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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
Q

What color is MTA?

A

Grey

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26
Q

What type of material is Biodentine? What was it designed for?

A
  • Calcium silicate cement.
  • Designed as a dentine replacement material.
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27
Q

What pulpal status leads to the best procedure success for partial pulpotomy?

A

Pre-operative pulpal status is SIGNIFICANT for procedure success - more successful in REVERSIBLE PULPITIS (compared to irreversible).

28
Q

What GIC type would you use in a posterior molar for a temporary endo dressing?

A

PINK GIC as it is in a non-aesthetic area and pink will be easier to remove.

29
Q

What does damaged dentine release?

A

Bioactive dentine matrix components (DMCs).

30
Q

What is the working and setting time of biodentine? When can you place a permanent restoration on top of it?

A

6 mins handling, 6 mins setting and after 12 mins you can restore the tooth.

31
Q

What are the steps for a TEMPORARY DRESSING for endo treatment?

A
  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
Q

Is intrapulpal anesthetic recommended for pulpotomy?

A

NOT recommended because vasoconstrictor can cause pulpal necrosis.

33
Q

What caries removal technique is used for a FULL pulpotomy and why?

A

NON-SELECTIVE CARIES REMOVAL as we know we are going to reach the pulp.

34
Q

How can hemostasis be achieved for a temporary full pulpotomy (before pulpectomy)?

A
  • INTRAPULPAL LA + sterile cotton pellet pressure with NaOCl.
35
Q

What is “healing” of the dentine-pulp complex?

A

Tertiary dentine formation.

36
Q

What are the 3 products that can be used for direct pulp capping? Which are most effective?

A

Better long term outcomes for BIODENTINE and MTA compared to calcium hydroxide.

37
Q

What color is a slowly progressing/ arrested carious lesion?

A

dark brown.

38
Q

What is a deep elevation pit? How is it created? What are its 2 advantages?

A

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
Q

What can be done during a full pulpotomy when amputating the pulp tissue to the canal orifice yet visibility is limited?

A

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
Q

What is the mixing and setting time of biodentine?

A
  • Mixing: 30 seconds, 4000rpm.
  • Setting: 9-12 mins.
41
Q

What is the concentration of sodium hypochlorite?

A

1.5% to 5.25%.

42
Q

list the step involved in a full pulpotomy (19)

A

see slide in notes

43
Q

What is partial pulpotomy?

A

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
Q

What are hydraulic calcium silicate based cements? What are their advantages/uses (6)? What are their disadvantages (3)? Give a named example.

A
  • 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
Q

How thick is the resin modified glass ionomer applied over biodentine?

A

at least 2mm

46
Q

What is a property of biodentine and what is its relevandce to how the procedure of pulpotomy is carried out?

A

Biodentine is thixotropic (material that follows moisture) thus we want to dry the cavity GENTLY following hemostasis.

47
Q

How much pulp is removed in a partial pulpotomy and with what instrument?

A

2mm depth of the pulp using a sterile diamond round bur.

48
Q

where must you place biodentine?

A

On the CANAL ORIFICES - ensure peripheral walls do not have any.

49
Q

What are the 5 uses of Totalfill RRM Fast-set putty?

A
  • Endo filling
  • apexification
  • root resorption
  • root perforation
  • pulp capping
50
Q

What are the 2 advatnages of totalfill?

A
  • Superior handling (fast setting 20 mins, resistant to washout, moldable putty).
  • Excellent healing (biocompatible, osteogenic, non-staining)
51
Q

What is the benefit of selective or stepwise caries removal?

A

Stepwise: 56% reduction in pulp exposure compared to complete removal.

Selective: 77% reduction in pulp exposure compared to complete removal.

52
Q

What is biodentine composed of (8)?

A

tricalcium silicate, dicalcium silicate, calcium carbonate, oxide filler, iron oxide, zirconium oxide, liquid calcium chloride (accelerator), hydrosoluable polymer (water reducing agent).

53
Q

What is TotalFill RRM Fast-Set Putty?

A

Calcium silicate bioceramic putty.

54
Q

what is MTA?

A

Hydraulic calcium silicate based cement

55
Q

What do DMCs release (3) and orchestrate (4)?

A

Release: cytokines, chemokines, growth factors

Orchestrate: recrutiment, migration, proliferation and differentiation of PULPAL PROGENITOR CELLS –> IMPORTANT FOR NEWLY DEPOSITED DENTINE

56
Q

What can be used to anesthetize posterior teeth?

A
  • IANB, buccal and lingual infiltrations.
  • If not enough can do Intraligamentary infiltration.
57
Q

What is pulpectomy?

A

Total removal of the pulp from the root canal system followed by root canal treatment, prior to placement of a permanent restoration.

58
Q

What would you do if sodium hypochlorite and a cotton pellet failed to stop the bleeding in an exposed pulp?

A

This suggests there is still inflamed tissue which could affect the outcome of direct pulp capping. –> PARTIAL/ COMPLETE PULPOTOMY TO ACHIEVE HEMOSTASIS.

59
Q

When should you review a patient that has undergone a pulpotomy (partial/full)?

A

6 months

60
Q

What type of product is biodentine?

A

calcium-silicate based cement.

61
Q

What does the release of Bioactive Dentine Matrix Components (DMCs) cause?

A
  • Releases: cytokines, chemokines, growth factors.
  • Orchestrates: differentiation of PULPAL PROGENITOR CELLS for TERTIARY DENTINE.
62
Q

What is full pulpotomy?

A

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
Q

How is the succes of VPT assessed (for each type of VPT)

A
  • 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
Q

What is Class II direct pulp capping?

A

Exposure through a zone of bacterial contamination.

65
Q

What is a radiographic sign (outwith no periapical pathology) that VPT has succeeded?

A

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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