Define indirect pulp cap
- Biocompatible material placed in deep carious tooth approximating the pulp
- No signs of pulpal degeneration or exposure
Define Direct pulp cap
Pinpoint mechanical exposure during prep covered with biocompatible material
Define pulpotomy
-Removal of pulp in the chamber with the intent to maintain the vitality of the radicular pulp
Define pulpectomy
Removal of entire pulp (coronal and radicular)
What is the typical restoration for a primary tooth after indirect pulp cap
SSC
What materials can be used for indirect pulp capping
- RMGI (vitrebond)
- CaOH2 followed by vitrebond
Which has a higher success rate indirect pulp capping or pulpotomy for primary teeth
indirect pulp cap
Success of indirect pulp capping is dependent on what
accurate pulpal diagnosis
Indirect pulp capping will not be successful if
- Furcation RL (or PA RL)
- Pathologic root resorption
What materials are used for direct pulp cap
MTA or CaOh2
Direct pulp cap is not recommended for pulp exposures that are _
carious (should be a mechanical pulp exposure)
What should you due for a carious pulp exposure
pulpotomy
(T/F) After a pulpotomy the tooth should remain in place and exfoliate at the normal time
t
After a pulpotomy you may see _ resorption but you should not see
internal… pathologic external root resorption
What are the criteria for a primary tooth pulpotomy
- Pulp exposure
- Dx normal or reversible pulpitis (reversible pulptitis= pain with stimulus no spontaneous pain)
- Clinical exam (no mobility, fistula, no pain with percusion and must be restorable)
- Radiographic exam (no furcation involvement or PA RL Want at least 2/3rds of the root remaining)
Contraindications for a pulpotomy
- Pulpal Dx or irreversible pulpitis (spontaneous pain- does your child wake up at night with a toothache)
- Clinical pathology (Swelling, fistula, pathologic mobility, pain with percussion)
- Radiographic pathology (Furcation/periapical lucency, external root resorption)
- Unrestorable tooth
- Excessive bleeding after coronal pulp amputation
- No bleeding after coronal pulp amputation (necrosis)
Preparation of a tooth for a SSC should occur (before/after) the pulpectomy
before
Coronal pulp removal should be done with what bur
Round bur slow speed
Hemorrhagic pulp means what
inflammation has spread to radicular pulp
During a pulpotomy the chamber should be treated with any one of these three medicaments
- Foromcresol
- Ferric sulfate
- MTA
Coronal filling after a pulpotomy should be done with
IRM
The ideal pulpotomy medicament has what properteries
Bactericisal
Harmless to pulp and surroundign tissues
Promote healing of radicular pulp
Not interfere with physiologic process of root resorption
Foromcresol should be placed in the chamber for how long
5 mins
Foromcresol can be diluted to what ratio
5:1
What is the gold standard medicament for pulpotomies
formocresol
What is formocresol made of
formaldehyde and cresol
Is foromcresol bactericidal
yes
What are the cons of formocresol
- Can cause inflammarory responses or necrosis in remaining radicular pulp (leads to internal root resorption)
- Potentially immunogenic, carcinogenic (formaldehyde)
Success rate of formocresol is
70-90%
Directions for ferric sulfate use are
apply to pulp chamber for 10-15 sec and rinse
-Seals BVs –> hemostasis
Success rate of ferric sulfate is
81-97%
Is ferric sulfate bactericidal
no
Which material for pulpotomies has the highest success rate
MTA (Close to 100%)
MTA sets in the presence of what
moisture
pH of MTA is _ similar to that of _
12.5… CaOH2
Is MTA antimicrobial
yes
does MTA has cytotoxic effects like formocresol
no
what are the cons of MTA
expensive and hard to work with
Does MTA promote hard tissue formation
yes
Pulpectomy is indicated when
- Pulpal Dx is necrosis or irreversible pulpitis
- Hemorrhagic coronal pulp removal
Filling material for a pulpectomy must be _ such as….
resorbable such as iodoform/CaOH2
Why can pulpectomies cause ectopic eruption
it is hard to resorb the filling materia
Pulpectomy is limited to what teeth
2nd primary molars
Maxillary incisors
Pulpectomies with _ root systems are difficult
Narrow and flared
T/F overinstrumentation during a pulpectomy can damage the permenant tooth
t
Root formation is generally complete _ years after eruption
3 years
For an immature permanent tooth- bleeding is controlled in pulpotomy by
irrigation or chlorhexidine or sodium hypochloritie
Cvek pulpotomies can be done for teeth that have undergone
traumatic exposures
What is apexogenesis
continued physiologic development and formation of the root’s apex
What is apexification
- Method of introducing end closure of an incompletely formed non-vital permanent teeth
- Non-vital pulp tissue removed just short of the root end
- Biocompatible CaOH2 placed in canal space to disinfecrt
- Apical barrier (MTA) placed
- Fill with gutta percha