of CH include

Answer 5

 weak marginal adaptation to dentin, degradation and dissolution over time.
 primary tooth resorption.

Question 6

• pH of MTA is

Answer 6

12.5 (When set) so, it has biological and histological properties similar to calcium hydroxide

Question 7

MTA Setting time

Answer 7

2 hours and 45 minutes

Question 8

MTA Contrast to Ca(OH)

Answer 8

 it produces hard setting non resorbable surface
 it sets in a moist environment (hydrophilic in nature)
 It has low solubility
 It shows resistance to marginal leakage
 It also reduces bacterial migration
 It exhibits excellent biocompatibility in relation with vital tissues

Question 9

TECHNIQUES FOR VITAL PULP THERAPY

Answer 9

• Indirect Pulp Capping
• Direct Pulp Capping
• Partial pulpotomy
• Complete pulpotomy

Question 10

Indirect Pulp Capping Indication

Answer 10

Indirect pulp treatment is indicated in a permanent tooth diagnosed with a normal pulp with no signs or symptoms of pulpitis or with a diagnosis of reversible pulpitis

Question 11

Direct Pulp Capping Reported prognosis is

Answer 11

in the range of 80%

Question 12

Partial pulpotomy def

Answer 12

The removal of coronal pulp tissues to the level of healthy pulp

Question 13

Partial pulpotomy Indications

Answer 13

• In cases of immature teeth ( open apex ) where the size pf exposure is larger than 1mm .
• The zone of inflammation in the pulp has extended more than 2mm in an apical direction but has not reached the root pulp ( a traumatic exposure a few days post injury in a large, young pulp).

Question 14

Partial pulpotomy prognosis

Answer 14

•Prognosis is extremely good ( 94% to 96%)

Question 15

Partial pulpotomy affords many advantages over pulp capping:

Answer 15

• Superficial inflamed pulp is removed in the preparation of the pulpal cavity
• Calcium hydroxide disinfects dentin & pulp
• Space is provided for a material that will provide a bacterial-tight seal

Question 16

Full (cervical) pulpotomy Indications

Answer 16

• When the pulp is inflamed to the deeper levels of coronal pulps
• Traumatic exposures after 72hr

Question 17

Full (cervical) pulpotomy is contraindicated in

Answer 17

mature tooth

Question 18

A major disadvantages of Full (cervical) pulpotomy tech

Answer 18

sensitivity test can’t be obtained bec. of the loss of the coronal pulp .
•Therefore radiographic follow-up is important to assess for signs of apical periodontitis & to ensure the continuation of root formation.

Question 19

Full (cervical) pulpotomy Prognosis

Answer 19

•It is ranged in 75%.

Question 20

The success of pulp capping & pulpotomy is determined clinically & radiographically by :

Answer 20

• 1- No clinical signs or symptoms
• 2- No evidence of periradicular pathologic changes
• 3- No evidence of resorption, either internal or external
• 4- Evidence of continued root formation in developing teeth

Question 21

The success of the pulpotomy procedure depends on several factors among which:

Answer 21

1- Size of the exposure:
The larger the size of the exposure, the greater the damage to the pulpal tissue resulting in less favorable prognosis.
2- Exposure to saliva:
The longer the time the pulp is exposed, the greater the chances of pulpal contamination with less favorable prognosis.
3- Microleakage:
If access cavity was not sealed very well salivary contamination decreases the chances for healing and repair.
4- Systemic factors:
Systemic condition of the patient interferes with repair of connective tissues. Patients suffering of anemia, liver diseases, malnutrition, and uncontrolled Diabetes are considered bad candidates for pulpotomy due to their impaired healing power.