vital pulp therapy and open apex

Question 1

What is a key factor in determining the pulp condition for VPT?

Answer 1

The degree of pulpal bleeding at the exposure site.

Question 2

What clinical signs are traditionally used to assess pulp condition?

Answer 2

Sensibility and pain testing.

Question 3

Why is pulpal bleeding a better indicator than traditional testing methods?

Answer 3

It suggests the depth of inflammation and can guide treatment decisions.

Question 4

What does increased pulpal bleeding indicate?

Answer 4

Inflammation extends deeper into the pulp tissue, requiring a more extensive treatment, such as partial pulpotomy.

Question 5

What are the key factors for successful VPT?

Answer 5

Blood supply, a healthy periodontium, and an adequate coronal seal.

Question 6

What grades of periodontal states are unsuitable for VPT ?

Answer 6

Teeth with moderate to severe periodontal disease are not suitable for VPT.

Question 7

What is the impact of an inadequate coronal seal on VPT?

Answer 7

It increases the risk of bacterial microleakage and decreases the prognosis.

Question 8

What is a common method used to control hemorrhage in VPT?

Answer 8

Applying mechanical pressure using a sterile cotton pellet soaked in water or saline.

Question 9

What role does NaOCl play in VPT?

Answer 9

It controls hemorrhage, removes coagulum and dentin chips, disinfects the cavity, and aids in dentinal bridge formation.

Question 10

Why is disinfection important in VPT?

Answer 10

It helps prevent bacterial contamination, which can compromise the success of the treatment.

Question 11

Which teeth are indicated for VPT?

Answer 11

Teeth with incomplete root development, primary teeth, and teeth with healthy pulps and minimal hemorrhage.

Question 12

Why are teeth involved in complex prosthetics contraindicated for VPT?

Answer 12

They require the root canal space for posts and core placement.

Question 13

Why are teeth with infected or inflamed pulps contraindicated for VPT?

Answer 13

The presence of infection reduces the chance of maintaining pulp vitality.

Question 14

What are the main techniques of vital pulp therapy?

Answer 14

Pulp capping (indirect and direct), pulpotomy (partial and full).

Question 15

What is indirect pulp capping?

Answer 15

A procedure where carious dentin close to the pulp is preserved to avoid pulp exposure and covered with a biocompatible material.

Question 16

What is the success rate of indirect pulp capping with a healthy pulp?

Answer 16

Approximately 90%.

Question 17

Why has calcium hydroxide traditionally been used in IPC?

Answer 17

Due to its alkaline pH, biocompatibility, and ability to induce pulpo-dentin remineralization.

Question 18

What is a concern with calcium hydroxide in IPC?

Answer 18

Its long-term solubility and lack of adhesion to dentin.

Question 19

What materials are commonly used in IPC other than calcium hydroxide?

Answer 19

Resin-modified glass ionomer cements (RM-GIC) and mineral trioxide aggregate (MTA).

Question 20

What is direct pulp capping?

Answer 20

Treatment of a mechanical or traumatic pulp exposure by placing a biomaterial directly on the exposed pulp.

Question 21

What is the success rate of direct pulp capping?

Answer 21

Around 70%, with a range from 30% to 70% depending on studies.

Question 22

Why does direct pulp capping have a high failure rate?

Answer 22

Due to the difficulty in maintaining a bacteria-tight restoration and proper pulpal healing.

Question 23

What is partial pulpotomy?

Answer 23

The surgical removal of a small portion of the coronal pulp tissue to preserve the remaining healthy pulp.

Question 24

When is partial pulpotomy indicated?

Answer 24

In cases of small pulp exposure with controlled pulpal bleeding within 2-5 minutes.

Question 25

What is a key advantage of partial pulpotomy over direct pulp capping?

Answer 25

It removes superficially inflamed pulp tissue and provides space for sealing materials.

Question 26

What materials are used in partial pulpotomy?

Answer 26

MTA, bioceramics, or Biodentin.

Question 27

What is the reported success rate for partial pulpotomy?

Answer 27

Around 90%, with predictable results if done correctly.

Question 28

In which teeth is partial pulpotomy commonly performed?

Answer 28

In permanent teeth with fully or incompletely formed roots.

Question 29

What is the definition of full pulpotomy?

Answer 29

The surgical removal of the entire coronal pulp to preserve the vitality of the remaining radicular pulp.

Question 30

When is full pulpotomy indicated?

Answer 30

When pulp inflammation extends deeper into the coronal pulp tissue.

Question 31

In which teeth is full pulpotomy performed?

Answer 31

In deciduous teeth or permanent teeth with incompletely formed roots.

Question 32

What are the advantages of calcium hydroxide in VPT?

Answer 32

It has antimicrobial properties, high pH, and stimulates pulp defense and repair.

Question 33

What is a drawback of calcium hydroxide in VPT?

Answer 33

It can degrade beneath restorations and lead to porosity in the dentinal bridge.

Question 34

Why are RMGIs not recommended for direct pulp capping?

Answer 34

They cause moderate to intense inflammatory responses in pulp tissue.

Question 35

What is a disadvantage of adhesive resins in VPT?

Answer 35

They can promote bleeding and cause unresolved inflammation in pulp tissue.

Question 36

Why is MTA considered superior in VPT?

Answer 36

It leads to faster and more predictable formation of a dentinal bridge with less inflammation.

Question 37

What are bioceramics used for in VPT?

Answer 37

They are newer materials with superior performance compared to calcium hydroxide for pulp capping and repair.

Question 38

What is the importance of pulp testing after partial pulpotomy?

Answer 38

It helps ensure the remaining pulp tissue remains healthy and vital over time.