Vital Pulpotomy Technique

Question 1

what is one of the most prevalent preventable health problems for children worldwide

Answer 1

dental caries

Question 2

understanding of ___ is a required skill set for anyone treating children

Answer 2

management of deep carious lesions

Question 3

T/F: primary teeth are smaller in all dimensions compared to permanent teeth, except the pulp is LARGER

Answer 3

TRUE

Question 4

thinner enamel in primary teeth lead to what?

Answer 4

less protection for the pulp

Question 5

there is a considerable variation in both the ___ and ___ of the pulp of primary teeth

Answer 5

size (follow the outer crown anatomy)
location (pulp horns are higher extending closer to outer enamel surface)

Question 6

the ___ pulp horn of primary 1st mand molar is ___ mm away from outer enamel surface

Answer 6

MB pulp horn; 1.8 mm

Question 7

do primary pulp have wider or thinner apical foramen?

Answer 7

wider

Question 8

how do primary pulps communicate with surrounding tissue?

Answer 8

numerous accessory canals

Question 9

roots of primary teeth are [short OR longer] and more [thick OR thin]

why?

Answer 9

longer; slender (thin)
to accommodate the developing tooth bud

Question 10

the radicular portions of the primary pulp are called what?

Answer 10

Radicular portions called “tortuous” & “ribbon-like” are characterized by apical branching, accessory canals & intertwining filaments making PE virtually impossible

Question 11

coronal pulp chamber of primary teeth are more [deep OR shallow] and are [less OR more] susceptible to perforation

Answer 11

shallow; more susceptible

Question 12

what is the surgical removal of the ENTIRE coronal pulp, leaving intact the vital (healthy) radicular pulp within the canals followed by placement of medicament and good coronal seal

Answer 12

pulpotomy (PT)

Question 13

what is a root canal procedure for pulp tissue that is irreversibly infected or NECROTIC due to caries or trauma

Answer 13

pulpectomy (PE)

Question 14

what are indications for pulpectomy

Answer 14

1. tooth tx planned for pupotomy in which radicular pulp exhibits clinical signs of irreversible pulpitis (excessive hemorrhage that is not controlled with a damp cotton pellet applied for several minutes)2
2. pulp necrosis
3. suppuration, purulence

ROTOS SHOULD EXHIBIT MINIMAL OR NO RESORPTION

Question 15

what is a procedure performed in a tooth with deep caries lesion approximating the pulp but without evidence of radicular pathology

Answer 15

indirect pulp treatment

Question 16

what treatment is a procedure that leaves the deepest caries adjacent to the pulp undisturbed to avoid a pulp exposure

Answer 16

indirect pulp treatment

Question 17

T/F: In IPT, caries-affected dentin is covered with a biocompatible material to produce a biological seal

Answer 17

TRUE

Question 18

indications for IPT

Answer 18

1. primary tooth with deep caries that exhibits NO PULPITIS (normal) or with REVERSIBLE PULPITIS when the deepest carious dentin is not removed to avoid a pulp exposure
2. The pulp is judged by clinical and radiographic criteria to be vital and able to heal from the carious insult.

Question 19

is IPT or PT shown to have higher success rate in long term studies? why?

Answer 19

Indirect pulp capping has been shown to have a higher success rate than pulpotomy in long term studies.

It allows a normal exfoliation time.

Question 20

medicament history for pulp therapy

Answer 20

1. formocresol (no longer used bc carcinogenic)
2. ferric sulfate 15.5%
3. mineral trioxide aggregate (currently used)

Question 21

what is a bioactive, nontoxic material that contains no resins use for pulp therapy

Answer 21

mineral trioxide aggregate (MTA)
@ CU we used NeoMTA

Question 22

what is the most widely accepted tx for carious or accidental exposures in teeth with vital pulps

Answer 22

pulpotomy

Question 23

Is calcium hydroxide recommended for direct pulp caps in primary teeth? why?

Answer 23

NO!

Properties of Ca(OH)2 that stimulate a pulp to heal & repair may over-stimulate a primary pulp causing chronic pulpal inflammation & internal resorption

Question 24

pulpal inflammation is frequently limited to what part of pulp?

Answer 24

site of exposure or confined to coronal portion of pulp

Question 25

what is the goal of PT?

Answer 25

maintain treated tooth in the arch until time of normal exfoliation

Question 26

can you electric pulp test for PT

Answer 26

no - primary teeth dont respond well

Question 27

examples of indications for PT

Answer 27

Carious/mechanical exposure in vital asymptomatic teeth Tooth free of radicular pulpitis Presence of at least 2/3 root length Absence of abscess or fistula Absence of bone loss in furcation Absence of internal or external root resorption Tooth must be restorable

Question 28

examples of contraindications for PT

Answer 28

Local Factors: Spontaneous pain Fistula or swelling Mobility Marked tenderness to percussion Internal/External Resorption Furcation involvement Absent/profuse hemorrhage/serous exudate at exposure Tooth is non-restorable Less than 2/3 root remaining Medical Factors: Cardiac condition Immunocompromised kids

Question 29

when completing PT, if one tooth fails, do all other treated teeth usually fail?

Answer 29

YES

Question 30

Many clinicians choose to provide a more definitive treatment in the form of ___ because pulpal/periapical/furcal infections during immunosuppression periods can become ___.

Answer 30

extraction; life-threatening

Question 31

Teeth that already have been treated pulpally and are clinically and radiographically sound should be monitored periodically for signs of ___

Answer 31

internal resorption or failure due to pulpal/ periapical/furcal infections.

Question 32

you should penetrate the roof of chamber in an area of what?

Answer 32

pulp horn - only the tip of bur penetrates the roof. you will feel slight break in resistance

Question 33

how to amputate coronal pulp

Answer 33

remove coronal pulp at the entrance to the canals with large excavator or large round bur on slow speed

Question 34

if access opening is too conervative, what happens

Answer 34

will not be able to remove entire coronal pulp will leave pulpal remnants and not be able to establish hemorrhage control

Question 35

how to control hemorrhage

Answer 35

1. Use a moist sterile cotton pellet over stumps with light pressure 2. If hemorrhage persists examine chamber for remaining tags of coronal tissue 3. Reconfirm tx by examining radicular tissue

Question 36

you should mix neoMTA to have what type of consistency

Answer 36

smooth putty-like consistency

Question 37

how should you press MTA into the walls and floor of the pulp chamber?

Answer 37

with cotton pellet and moistened with sterile water. it is important to cover all of root canal orifices and the floor with adequate thickness

Question 38

how is MTA secured in the pulp chamber

Answer 38

glass ionomer or flowable composite to prevent wash out tooth is then prepped for SSC and cemented with cement. the cement fills remainder of prep

Question 39

are buildups required prior to prepping and placement of SSC?

Answer 39

NO

Question 40

what shows successful PT (4)

Answer 40

1. Elimination of infection within tooth 2. Tooth is preserved in healthy, non-pathologic condition 3. Arch length is maintained 4. Normal resorption of primary tooth & eruption of permanent successor

Question 41

If SSC is not done at PT appointment, what is placed as a temporary? when is the SSC done?

Answer 41

GI placed as temporary. SSC done on subsequent appointment

Question 42

Do primary molars with PT require stainless steel crowns? exception?

Answer 42

YES EXCEPTION: tooth that will be in mouth less than 2 years and there is a large amount of sound tooth structure allowing placement of a restoration that will no leak.