vital pulp therapy and open apex Flashcards
What is a key factor in determining the pulp condition for VPT?
The degree of pulpal bleeding at the exposure site.
What clinical signs are traditionally used to assess pulp condition?
Sensibility and pain testing.
Why is pulpal bleeding a better indicator than traditional testing methods?
It suggests the depth of inflammation and can guide treatment decisions.
What does increased pulpal bleeding indicate?
Inflammation extends deeper into the pulp tissue, requiring a more extensive treatment, such as partial pulpotomy.
What are the key factors for successful VPT?
Blood supply, a healthy periodontium, and an adequate coronal seal.
What grades of periodontal states are unsuitable for VPT ?
Teeth with moderate to severe periodontal disease are not suitable for VPT.
What is the impact of an inadequate coronal seal on VPT?
It increases the risk of bacterial microleakage and decreases the prognosis.
What is a common method used to control hemorrhage in VPT?
Applying mechanical pressure using a sterile cotton pellet soaked in water or saline.
What role does NaOCl play in VPT?
It controls hemorrhage, removes coagulum and dentin chips, disinfects the cavity, and aids in dentinal bridge formation.
Why is disinfection important in VPT?
It helps prevent bacterial contamination, which can compromise the success of the treatment.
Which teeth are indicated for VPT?
Teeth with incomplete root development, primary teeth, and teeth with healthy pulps and minimal hemorrhage.
Why are teeth involved in complex prosthetics contraindicated for VPT?
They require the root canal space for posts and core placement.
Why are teeth with infected or inflamed pulps contraindicated for VPT?
The presence of infection reduces the chance of maintaining pulp vitality.
What are the main techniques of vital pulp therapy?
Pulp capping (indirect and direct), pulpotomy (partial and full).
What is indirect pulp capping?
A procedure where carious dentin close to the pulp is preserved to avoid pulp exposure and covered with a biocompatible material.
What is the success rate of indirect pulp capping with a healthy pulp?
Approximately 90%.
Why has calcium hydroxide traditionally been used in IPC?
Due to its alkaline pH, biocompatibility, and ability to induce pulpo-dentin remineralization.
What is a concern with calcium hydroxide in IPC?
Its long-term solubility and lack of adhesion to dentin.
What materials are commonly used in IPC other than calcium hydroxide?
Resin-modified glass ionomer cements (RM-GIC) and mineral trioxide aggregate (MTA).
What is direct pulp capping?
Treatment of a mechanical or traumatic pulp exposure by placing a biomaterial directly on the exposed pulp.
What is the success rate of direct pulp capping?
Around 70%, with a range from 30% to 70% depending on studies.
Why does direct pulp capping have a high failure rate?
Due to the difficulty in maintaining a bacteria-tight restoration and proper pulpal healing.
What is partial pulpotomy?
The surgical removal of a small portion of the coronal pulp tissue to preserve the remaining healthy pulp.
When is partial pulpotomy indicated?
In cases of small pulp exposure with controlled pulpal bleeding within 2-5 minutes.
What is a key advantage of partial pulpotomy over direct pulp capping?
It removes superficially inflamed pulp tissue and provides space for sealing materials.
What materials are used in partial pulpotomy?
MTA, bioceramics, or Biodentin.
What is the reported success rate for partial pulpotomy?
Around 90%, with predictable results if done correctly.
In which teeth is partial pulpotomy commonly performed?
In permanent teeth with fully or incompletely formed roots.
What is the definition of full pulpotomy?
The surgical removal of the entire coronal pulp to preserve the vitality of the remaining radicular pulp.
When is full pulpotomy indicated?
When pulp inflammation extends deeper into the coronal pulp tissue.
In which teeth is full pulpotomy performed?
In deciduous teeth or permanent teeth with incompletely formed roots.
What are the advantages of calcium hydroxide in VPT?
It has antimicrobial properties, high pH, and stimulates pulp defense and repair.
What is a drawback of calcium hydroxide in VPT?
It can degrade beneath restorations and lead to porosity in the dentinal bridge.
Why are RMGIs not recommended for direct pulp capping?
They cause moderate to intense inflammatory responses in pulp tissue.
What is a disadvantage of adhesive resins in VPT?
They can promote bleeding and cause unresolved inflammation in pulp tissue.
Why is MTA considered superior in VPT?
It leads to faster and more predictable formation of a dentinal bridge with less inflammation.
What are bioceramics used for in VPT?
They are newer materials with superior performance compared to calcium hydroxide for pulp capping and repair.
What is the importance of pulp testing after partial pulpotomy?
It helps ensure the remaining pulp tissue remains healthy and vital over time.
