Pulp Therapy in Primary Teeth Flashcards
Direct pulp capping
Useful for
Not good prognosis in
Keep exposure isolated
Traumatic pulp exposures in asymptomatic teeth
Primary molars
Indirect pulp capping
Options for restoration
Indicated in
Success rate for IPC
Success rate for Hall technique
Remove as much caries as possible Place PC material on top and good seal on top Preformed metal crown w/ Hall Technique Resin modified GIC base + composite Vital asymptomatic teeth 90% - Ricket's et all Cochrane review >90% over 5 years
Is the pulp reversibly or irreversibly inflamed?
Pain/response to thermal testing (unreliable)/residual dentine thickness
Pulpotomy for reversibly inflamed - steps
Fixation/Denaturisation - radicular pulp remains - treated with formaldehyde
Arrest of bleeding - laser/ferrous sulphate
Regeneration of hard tissue - Ca(OH)2, MTA, biodentine
Mineral trioxide aggregate
Increasing use as endodontic material for permanent teeth
Good biocompatibility
role of ferrous sulphate
Haemostatic agent Clot acts as barrier to further pulpal injury Arrest pulpal bleeding with moist cotton wool pledget and gentle pressure • Apply with microbrushes for 20 secs • Wash off with sterile water (repeat once if bleeding persists)
Management of irreversibly inflamed/non-vital primary teeth
One stage
Two stage where there is XS bleeding
Pulpectomy procedure
Pre-operative periapical radiograph LA and RD Identify root canals and root length Irrigate with saline, CHX, sodium hypochlorite Estimate WLs 2m short of apex Gentle filing with small files Irrigate and dry canals
Pulpectomy - clinical procedure
Better success when
If infection present then dress RCs with CaOH2 and temporise for 2 weeks
Dry canals and obturate with slow setting ZOE, non setting CaOH
canals under filled rather than overfilled
Restore with good coronal ss
Lesion sterilisation wrt Pulpectomy
Placement of mixture of 3 antibiotics
Metronidazole, ciprofloxacin,
minocycline
Placed in pulp chamber for short period/sealed permanently
