Direct Pulp Capping - Biodentine Flashcards
how to use biodentine
- 5 drops from pipette into capsule, close and place in mixing 4000-4200 vibrations per min, makes line of biodentine along capsule, place with probe in kit
- Flat plastic
- Do not pack, puddle it only
- Rinse and clean instruments immediate
- Restore afer 12mins initial set or 2nd app within 6 months
- 2 stage technique – fill tooth, cut back biodentine in 2nd app
- After placing as desired do not touch the surface till 12 min initial set
biodentine is a
calcium silicate cement
biodentine use
single session pulp cap (with composite on top - wait 12 mins)
or 2 session (fill with biodentine in first app and cut back in 2nd app within 6 months)
biodentine effect on pulp
Positive effect on vital pulp cells and stimulates tertiary dentine formation (in particular reparative dentine)
CaOH effect on pulp cells
promote differentiation of odotoblast like cells which form a hard tissue bridge and in low concs can induce the proliferation of pulp fibroblasts
But poor bonding to dentine, mechanical instability and continued resorption after placement – so doesn’t prevent microleakage
Dx
- 23 year-old male patient attends your practice for an examination. He has not attended for over 18 months
- He states that recently he noted some sensitivity form the upper right quadrant when consuming cold drinks and sweet foods. The sensitivity is short lived lasting only a few seconds. He experiences no spontaneous pain
short sharp to cold stimulus - symptomatic reversible pulpitis
tx options for tooth 17
- Do nothing
- Partial caries removal – leave some and seal off with RMGI
- Stepwise caries removal – leave some and temporary restore and come back in 6 months to remove remaining
- Total caries removal and restore
- Pulp cap or line depending if breach it or just close to it
pulp capping procedure
- Place dental dam
- Ensure no bacteria can ingress the tooth
- Cut an MO cavity in tooth 17
- Place a direct pulp cap using Dycal over the exposure
- Place vitrbond over the Dycal once set
- Restore with composite resin
when to use pulp cap?
Large metal restorations have high thermal conductivity and may transfer heat to the pulp
- use lining for thermal insulation
Composite can have toxic effect as unset resin can be irritant
- use lining for insulation
Soft caries must always be removed
- Pulp exposure can occur in removal of soft caires - need CAP
Teeth react to caries – tertiary dentine and dead tracts laid down
what material is not suitable for direct pulp cap but can be used for indirect pulp cap
RMGI
indirect pulp caps with RMGI when
- Remaining dentine thickness between cavity floor and pulp is small (e.g. deepest part of cavity, likely where hybrid layer will not form readily)
- No caires remaining
- Not in contact with pulp
- Cover setting CaOH
- Place over poor quality dentine
properties of settng CaOH (Dycal)
promotes dentine bridge formation
use of Dycal (setting CaOH)
in contact with pulp exposure
contraindicated in irreversible pulpitis (need endo)
after placing setting CaOH pulp cap, what can be used for provisional restoration
- RMGI
- Zinc Oxide/Eugenol
- Antibiotics/Steroid Pastes – effective anti-inflammatory for use under provisional restorations (endo required)
- Ledermix
- Odontopaste
example of placing setting CaOH pulp cap
Gross occlusal caries removed, exposure of MB pulp horn
Tooth dried
Exposure not bleeding – indicating no irreversible pulpitis
Setting CaOH mixed
- Express equal amounts of base and catalyst setting CaOH pastes
- Blend with clean spatula
- Small well mixed amount needed
- Place with suitable instrument
- Allow to set before adjustment
- Trim and take care not to smear unnecessarily esp cavosurface margins
Mix RMGI and place on top of setting CaOH and cure – not on axial walls
- Clean tips and spatula
Dried dentine during this so rehydrate to make hybrid layer before composite placement
direct pulp cap indicated when (4)
- the dentine surrounding the exposure is sound
- red, homogenous and blood filled tissue is observed on the surface of the pulp wound with no yellowish liquefied areas or dark non-bleeding zones
- no dentine chips, displaced during excavation are present on the wound
- heamostasis can be achieved within 2-3mins after rinsing with a mild disinfectant (CHX or 1% NaOCl) followed by application of a sterile cotton pellet on the wound
when is there no inidcation to pulp cap when pulp exposed
- Tissue at the exposure is avascular and yellowish, indicating an area of liquefaction necrosis
- Surrounding area has a red colour, visible through dentine, indicating hyperaemia
This indicated PARTIAL NECROSIS – partial pulpotomy needed
(pulp cap would seal bacteria in à failure)
