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Module 5 - Endodontics > Vital Pulp Treatment > Flashcards

Vital Pulp Treatment Flashcards

1
Q

What are the 2 different types of vital pulp treatment?

A
  • Direct/indirect pulp capping.
  • Partial/full pulpotomy.
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2
Q

What is indirect pulp capping?

A

Application of a BIOMATERIAL onto a thin dentine barrier in a one-stage carious tissue removal technique to HARD dentine.

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3
Q

How thick is the biodentine layer in a full pulpotomy?

A

3mm

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4
Q

What is the AAE diagnostic system for pulpitis?

A

Normal, reversible, irreversible.

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5
Q

What can be used to achieve haemostasis of a hyperemic pulp?

A

sodium hypochlorite and pressure with a cotton pellet.

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6
Q

What must you check about the canal orifices after you have exposed them? Why?

A

Must check they are NOT necrotic - must be pink/red.

Necrotic tissue would increase reinfection risk.

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7
Q

What is Ultracal XS 35%? What is one of its uses? What are 2 advantages?

A
  • Non-setting calcium hydroxide cement.
  • Used as a temporary dressing furing endo treatment.
  • Bacteriocidal (12.5pH which lasts over up to 3 months, no staining of the teeth).
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8
Q

What is stepwise excavation?

A

Stage 1: selective caries removal to SOFT dentine to an extent that facilitates proper placement of a temporary restoration.
Stage 2: removal to FIRM dentine. Final placement of a permanent restoration.

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9
Q

What is direct pulp capping?

A

Preserving an aseptic field, apply a biomaterial directly onto exposed pulp and immediately place permanent restoration.

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10
Q

What are DMCs? What causes their release (4).

A

Dentine matrix components, bioactive molecules.

Release induced by caries? material, irrigants, ultrasonics.

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11
Q

What is selective carious tissue removal in one stage?

A

Removal to soft/ firm dentine and immediate placement of a permanent restoration.

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12
Q

Give an example of a calcium silicate bioceramic putty

A

TotalFill RRM Fast-Set Putty.

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13
Q

What are the 3 important steps you must take if the pulp is inevitably exposed?

A
  1. Aseptic environment (RUBBER DAM + NaOCl).
  2. Haemostasis
  3. Opt for most conservative and predictable technique (direct pulp cap, partial pulpotomy, full pulpotomy, pulpectomy).
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14
Q

What are 4 advantages of pulpotomy?

A
  • preserve tooth vitality + functions + retain more structural integrity.
  • simplify treatment + avoid procedural errors
  • less painful
  • cheaper + less appointments thus more accessible to patients.
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15
Q

What color is a slowly progressing carious lesion?

A

light or dark brown

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16
Q

What is the Walters et al diagnostic system for pulpitis? What treatment is recommended for each?

A
  • Initial pulpitis –> indirect pulp capping.
  • Mild pulpitis –> indirect pulp capping.
  • Moderate pulpitis –> coronal pulpotomy (partial/full).
  • severe pulpitis –> coronal pulpotomy/ RCT/ extraction.
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17
Q

What is the advantage and disadvantage of Biodentine XP?

A
  • Advantage: more reliable
  • Disadvantage: required specific mixing device (6500RPM 30 secs) and gun
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18
Q

What is Class I direct pulp capping?

A

Exposure due to traumatic injury to the tooth or an iatrogenic exposure.

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19
Q

How can hemostasis of an exposed pulp be achieved?

A
  • 5 minutes continous pressure with cotton pellet + sodium hypochlorite
  • 2 minutes increments and review after 2 minutes to see if hemostasis achieved –> PREFERRED METHOD.
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20
Q

What color is an actively progressing carious lesion?

A

light yellow

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21
Q

What is the spacer of choice for a temporary endo dressing?

A

PTFE/ SEPTOTAPE tape as it is associated with reduced contamination levels.
- historically used cotton pellets yet cotton fibers could impede on coronal seal.

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22
Q

What can be done when sufficient haemostasis for full pulpotomy CANNOT be achieved?

A
  • Tooth will requiere PULPECTOMY and RCT.
  • TEMPORARY PULPOTOMY` can allow adequate pain relied with a quicker and simpler technique than pulpectomy.
  • Achieve hemostasis with Intrapulpal LA + pressure with sterile cotton pellet.
  • temporarily dress tooth.
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23
Q

What are the 3 factors/elements of the Dentine-pulp complex following microbial or traumatic insult? What is the importance of these?

A

Inflammation, host defence responses, infection control.

These determine TISSUE OUTCOME (healing vs necrosis).

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24
Q

How long is the initial set for biodentine?

A

12 minutes

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25
What color is MTA?
Grey
26
What type of material is Biodentine? What was it designed for?
- Calcium silicate cement. - Designed as a dentine replacement material.
27
What pulpal status leads to the best procedure success for partial pulpotomy?
Pre-operative pulpal status is SIGNIFICANT for procedure success - more successful in REVERSIBLE PULPITIS (compared to irreversible).
28
What GIC type would you use in a posterior molar for a temporary endo dressing?
PINK GIC as it is in a non-aesthetic area and pink will be easier to remove.
29
What does damaged dentine release?
Bioactive dentine matrix components (DMCs).
30
What is the working and setting time of biodentine? When can you place a permanent restoration on top of it?
6 mins handling, 6 mins setting and after 12 mins you can restore the tooth.
31
What are the steps for a TEMPORARY DRESSING for endo treatment?
1. Place non-setting calcium hydroxide cement - ULTRACAL XS 35%. 2. Use a SPACER (historically cotton pellets, now PTFE/ SEPTOTAPE tape). 3. COLTOSOL to seal off cavity. 4. Use GIC to ensure adequate coronal seal.
32
Is intrapulpal anesthetic recommended for pulpotomy?
NOT recommended because vasoconstrictor can cause pulpal necrosis.
33
What caries removal technique is used for a FULL pulpotomy and why?
NON-SELECTIVE CARIES REMOVAL as we know we are going to reach the pulp.
34
How can hemostasis be achieved for a temporary full pulpotomy (before pulpectomy)?
- INTRAPULPAL LA + sterile cotton pellet pressure with NaOCl.
35
What is "healing" of the dentine-pulp complex?
Tertiary dentine formation.
36
What are the 3 products that can be used for direct pulp capping? Which are most effective?
Better long term outcomes for BIODENTINE and MTA compared to calcium hydroxide.
37
What color is a slowly progressing/ arrested carious lesion?
dark brown.
38
What is a deep elevation pit? How is it created? What are its 2 advantages?
A deep elevation pit is made in DEEP CAVITIES with a MISSING WALL using a PLASTIC MATRIX BAND. This elevated the MARGIN (ex. the proximal margin on the mesial surface) - Advantages: 1. avoids contamination from saliva once pulp is exposed. 2. materials like MTA are very moisture sensitive.
39
What can be done during a full pulpotomy when amputating the pulp tissue to the canal orifice yet visibility is limited?
If visibility is limited, can use a rose head bur on a slow-speed or a sharp excavator to start with, however high speed is recommended to give a clean cut without causing further damage from heat or pressure.
40
What is the mixing and setting time of biodentine?
- Mixing: 30 seconds, 4000rpm. - Setting: 9-12 mins.
41
What is the concentration of sodium hypochlorite?
1.5% to 5.25%.
42
list the step involved in a full pulpotomy (19)
see slide in notes
43
What is partial pulpotomy?
Removal of a small portion of coronal pulp tissue after exposure, followed by application of a biomaterial directly onto the remaining pulp tissue prior to placement of a permanent restoration.
44
What are hydraulic calcium silicate based cements? What are their advantages/uses (6)? What are their disadvantages (3)? Give a named example.
- Cements or root canal sealers made from calcium and silicate. - Advantages: biocompatible, apical plug, sealers, pulp capping, root-end filling, perforation repair. - Disadvantages: Expensive, long setting time (24 hours), mixing precise and challenging. - Ex. MTA
45
How thick is the resin modified glass ionomer applied over biodentine?
at least 2mm
46
What is a property of biodentine and what is its relevandce to how the procedure of pulpotomy is carried out?
Biodentine is thixotropic (material that follows moisture) thus we want to dry the cavity GENTLY following hemostasis.
47
How much pulp is removed in a partial pulpotomy and with what instrument?
2mm depth of the pulp using a sterile diamond round bur.
48
where must you place biodentine?
On the CANAL ORIFICES - ensure peripheral walls do not have any.
49
What are the 5 uses of Totalfill RRM Fast-set putty?
- Endo filling - apexification - root resorption - root perforation - pulp capping
50
What are the 2 advatnages of totalfill?
- Superior handling (fast setting 20 mins, resistant to washout, moldable putty). - Excellent healing (biocompatible, osteogenic, non-staining)
51
What is the benefit of selective or stepwise caries removal?
Stepwise: 56% reduction in pulp exposure compared to complete removal. Selective: 77% reduction in pulp exposure compared to complete removal.
52
What is biodentine composed of (8)?
tricalcium silicate, dicalcium silicate, calcium carbonate, oxide filler, iron oxide, zirconium oxide, liquid calcium chloride (accelerator), hydrosoluable polymer (water reducing agent).
53
What is TotalFill RRM Fast-Set Putty?
Calcium silicate bioceramic putty.
54
what is MTA?
Hydraulic calcium silicate based cement
55
What do DMCs release (3) and orchestrate (4)?
Release: cytokines, chemokines, growth factors Orchestrate: recrutiment, migration, proliferation and differentiation of PULPAL PROGENITOR CELLS --> IMPORTANT FOR NEWLY DEPOSITED DENTINE
56
What can be used to anesthetize posterior teeth?
- IANB, buccal and lingual infiltrations. - If not enough can do Intraligamentary infiltration.
57
What is pulpectomy?
Total removal of the pulp from the root canal system followed by root canal treatment, prior to placement of a permanent restoration.
58
What would you do if sodium hypochlorite and a cotton pellet failed to stop the bleeding in an exposed pulp?
This suggests there is still inflamed tissue which could affect the outcome of direct pulp capping. --> PARTIAL/ COMPLETE PULPOTOMY TO ACHIEVE HEMOSTASIS.
59
When should you review a patient that has undergone a pulpotomy (partial/full)?
6 months
60
What type of product is biodentine?
calcium-silicate based cement.
61
What does the release of Bioactive Dentine Matrix Components (DMCs) cause?
- Releases: cytokines, chemokines, growth factors. - Orchestrates: differentiation of PULPAL PROGENITOR CELLS for TERTIARY DENTINE.
62
What is full pulpotomy?
Complete removal of coronal pulp and application of a biomaterial directly onto the pulp tissue at the level of the canal orifices prior to placement of a permanent restoration.
63
How is the succes of VPT assessed (for each type of VPT)
- Direct/indirect pulp capping AND partial pulpotomy --> cold test, electric pulp test, absence of clinal signs/ symptoms, no radiographic radiolucency. - Full pulpotomy, crowned tooth --> absence of clinal signs/ symptoms, no radiographic radiolucency. REGULAR FOLLOW UP CLINICALLY AND RADIOGRAPHICALLY IMPORTANT.
64
What is Class II direct pulp capping?
Exposure through a zone of bacterial contamination.
65
What is a radiographic sign (outwith no periapical pathology) that VPT has succeeded?
Formation of a dentinal bridge which is a sign that dentine-pulp complex has responded and produced the reparative tertiary dentine

Module 5 - Endodontics (11 decks)

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