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Flashcards in Pee Dos Deck (127):
1

How do we determine vitality of Primary teeth?

*4 tests

*unreliable in Primaries

Thermal

Percussion

Palpation

Mobility

2

How do we determine vitality of Immature Permanent Teeth?

*useful to establish baseline in trauma

Electric

Thermal

Percussion

Palpation

Mobility

3

How do we determine viability of Permanent Teeth?

Electric

Thermal

Percussion

Palpation

Mobility

4

Feel changes in alveolus/furcation/mobility

Infection leads to Resorption leads to Mobility

True

5

T/F
Never base Tx decisions on sensibility tests/feedback

True

6

Tx exposes pulp, how determine Pulp Status?

*2 options

Purulent/profuse bleeding - Irreversible Pulpitis

Bright red/arrests 5 min. - Reversible Pulpitis

7

12/24 month (general) Success Rate: MTA

FS:

FMC:

Laser:

ZOE:

CaOH

100 98

86 86

96 85

93 78

92 68

86 53

8

What is the best filler for Pulpotomy?

MTA

9

4 reasons MTA best filler for Pulpotomy:

Bioactive glass/ceramic

biocompatible (non-toxic)

Minimal inflammatory response

HA forms dentin and filling material

10

What is a dentinal bridge?

Reparative Dentin laid down after Pulpotomy

*MTA

11

3 Protective Liner Meds (Primary and Permanent)

GI (Vitrebond/Fuji IX)

CaOH

Dentin Bonding Agent

12

4 Direct Pulp Cap Meds (Primary/Permanent)

MTA (Mineral trioxide aggregate)

BIO

CaOH

RMGI/GI

13

What 2 products would you NEVER USE for Pulpotomy for Permanent teeth?

What 2 products are ok to use?

FMC or FS

MTA or CaOH

14

6 Pulpotomy meds:

*that can be used on Primary teeth

Formocresol (FMC)

Ferric Sulfate

MTA

Electrosurgery/Laser

TempIt (ZOE)

NaOCl (bleach)

15

Primary Pulpotomy Meds: FMC ___ application, is _____

Ferric Sulfate ____ application, is _______

MTA/Endosequence, ________

Electrosurgery/Laser, careful of...

ZOE, aka...

NaOCl, similar success rate to ______

5 minute, bactericidal

15 second, coagulant

leave it in

exces heat/energy

TempIt

FMC

16

4 Indirect Pulp Tx Meds (Primary/Permanent)

GI

RMGI

CaOH

ZOE/IRM

17

3 Pulpectomy Meds to never use with Primary teeth:

Why?

IRM, MTA, Gutta Percha

non resorbing

18

IRM, MTA, GP never used for Pulpectomy on Primary teeth (non resorbing), what do you use instead?

Vitapex

followed by ZOE/GI

*flush canals w/ NaOCl 1%

19

there is a tendency to ______ Vitapex and ______ ZOE

*primary pulpectomy

overfill Vitapex

underfill Zoe

20

What are the steps for Immature Permanent Apexification?

(like pulpectomy) Irrigate NaOCl

CaOH 2 wks for disinfection

Apical collagen as needed

MTA (moist pellet 24 hrs)

check MTA after 24 hrs, Place GP

***MTA/composite fill for reinforcement of immature root (this is apexification)

21

What is used for Apexification?

MTA/composite fill to reinforce immature root

22

What are the filling (obturating) materials for the chamber?

ZOE (IRM)

23

FMC has similar success to FS and Bleach

True

24

If the Pulp is Vital, what procedures can you do?

Direct Pulp Cap

Pulpotomy

Indirect Pulp Cap

Revascularization

25

If the Pulp is Non-Vital, what procedures can you do?

Pulpectomy

26

Use a Protective Liner in Normal Pulp for what?

Dentinal tubules exposed by prep

27

A Protective Liner is only used when what 2 conditions are met?

All decay removed

no pulp exposure

28

When can you use a Direct Pulp Cap?

2 conditions

Vital

Small/pinpoint exposure (less than 1mm)

29

A Direct Pulp Cap is NOT recommended for a Primary tooth when?

if carious exposure

*internal resorption

30

Pulpotomy on a Primary, do when the Tooth is Vital, or ______ pulpitis

And the tooth is restorable

Reversible Pulpitis

31

3 options if you have a Vital tooth and a Large exposure due to caries on a Permanent tooth:

Direct pulp cap

Partial pulpotomy

Pulpotomy

32

Direct Pulp Cap, Partial Pulpotomy, and Pulpotomy for large carious exposure, vital tooth absence of _______, no radiographic pathology

And what?

spontaneous pain

open apex

33

For an Indirect Pulp Tx on Primary you must remove what?

Re-enter?

Caries should be __ mm from the pulp

All caries that would potentially expose pulp

no

1 mm

34

When would you do a Pulpectomy on a Primary?

Non vital

Strategic

Resorable

Adequate root

35

Immature Permanent Apexification:

RCT

36

Vital Pulp Tissue

Dentin pulp complex free of bacteria

Creation of new pulp for Apexogenesis

Revascularization

37

Procedure that addresses the shortcomings involved with capping the inflamed dental pulp of an incompletely developed (immature) permanent tooth. The goal is the preservation of vital pulp tissue so that continued root development with apical closure may occur on its own naturally

Apexogenesis

38

Achieving artificial closure of the Apex, pulp is non vital in immature permanent teeth, tooth discontinues its natural maturation process and can be weakened

Apexification

39

Primary Pulpectomy, can't use what 2 products?

Use what instead?

MTA/IRM

Vitapex

40

Which medications/Tx are not used in Permanent Pulpotomies?

*why?

FS/FMC

*don't want existing vital pulp inert/leave clot

41

In what scenario do we not perform a direct pulp cap?

why?

Carious pulp exposure, Primary teeth

mesenchymal cells differentiating into odontoclasts and resorbing the pulp internally

42

How do we promote apexogenesis in pulpally involved teeth?

Vital

no RCT, pulpectomy, apexificatoin

vital pulp therapy options instead

43

Where would a Primary Pulpectomy be a good Tx option?

Where do we NOT do them?

necrotic, strategic, restorable

primary 1st Molars

44

Apexogenesis is used...

Apexification is used...

normal natural closure of root for Immature Permanent

artificial closure (RCT)

***vital vs non-vital

45

When would you remove a tooth instead of doing a Pulp Therapy?

infection uncontrolled

Bony support can't be regained

inadequate tooth structure

excessive root resorption

not strategically important

46

Good pain often sharp

Bad pain often throb

True

True

47

What is the most reliable pulp test?

Electric, Thermal, Percusssion/palpation/mobility

Percussion/Palpation/Mobility

48

Never base Tx on sensibility tests alone. They are only one possible indication of pulp vitality

True

49

2 indications, Irreversible Pulpitis:

2 indications, Reversible Pulpitis:

Profuse Bleeding, purulent exudate

bright red, 5 min arrested

50

What isn't recommended in a Primary Tooth with Carious Exposure?

Direct Pulp Cap

51

Primary tooth w/ Carious Exposure, no Direct Pulp Cap

What instead?

Pulpotomy

52

Biocompatibility is a function of...

Microleakage

53

IPT (indirect pulp treatment) is better than what?

__% at 3 years

Formocresol

94%

54

ITR (Interim Therapeutic Restoration) will successfully diagnose treateable vital pulp therapy teeth ___% of the time

98%

55

Early tooth extraction may decrease the length of stay in the hospital

True

56

ABCDE: missing E:

Missing D:

Missing E on both sides:

Missing D on both sides

distal shoe

banded loop

Nance/Transpalatal Arch

Two banded loops (or Transpalatal Arch)

57

ONMLK: Missing K

Missing L (after 1st molars in)

LLHA

Do nothing

58

Most reliable pulp test for Primaries:

Percussion

Mobility

Palpation

59

When evaluating Primary for pulp Vitallity, what x-rays are the most helpful:

BW

PA

60

8 y/o, tooth 30, deep lesion, vital, all decay removed, moderate sized pulp exposure:

What meds?

Pulpotomy

MTA

61

6 y/o, tooth K, deep lesion, all decay removed, no exposure:

Meds:

Liner

GI

62

10 y/o, tooth 3, deep lesion, vital, potential for pulp exposure:

Meds:

Indirect pulp therapy

RMGI

63

5 y/o, tooth D, deep lesion, non-vital, moderate sized pulp exposure, pulpal necrosis/purulence

Extraction

64

T/F
A tooth cannot be fractured without having had an associated displacement injury

True

65

Prognosis of crown fracture: depends upon ______ to PDL

concomitant injury

66

Age of pulp exposure, extent of dentin exposed, stage of root development at the time of injury secondarily affect the tooth's prognosis

True

67

Crown/root fractures: When the primary tooth can't be restored, entire tooth removed unless?

Retrieval apical fragments might damage Succedaneous Tooth

68

Root fracture involves what?

dentin, cementum, pulp

69

Reduce/reposition a root fracture and space in a ______ splint for ______

rinse with what?

Prognosis:

In the event that the pulp becomes necrotic...

If necrotic part removed:

non rigid, 4 weeks

CHX, antibiiotics

improves w/ fracture closer to Apex

radiolucency at fracture site

apical segment continues to develop/calcify

70

T/F
It is typical for slight root resorption to occur at the fracture site early in the healing process

True

71

Follow up timeline for a fracture: 4 week splint removal

4 month splint:

4 weeks splint removal:

2 week splint removal:

apical third and mid root fractures

root fracture near cervical area

lateral luxation, alveolar involvement

intrusion alveolar fracture

72

Splinting should be non-ridig, passive atraumatic, with small diameter ortho wire measuring:

.014 - .015

or monofilament fishing line + composite

73

Splinting involves 2 non-affected teeth on either side and must allow movement, otherwise...

risk ankyloses

74

4 things requiring 2 week splint:

3 things requiring 4 week splint:

subluxation, extrusion, intrusion, avulsion

lateral luxation, delayed avulsion, root fracture

75

ECC, presence of ____ decayed/missing/filled in any primary tooth in a child ____ months or younger

1+

71 months

76

Severe ECC any smooth surface lesions in a child younger than...

3 y/o

77

From ages 3-5, one or more cavitated/missing/filled smooth surface where?

or...

Primary Mx Anterior

decayed/missing/filled score

78

What meds do we Never use on a Permanent tooth?

What do we use instead?

FMC/FS

MTA/CaOH

79

4 options for Vital Pulp therapy:

Liner

Indirect Pulp Cap

Direct Pulp Cap

Pulpotomy

80

Never do a Direct Pulp cap if there is what?

***Primary tooth

Carious lesion

81

3 meds suitable for a Direct Pulp Cap:

DiCal, MTA, CaOH

82

FMC, time...

FS, time...

5 minutes

15 seconds

83

Depth of a Partial Pulpotomy in a Permanent tooth:

1-3 mm

84

Primary Pulpectomy, never use...

Instead use...

MTA, IRM

Vitapex, ZOE

85

IRM is reinforced ______

Therefore, you can't use IRM in a Primary Pulpectomy, but you can use...

ZOE

86

Apexification:

Collagen plug, GP

87

Revascularization, make the canal ______, then do what?

Sterile

puncture alveolus, bleed, creates scaffolding that creates new pulp

88

Pulp vitality in Primary teeth: (3 things)

Also what?

percussion, mobility, palpation

Hx

89

4 y/o, tooth T, deep lesion, no exposure:

Liner

90

5 y/o S and L extracted, what is space management?

LLHA or Band/Loop

***in this case, go with 2 Band/Loop
***if M also gone, LLHA (but warn about linguals)

91

Primary pulpectomy, don't use IRM or MTA why?

don't resorb

92

Why would we do a Pulpectomy in a Primary tooth?

non vital

root intact

Anterior Teeth

2nd Primary Molars

93

Apexogenesis:

Apexification:

natural growth of the root

collagen Plug (non-vital, immature)

94

PERRLA:

Pupils equal, Round, Responsive to Light, Accommodation

95

4 types of Displacement Injuries:

Concussion

Subluxation

Luxation (3 subtypes)

Avulsion

96

3 types of Luxation:

Extrusion

Lateral

Intrusion

97

Injury to tooth-supporting structures without abnormal loosening or displacement of the tooth

Concussion

98

Prognosis for Primary Concussion:

53% discolor

99

PRIMARY/Permanent Concussion Tx: ____ radiograph

Pulp sensibility tests:

Observation ____ diet

____ week follow up

_____ week follow up w/ radiograph

Follow for ______ and signs of necrosis

1 occlusal

don't do (perm: should be negative)

soft

1 week (perm: 4 weeks)

6-8 week

1 year

100

Radiographic evidence Pulp Necrosis:

Inflammatory resorption:

Replacement resorption:

2 weeks

3 weeks

6 weeks

101

Injury to tooth-supporting structures with Loosening but no displacement

Subluxation

102

Subluxation will get bleeding from where?

because PDL is _____

Radiographs show no ______ and minimal PDL thickening

sulcus

torn

displacement

103

PRIMARY Subluxation Tx: ____ radiograph

sensibility tests?

Observation and ____ diet

____ week follow up

_____ week follow up w/ radiograph

Prognosis:

1 occlusal

no

soft

1

6-8 week

possible discoloration, can lead to pulp canal obliteration

104

Permanent Subluxation Tx: 1 occlusal radiograph, Splint for ______ weeks

___week follow up

______ week follow up w/ radiograph

Follow for ___ signs necrosis

Prognosis open apex:

Prognosis Closed apex:

2 weeks

4 week

6-8 week

1 year

minimal risk necrosis

slight risk necrosis (15%)

105

While Splinting, _____ is required ____ times/day

CHX

2x

106

Displacement of the tooth axially

PDL partially/totally separated

*tooth appears elongated

*negative pulp tests

Extrusion Luxation

107

Extrusion Luxation, reposition/splint Primary tooth is less than ___ mm extrusion

Extract if....

3 mm

greater than 3 mm

108

How long to splint Extrusion Luxation?

2 weeks

109

The need to Splint Extrusively luxated Primary Tooth is likely an indication for what?

Extraction

110

Permanent Extrusion Luxation Tx: splint:

Follow ups at:

Prognosis for Open Apex

Prognosis for Closed Apex:

2 weeks

1, 2, 4, 8 weeks, 6 months, 1 year, follow annually 5 yrs

best

necrosis/obliteration common Ankylosis

111

Lateral Luxation Primary Tx, if Crown displaced labially:

follow ups:

Prognosis:

Extract

1 week, 2-3 weeks (splint), 6-8 weeks (radiographs)

if repositioned, pulp necrosis increases

112

Lateral Luxation Permanent Tx: when reposition?

follow ups:

Prognosis Open Apex

Prognosis Closed Apex:

immediately

2, 4, 6-8 weeks, 6 months, 1 yr, annually 5 yrs

best

necrosis/obliteration common

113

Lateral Luxation in Permanent tooth has ___% chance of necrosis:

75%

114

Primary Apical Luxation Tx: displaced labially:

displaced lingually:

if extract?

re-eruption

extraction

radiograph every yr until permanent erupts

115

___% of intruded teeth will re-erupt spontaneously

90%

116

Intrusion Luxation Permanent Tx: remove splint when?

If Immature:

If mature:

2 weeks

spontaneous eruption (ortho after 3 wks)

reposition ASAP surgically

117

Intrusion: if Apex is Open, when allow spontaneous eruption?

When ortho/surgical

If Apex Closed, when allow spontaneous eruption?

When ortho/surgical?

up to 7 mm

more than 7 mm

up to 3 mm

ortho 3-7, surgical more than 7

118

Most complicated luxation injury

Ankylosis

119

Avulsion for Primary Teeth:

Never Replant

120

Avulsion Tx permanent:

put back in right away

121

Avulsion Tx, if less than 60 minutes:

if more:

replant

will Ankylose and fail - replant for esthetic, delayed resorption

122

Any immature tooth out for less than 1 hour is worth replanting

True

123

Mature Apex (closed) tooth Avulsion, pulpectomy when?

within 7-10 days

*before removal of splint

124

Avulsion: Mature apex replant?

don't replant?

less than 1 hr

more than 1 hr

125

Partial pulpotomy removes 1-3 mm and is called what?

What is goal?

Cvek

apexogenesis

126

If a fracture is near the cervical area the Splint should be kept in how long?

4 months

127

In order, the best transport medium for teeth:

never:

put in socket, hanks, milk, saliva

water

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