Dentin wound Flashcards
1
Q
Wound:
A
Perforation or tearing somewhere in a living body, reaching the interior of any part of the body. f Med.
(after trauma) Intentional injury (surgery) or accidental (pathogenic or traumatic agents )
2
Q
Dentin wound (Ten Cate 1986)
A
Whenever there is a solution of continuity in the dentin pulp complex (DPC), there is a communication with the oral environment.
exposed dentin = dentin pulp wound
there is a communication with the indeed of the wound
3
Q
Dentin injury
if aggression to the DPC
(dentin pulp complex)
A
- Inflammatory respone
2. Respirative response
4
Q
Inflammatory response:
A
defensive mechanism in order to isolate and destroy harmful agent, as well as repair the tissue or organ affected.
5
Q
Reparative response:
A
reparative or tertiary dentin (2-3 months to form in pulp horns).
We cannot form new enamel, but we can form new cells, when there is a lesion, dentin can be formed
6
Q
Whats the goal of dentin injury?
A
to restore the injured epithelial barrier
7
Q
What problems do we have by dentin injury?
A
- pain
- infection
- loss of structure
8
Q
Dentin injury and pain:
A
produced by the exposure of the dentin tubules.
when the dentin tubules are exposed, people can feel pain to cold or by brushing
9
Q
Dentin injury and infection:
A
already established or possible. It depends on the etiology of the wound.
if there is a caries and we dont clean it, it can be affected but depends how large the fracture and caries is
10
Q
Dentin injury and loss of structure:
A
Depending on the size of the wound.
11
Q
Reversible pulpitis characteristics:
A
- Beginning: stimulated
- Duration: short
- Quality: bearable
- Pain to cold: appears
- Heat: no
- Mastication pain: no
12
Q
Irreversible pulpitis characteristics:
A
- Beginning: spontaneous
- Duration: maintained
- Quality: stabbing
- Pain to cold: very intense, weaken or eliminate
- Heat: intense
- Mastication pain: Mastication dysfunction
13
Q
Perioapical diagnosis:
A
reversible pulpitis, healthy, acute apical periodontitis
14
Q
What medications do we need to take by irreversible pulpitis?
A
pain killers
15
Q
What do we always have by an inflammation?
A
Always pulpitis
16
Q
If we have an injury, what is most likely that we have?
A
pulpitis
17
Q
To what does physical, chemical, and thermal injuries and dental caries lead?
A
To pulp irritation
18
Q
To what do pulp irritation lead?
A
To inflammation
19
Q
What two kind of inflammations do we have?
A
- Reversible (repair)
2. Irreversible/ pulp necorsis
20
Q
What would be the therapy of reversible and repair pulpitis?
A
Vital pulp therapy
21
Q
What would be the treatment of irreversible/ pulp necrosis?
A
RCT
22
Q
Dentin injury treatment:
A
Sealing and protection of the DPC with a similar material (mechanical properties) + replace the lost tissue (dentin)
23
Q
Vital pulp therapy
A
Recommended on teeth with no evidence of irreversible pulp inflammation.
Treatment initiated to preserve and maintain pulp tissue in a healthy state.
Capacity of the pulp to repair in the absence of microbial contamination.
24
Q
Treatment
Outcome:
A
1.Age.
2.Size and location of the damage/exposure. 3.Bacterial contamination.
4.Pulp capping material.
5.Quality of final restoration.
(depends on our treatment we do)
25
Treatment
| Objective
Stimulate the formation of operative dentin to maintain the tooth as a functional unit
26
Treatment caries:
location, proximity to pulp, pulp involvement...
27
Treatment fracture:
Fracture: exposure of the DPC (dentin pulp complex) by trauma.
28
Treatment fissure:
Fissures: difficult diagnosis and treatment.
29
Treatment root exposure:
gingival recession.
30
Treatment no material lesions:
attrition, erosion, abrasion, abfraction, resorption.
31
What do we have to do, when we find a wound?
Eliminate pain and close the wound
1. Disinfect the wound.
2. Suture: seal the DPC (Dentin pulp complex)
3. Return loss structural integrity (if applicable)
32
What do we do first?
Disinfect the wound
first cause bacteria that gets in the tubules, so remove all the injured tissue in order to seal it, body cant break all the infected dentin
33
Desinfection:
Bacterial invasion of the dentin tubules = 1st cause of pulp irritation.
Removal of the injured tissue is very important, since the body is not able to produce necrotic tissue lysis.
34
Desinfection
| If there is a bacterial origin: eliminate of caries
1. Enamel- turbine and diamond bur
| 2. Dentin- low speed tungsten burs and excavator
35
Whats important during the disinfection?
Its important not to overheat the DPC:
- Water
- Good condition of burs and excavators
36
Whats the second step?
| And what do we do?
Suture: seal the DPC (Dentin pulp complex)
a) Adhesives.
b) Cavity bases: GIC with or without pulp protection. C) Pulp protectors: CaOH2 and MTA.
Pulp capping: indirect (IPC) or direct (DPC)
37
Whats indirect pulp capping?
IPC is used in the management of deep carious lesion. The aim is to induce a physical protective barrier over pulp
to maintain its vitality and function.
There is NO pulp exposure but we are close to it.
(if we have a deep caries and the pulp is not exposed, we gonna use a material as a barrier over the pulp, we are really close to the pulp
We also use glass ionomer, but just if there is no pain and no pulp exposure)
38
Indications of indirect pulp capping:
- Absence of severe or spontaneous pain.
- Normal pulp response.
- No pain to percussion or palpation.
- No evidence of periapical pathology.
- Absence of internal resorption
(if the pulp is vital and healthy, we can do it)
39
Whats a cavity base?
Material used between restoration material and tooth surface
| between tooth surface and final restoration
40
Objective of cavity base:
1. Replace lost tissues.
2. Avoid problems due the treatment technique and complications inherent to the behavior of the final restorative material.
41
When do we use the cavity bases?
in large cavities, nowadays they are loosing indications
42
Whats the behaviour of cavity base?
Good behavior as replacements for dentine.
43
What do we have to do after we put the cavity base?
Must be covered with another material
44
What do we have to be aware with?
If we use a technique and need to use etching, it can affect the dentin
We use a cavity base that doesnt contract that much cause composite contracts a lot
45
Glass Ionomer Cements
Three different types:
1. Conventional GIC
2. GIC with resins or hybrids
3. Composite with glass ionomer or composer resin
46
What are conventional GIC?
Glass ionomer cements
| they set through chemical reaction acid- base
47
What are GIC with resin or hybrid?
Glass ionomer cements
| Photo or self curing resins
48
What are composite with glass ionomer or composer resins?
Glass ionomer cement
They contain more photo resins
49
Glass Ionomer Cements composition:
1. Main components (same in all GIC)
2. Other components to improve handling and
proper ties
• Resinreinforcers
✓
Improve the mechanical and aesthetic properties
✓ Protect from moisture and drying: less moisture-sensitive ✓ Facilitate handling: Longer working time
50
What are the main components of Glass Ionomer cements?
- 50% water
- Tartaric acid
- Glass particles
- Polyalkenoic acids
51
What feature does the water have in GIC?
setting essential
52
What feature does the Tartaric acid have in the GIC?
Setting accelerators
53
What feature does the Glass particles have in the GIC?
crystals of Si, Al and fluorine
| calcium fluoride
54
What setting reaction does the conventional GIC have?
Setting reaction: no exothermic, ion release (F).
55
What main characteristic does the conventional GIC have?
Little contraction. Prolonged in time (12-18 weeks).
Opening of the double bonds of the polyacids + bonds to
dental tissue Ca. Seals with a chemical bond (doesn’t need adhesive).
56
What properties does the conventional GiC have?
Properties very similar to dentin.
| but more elastic
57
What characteristic does the conventional GIC regarding the tooth bonding have?
Hydrophilic: well adaptation to the dentin humidity.
| Bind to the tooth with no problem
58
What characteristic does the conventional GIC regarding the setting have?
During setting: sensitive to loss and gain of water (isolation).
We have water from the saliva
59
When do we use the conventional GIC?
Use: For cementation. Early moisture sensitivity Technique sensitive.
Just use it for cementation, for metal crown or orthodontic bonds
60
Resin modified GIC (RMGIC) what does it have what the conventional not have?
The introduction of resins in GIC significantly improved their properties
61
What 2 settings reactions can we find in resin modified GIC?
1. Acid-base reaction.
2. Resin-polymerization reaction:
a. Light-cured.
b. Self-cured.
62
How do we use resin modified glass ionomers?
2 mm per layer. Light cure quickly after placement.
Avoid touching it with burs in order to not alter the chemical polymerization.
( we can just put 2mm of this material cause it has composite in it, if we dont do it, it cant polymerise properly)
63
What problem do we have with resin modified glass ionomer?
The adhesion is problematic:
- If we don’t use adhesive the part of the resin does not adhere ... and
also contracts.
- If we use adhesive, we prevent the chemical bonding of GIC- tooth.
(we use bond cause we want that the tooth doesnt release fluoride, we shouldn't touch it with burs, resin and composite need and adhesive)
MATERIAL IN DISPUTE BETWEEN MANY CLINICIANS
64
Resin modified glass ionomer cement (RMGIC) indications:
1. As a cavity base.
2. Cement: good chemical adhesion (good sealing), F release (anticariogenic and desensitizing) good viscosity and small thickness.
3. Fissures sealing: better use flowable resins.
4. As a direct restoration material
65
When do we use it as a direct restoration material?
* Class V cavities with a significant lack of enamel in the cavity margin and also if abfraction (modulus of elasticity similar to dentin).
* To fill undetermined areas in big restorations, if core of a crown. • Do not use them in restorations if direct occlusal forces.
undercuts= untersichgehende Stellen, never do it for indirect restoration
66
How do we use RMGICs?
•
Do total etching and conventional adhesion or....
Place the RMGIC directly on dentin. It depends on whether we want it to release fluoride or not.
67
How do we use RmGICs that come in a capsule?
- Press the back to activate it.
- Vibrate it.
- Take the gun and check out the mix.
- Place the cannula at the bottom of the cavity. Place the material. Avoid air entrapment.
- Polymerize ( RC ).
- Allow the selfpolymerizing part ( GIC ) to set
press, mix it with the mixer that vibrates and then out it in the cavity and polymerise t, dont polymerise it quickly
GIC does selfure on its own
68
Indirect pulp capping (IPC) technique:
* Cavity preparation.
* Final removal of carious dentine on the floor using a large round bur at slow speed.
* Use glass ionomer cement reinforced with resin (hybrid GIC) near the pulp as a base (dentin).
* Composite resin or ceramic as enamel.
69
Whats the aim of Direct pulp capping?
The aim of DPC is to stimulate the pulp tissue close to the exposure, by hard tissue formation (dentin bridge) without inflammatory changes in
the residual pulp.
(when the pulp is exposed, we use a material to directly cover it to stimulate the tissue to form a dentin bridge without causing a damage)
70
Direct pulp capping indications:
- Pulp exposure:
(Dental trauma., Accidental: during mechanical procedures)
- Exposure in an isolated area: asepsis.
- No bleeding (but vital) or under control.
- Young patient.
- < 1mm diameter.
- Not previous symptomatology.
71
When do we just do direct pulp capping?
we only do it when the pulp is not affected by a caries, so NO bacteria
so if there are bacteria always do direct one
72
CONTRAINDICATIONS of direct pulp capping:
- Necrotic teeth: absence of bleeding at exposure site, empty chamber.
- Severely broken teeth.
- Exposed pulp > 1mm by caries.
- Bleeding.
- Severely inflamed pulp (symptoms before).
- Xray changes.
73
Whats the direct pulp capping technique?
- Bleeding at the exposure site is arrested by pressure.
- Clean the pulp exposure with chlorhexidine, normal saline.
- Cover the pulp wound with:
(Calcium hydroxide, MTA or Biodentine, Cover pulp protectors: Bonding agent(self etch adh +RC).
(we should be able to stop the bleeding with cotton balls, than we cover that exposure with glass ionomer, the modified one, the one that doesnt need edge, since we use a glass ionomer, we need to complete with composite)
MtA = most used
74
Whats a pulp protector?
- Material that can be placed on the exposed pulp and stimulates the odontoblasts in the production of
tertiary or reparative dentin.
- Protectors: calcium hydroxide, MTA, Biodentine.
(odotoblasts in the production of the protector)
75
What can calcium hydroxide do?
is able to form calcified tissue
76
What are the properties of calcium hydroxide?
The biological properties of calcium hydroxide have been extensively investigated. Its capacity of inducing the formation of calcified tissue barriers as well as the bactericidal and bacteriostatic properties resulting from its high pH are well demonstrated
77
How does calcium hydroxide work?
- Stimulation of vital cells: 3ry dentin.
- Source of calcium ion: Ca2+ release.
- Good insulator (low coefficient of thermal expansion)
- Alkaline ph (12).
- Antibacterial agent.
- Enzymatic effects.
good: doesnt produce heat
bad: instability and very stiff, solubility, difficult handling
long term problems: degradation and contamination
78
Presentation of calcium hydroxide:
Presentation: pure, self cure (life, dycal) or light cure 20” (with resins)
79
Whats the calcium hydroxide technique/ how do we use it?
- Ca(OH)2 over the pulp exposure
- Hybrid Glass ionomer cement covering ?
- Enamel and dentin adhesive
- Obturation
( we cover it with the glass ionomer and then we do the obturation)
80
Whats the full name of MTA?
Mineral Trioxide Aggregates
81
What are the characteristics of MTA?
Mineral Trioxide Aggregates exhibit high pH, excellent seal, and are radiopaque (Camilleri et al, 2004; Ford et al, 1996; Aeinehchi
et al, 2003).
Their Clinical usefulness is limited by slow setting time (Torabinejad et al, 1995)
82
What advantage does the MTA have?
it doesnt disappear, it stays and we achieve a good sealing, is radiopaque so we see it on the xray
83
What are other characteristics of MTA?
- Excellent sealing.
- Alkaline pH (10.2 just mixed-12.5 at 3 h).
- Biocompatibility.
- Radiopaque.
Although low compressive strength, greater than the Ca(OH)2 (better physical mechanical properties).
84
What about the inflammation response and MTA?
inflammatory response is very less, much more less than the others
85
What about the MTAs pH?
“MTA also has a high pH, which suggests that this is one of the main characteristics that pulp capping agents must have in order to induce,
stimulate or at least to provide pulpal healing.”
MTA easier to use clinically as a direct pulp capping material. MTA provided better long term results more effective than Calcium Hydroxide in maintaining long-term vitality. ... MTA is less toxic, less pulpal inflammation capping compared to Calcium Hydroxide.”
86
Whats biodentine?
- It is a calcium silicate by-product.
87
When do we use Biodentine?
- Indirect pulp capping.
- Direct restorations in deep cavities.
- Inlay/onlay.
- Direct pulp capping
88
How do we do a treatment?
Eliminate pain and close the wound.
1. Disinfect the wound.
2. Suture: seal the DPC.
(after we can restore the tooth)
3.Return loss structural integrity (if applicable)
89
What do we do in order to minimize micro leakage?
In order to minimize risk of micro leakage: a final restoration should be made.
90
How do we restore the tooth?
Artificial dentin: hybrid glass ionomer cement or composite resins.
Artificial enamel: composite resins.
91
Whats the aim of all treatments?
I always want to be released fluoride by the tooth
92
What do we have to do before we do a treatment?
We have to check, if there is any pain, the vitality cause we cant see underneath
Always when we do the direct and indirect pul capping, check it cause you cant see underneath and we need to see how the pulp reacts
