Vital Pulpotomy Technique Flashcards
what is one of the most prevalent preventable health problems for children worldwide
dental caries
understanding of ___ is a required skill set for anyone treating children
management of deep carious lesions
T/F: primary teeth are smaller in all dimensions compared to permanent teeth, except the pulp is LARGER
TRUE
thinner enamel in primary teeth lead to what?
less protection for the pulp
there is a considerable variation in both the ___ and ___ of the pulp of primary teeth
size (follow the outer crown anatomy)
location (pulp horns are higher extending closer to outer enamel surface)
the ___ pulp horn of primary 1st mand molar is ___ mm away from outer enamel surface
MB pulp horn; 1.8 mm
do primary pulp have wider or thinner apical foramen?
wider
how do primary pulps communicate with surrounding tissue?
numerous accessory canals
roots of primary teeth are [short OR longer] and more [thick OR thin]
why?
longer; slender (thin)
to accommodate the developing tooth bud
the radicular portions of the primary pulp are called what?
Radicular portions called “tortuous” & “ribbon-like” are characterized by apical branching, accessory canals & intertwining filaments making PE virtually impossible
coronal pulp chamber of primary teeth are more [deep OR shallow] and are [less OR more] susceptible to perforation
shallow; more susceptible
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
pulpotomy (PT)
what is a root canal procedure for pulp tissue that is irreversibly infected or NECROTIC due to caries or trauma
pulpectomy (PE)
what are indications for pulpectomy
- 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
- pulp necrosis
- suppuration, purulence
ROTOS SHOULD EXHIBIT MINIMAL OR NO RESORPTION
what is a procedure performed in a tooth with deep caries lesion approximating the pulp but without evidence of radicular pathology
indirect pulp treatment
what treatment is a procedure that leaves the deepest caries adjacent to the pulp undisturbed to avoid a pulp exposure
indirect pulp treatment
T/F: In IPT, caries-affected dentin is covered with a biocompatible material to produce a biological seal
TRUE
indications for IPT
- 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
- The pulp is judged by clinical and radiographic criteria to be vital and able to heal from the carious insult.
is IPT or PT shown to have higher success rate in long term studies? why?
Indirect pulp capping has been shown to have a higher success rate than pulpotomy in long term studies.
It allows a normal exfoliation time.
medicament history for pulp therapy
- formocresol (no longer used bc carcinogenic)
- ferric sulfate 15.5%
- mineral trioxide aggregate (currently used)
what is a bioactive, nontoxic material that contains no resins use for pulp therapy
mineral trioxide aggregate (MTA)
@ CU we used NeoMTA
what is the most widely accepted tx for carious or accidental exposures in teeth with vital pulps
pulpotomy
Is calcium hydroxide recommended for direct pulp caps in primary teeth? why?
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
pulpal inflammation is frequently limited to what part of pulp?
site of exposure or confined to coronal portion of pulp
what is the goal of PT?
maintain treated tooth in the arch until time of normal exfoliation
can you electric pulp test for PT
no - primary teeth dont respond well
examples of indications for PT
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
examples of contraindications for PT
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
when completing PT, if one tooth fails, do all other treated teeth usually fail?
YES
Many clinicians choose to provide a more definitive treatment in the form of ___ because pulpal/periapical/furcal infections during immunosuppression periods can become ___.
extraction; life-threatening
Teeth that already have been treated pulpally and are clinically and radiographically sound should be monitored periodically for signs of ___
internal resorption or failure due to pulpal/ periapical/furcal infections.
you should penetrate the roof of chamber in an area of what?
pulp horn - only the tip of bur penetrates the roof. you will feel slight break in resistance
how to amputate coronal pulp
remove coronal pulp at the entrance to the canals with large excavator or large round bur on slow speed
if access opening is too conervative, what happens
will not be able to remove entire coronal pulp
will leave pulpal remnants and not be able to establish hemorrhage control
how to control hemorrhage
- Use a moist sterile cotton pellet over stumps with light pressure
- If hemorrhage persists examine chamber for remaining tags of coronal tissue
- Reconfirm tx by examining radicular tissue
you should mix neoMTA to have what type of consistency
smooth putty-like consistency
how should you press MTA into the walls and floor of the pulp chamber?
with cotton pellet and moistened with sterile water. it is important to cover all of root canal orifices and the floor with adequate thickness
how is MTA secured in the pulp chamber
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
are buildups required prior to prepping and placement of SSC?
NO
what shows successful PT (4)
- Elimination of infection within tooth
- Tooth is preserved in healthy, non-pathologic condition
- Arch length is maintained
- Normal resorption of primary tooth & eruption of permanent successor
If SSC is not done at PT appointment, what is placed as a temporary? when is the SSC done?
GI placed as temporary. SSC done on subsequent appointment
Do primary molars with PT require stainless steel crowns? exception?
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.
