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24 Pedodontics > Vital Pulpotomy Technique > Flashcards

Vital Pulpotomy Technique Flashcards

1
Q

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

A

dental caries

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2
Q

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

A

management of deep carious lesions

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3
Q

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

A

TRUE

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4
Q

thinner enamel in primary teeth lead to what?

A

less protection for the pulp

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5
Q

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

A

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

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6
Q

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

A

MB pulp horn; 1.8 mm

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7
Q

do primary pulp have wider or thinner apical foramen?

A

wider

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8
Q

how do primary pulps communicate with surrounding tissue?

A

numerous accessory canals

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9
Q

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

why?

A

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

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10
Q

the radicular portions of the primary pulp are called what?

A

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

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11
Q

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

A

shallow; more susceptible

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12
Q

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

A

pulpotomy (PT)

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13
Q

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

A

pulpectomy (PE)

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14
Q

what are indications for pulpectomy

A
  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

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15
Q

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

A

indirect pulp treatment

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16
Q

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

A

indirect pulp treatment

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17
Q

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

A

TRUE

18
Q

indications for IPT

A
  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.
19
Q

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

A

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

It allows a normal exfoliation time.

20
Q

medicament history for pulp therapy

A
  1. formocresol (no longer used bc carcinogenic)
  2. ferric sulfate 15.5%
  3. mineral trioxide aggregate (currently used)
21
Q

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

A

mineral trioxide aggregate (MTA)
@ CU we used NeoMTA

22
Q

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

A

pulpotomy

23
Q

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

A

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

24
Q

pulpal inflammation is frequently limited to what part of pulp?

A

site of exposure or confined to coronal portion of pulp

25
Q

what is the goal of PT?

A

maintain treated tooth in the arch until time of normal exfoliation

26
Q

can you electric pulp test for PT

A

no - primary teeth dont respond well

27
Q

examples of indications for PT

A

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

28
Q

examples of contraindications for PT

A

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

29
Q

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

A

YES

30
Q

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

A

extraction; life-threatening

31
Q

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

A

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

32
Q

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

A

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

33
Q

how to amputate coronal pulp

A

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

34
Q

if access opening is too conervative, what happens

A

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

35
Q

how to control hemorrhage

A
  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
36
Q

you should mix neoMTA to have what type of consistency

A

smooth putty-like consistency

37
Q

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

A

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

38
Q

how is MTA secured in the pulp chamber

A

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

39
Q

are buildups required prior to prepping and placement of SSC?

A

NO

40
Q

what shows successful PT (4)

A
  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
41
Q

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

A

GI placed as temporary. SSC done on subsequent appointment

42
Q

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

A

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.

24 Pedodontics (4 decks)

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