Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pulpal disease > Principles of treatment of diseases of the vital pulp > Flashcards

Principles of treatment of diseases of the vital pulp Flashcards

(60 cards)

Start Studying
1
Q

Endodontics definition

A

Scientific/study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Endodontology definition

A

Therapeutic procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Interceptive endodontics

A

Pulp capping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Preventive endodontics

A 
Good restorative and operative practice
Maintenance of pulpal health
Prevention of pulpal damage
Minimising negative impact of therapeutic interventions on pulpal health
'keeping pulp alive'
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Corrective RCT

A

Repeat RCT

Re-treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Vital pulp

A

Living tissue with blood supply
May or may not be innervated
Non-innervated tissue insensitive
Key-critical component of tooth and without it tooth is irreversibly compromised, with very negative effect on durability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Contrast between vitality and sensitivity

A

Vitality - blood supply

Sensitivity - nerve supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Apical foramen

A

Opening at the apex of the root of a tooth, through which the nerve and blood vessels that supply the dental pulp pass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does pulpal tissue contain

A 
Blood supply
Nutrients
Immune factors
Nerve supply
Controls dentine fluid flow
Important in mineralisation
Essential for proper physiological functioning of dentine and enamel
Proprioception - regulates max loads
Resides inside pulp chamber that provides structural integrity to tooth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Preservation of pulp vitality - why?

A 
To keep the tooth (avoid extraction)
To avoid root-canal treatment
To preserve structural integrity of tooth
To maintain proprioception of pulp
To minimise operative treatment
-->To prolong durability of tooth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Consequences of loss of pulp vitality to the individual

A

Inflammation & infection of pulp and local and systemic consequences of this
Pain, in different grades and of unpredictable nature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Consequences of loss of pulp vitality to the tooth

A
  1. Necrotic pulp
    - loss of proprioception
    - breakdown of pulp into dentine: dark tooth
    - need for RCT or XLA
  2. RCT: significant loss of structural integrity
  3. Restoration of root filled tooth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Consequences of RCT: significant loss of structural integrity

A

Loss of roof of pulp chamber (mechanical prep)
Effects of RCT mechanical prep
-NaOCl - dissolution of superficial (canal wall) collagen - makes dentine more brittle
-EDTA - dissolution of superficial (canal wall) calciumHAP
-Effect of eugenol - makes dentine more brittle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Consequences of necrotic pulp

A
  • loss of proprioception
  • breakdown of pulp into dentine: dark tooth
  • need for RCT or XLA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Consequences of restoration of root filled tooth

A

Always more compromised
At best = occlusal adhesive restoration
At worst= retained root that needs post-core and crown restoration
Durability and overall prognosis very poor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why avoid extraction?

A

Loss of tooth
Functional and aesthetic problems
Avoid compromising other teeth
Avoid other treatment modalities with > morbidity and unpredictable outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why avoid RCT

A

To avoid irreversible and catastrophic structural degradation
To maintain proprioception
To avoid periapical and periradicular infection - with local and systemic complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How compromised is a root-filled tooth?

A

Loss of roof of pulp chamber significantly reduces fracture strength
Direct relationship between amount of remaining tooth structure and ability to resist occlusal loads
Minimal access cavity in intact tooth reduces cuspal stiffness by 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Upper 6

A

4 canals, 3 roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What makes a root-filled tooth different?

A

Compromised architecture
Changes in physical properties
Changes in loading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If lesion at bottom of root (periapical)

A

Do a sensitivity test
If asymptomatic, monitor
If symptomatic, RCT
Should do something about it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Reduction in fracture strength due to

A

Loss of structural integrity
Tubular sclerosis, secondary and reparative dentine
< in amount of mature collagen in dentine matrix
Eugenol > dentine microhardness
NOT due to < in moisture content

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Darker tooth

A

Something wrong with pulpal tissue
Sensibility test - vital or non-vital
Then radiograph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Challenges to the pulp

A

Mechanical prep e.g. trauma, cavity prep
Thermal damage e.g. pulp testing, cavity prep
Chemical substances e.g. dietary acids, eugenol
Microorganisms e.g. caries, periodontal disease, cracks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Change in what temp can pulp not tolerate
5 degrees C
26
Factors affecting tooth
``` Bacterial biofilm Variable pH Constantly wet Changes in T Tooth-materials interactions ```
27
Environmental damage
``` Temp cycling Permanentlywet pH changes Functional loads Parafunctional loads ```
28
Total or partial caries removal?
A lot more pulpal exposures from total (50 vs 219) No evidence of diff. restoration longevity Insufficient evidence to determine whether diff. in signs and symptoms of PD between partial and total
29
Partial caries removal advantages
1. Partial caries removal < incidence of pulpal exposure in symptomless, vital, carious primary as well as permanent teeth 2. PCR technique shows clinical advantage over complete caries removal in management of dentinal caries Reduces cavity size - preserve tooth structure
30
Effect of operative damage
``` Overheating Inappropriate cavity prep Over cutting during caries removal Mismatch of material properties Inappropriate use of materials Lack of attention to detail ```
31
Spray coolant
Irreversible structural damage to dentine occurs at temp over 70 degrees All cavity prep under effective spray coolant Once damaged thermally, dentine cannot recover -visco-elastic properties ruined for life
32
Pulpal protection
1. Prevention of bio-film contamination 2. Cleaning surface - oil-free prophylactic paste or pumice - prophylactic slow-speed cup (500rpm) 3. Disinfecting surface and adjoining teeth/ surfaces - 2% chlorhexidine - 2.5 mins (impregnated cotton wooil)
33
Remaining dentine thickness
Remaining odontoblasts were reduced -13.6% beneath RDT of 2.5-0.5mm -33.7% beneath RDT 0.5-0.01mm -By 99% beneath pulp exposed cavities Reparative dentine observed following pulp exposure and reactionary dentine was observed with mean RDT of 0.77mm (2.5-0.01mm) Cavity RDT mediates powerful influence on underlying pulp tissue vitality Cavity RDT has little effect on reactionary dentine secretion and inflammatory activity Gross tissue injury explains poor pulp capping prognosis following exposure and underlies need to avoid this type of injury Following restoration, RDT of 0.5mm or greater necessary to avoid evidence of pulp injury
34
Pulpal death following crown preps
``` Aggressive insult to tooth, dentine, and odontoblasts Thermal damage LA Dessication Bacterial contamination ~10% pulpal death ```
35
Minimum of dentine thickness recommended for pulpal protection
0.7mm | Shoulder prep of 1.2mm leaves remaining dentine width of 0.7mm only in 50% of maxillary molars
36
Natural course of 'untreated' pulpal inflammation
1. Pulpitis - symptomatic or asymptomatic 2. Pulp necrosis 3. Root canal infection, leading to periapical inflammatory lesion (periapical peiodontitis)
37
Pumice with which bur
Intracoronal brush for proximal box | Cup for rest of cavity
38
Cavity disinfection
Avoiding infection Effective isolation - with rubber dam Cavity and prep disinfection with chlorhexidine (conc.not so important) Sealing dentine with adhesive should be considered for crown preps.
39
Cavity disinfection - effect of chlorhexidine on dentine
Dentine contains matrix metalloproteinases (MMPs), a group of neutral zinc- and calcium-dependent enzymes that regulate physiologic and pathologic metabolism of collagen-based tissues CHX preserves hybrid layer by preventing release of MMPs from incompletely infiltrated collagen fibrils, thus preventing that will breakdown collagen Does not improve bond strength, but preserves its durability
40
Posterior tooth composite shade
Lighter cures better | Aesthetic not as important
41
Conservative approach
Preserves pulp, re-establish healthy longterm conditions | 'Biological' caries excavation to remove dentine but retaining dentine, so avoiding pulpal exposure
42
Radical approach
Remove pulpal tissue (pulpectomy) and replace with RCT | Total and uncompromising removal of caries and if pulpal exposure occurs it is then managed biologically
43
Vital pulp therapy
Clinical procedures aimed at - relieving painful symptoms of pulpitis - preventing development of destructive course of inflammation, pulp death and subsequent infection of root canal space
44
The pulpal wound
Has little self-healing capacity unless properly treated, in contrast to skin and mucosal tissues Has no epithelia with which to bridge the defect
45
Vital pulp treatments
``` Partial caries removal Indirect pulp capping Direct pulp capping Partial pulpotomy Coronal pulpotomy Pulpectomy and RCT ```
46
Indirect pulp capping
Residual caries - affected dentine retained in close proximity to pulp without a breach (exposure) Restore permanently with: -GIC and/ or DBAs composite resin -GIC and amalgam alloy Review pulp status in time by signs and symptoms, and sensibility testing
47
Direct pulp capping
Managing exposed surface of pulp using suitable material to try and stimulate dentine bridge formation to close over exposure so repairing the breach
48
Pulp capping
``` Place rubber dam Remove any blood clot with sharp excavator Establish haemostasis -chlorhexidine -sodium hyperchloride -saline Gently apply capping agent without firm pressure (MTA) Cover wound dressing with hard setting cement e.g. GIC Restore and seal with permanent restoration Review at 1 week to check on symptoms Review at 6 months to evaulate -symptoms -reaction to thermal stimuli -sensitive to electric pulp testing Radiographic changes -periapical -dentine 'bridge' formation ```
49
Pulpal exposure damage
Calcium hydroxide pulp capping material pushed into exposure causing major bleed
50
Barthel 2000 method
123 pulp cappings Teeth checked for sensitivity, percussion and palpation Radiographs were taken to assess periapical status Contributing factors considered 5 and 10 years
51
Barthel 2000 results
``` At 5 years -44.5% failures -18.5% questionable -27% successful cases At 10 years -79.7% failing -7.3% questionable -13% successful cases Main factor of survival influence: placement of definitive restoration within first 2 days after pulp exposure All questionable and successful cases showed radiographic evidence of calcific reactionary dentine in pulp space when compared with adjacent teeth that had no pulp exposure ```
52
Barthel 2000 conclusions
Pulp capping of carious exposures has poor outcome Definitive restoration (immediately) > survival Consideration given to likely need to undertake RCT in tooth with > reactionary calcifications in pulp space
53
Al-Hiyasat 2006 method and results
Treatment outcomes of 193 pxs with 204 pulp exposures with direct pulp capping Radiographic review 3 years Success rate of pulp capping 59.3% Mechanical exposure 92.2% Carious exposure 33.3% Permanent restoration 80.8% Temporary 47.3% Class I restoration 83.8% Proximal multiple surface restorations 56.1% MO to 28.6% MOD Pxs' age, sex, tooth location and position no significant effect on outcome
54
Al-Hiyasat 2006 conclusions
Carious pulp caps have very low success rate, worse if temporary restoration and large cavity - direct pulp capping recommended after mechanical exposure with immediate placement of permanent restoration - RCT would be choice of treatment if exposure was due to caries, large cavity and not able to place permanent restoration
55
Effect of infected dentine
Following carious exposures outcomes (pulp likely to be compromised) are poor Avoidance of carious pulpal exposures critical to long term outcome of tooth Management using direct pulp capping technique associated with poor prognosis for maintaining vital pulp Extirpation of damaged pulp and RCT would then be required
56
Factors of importance in successful outcome to direct pulp capping
Type of injury - caries, trauma or iatrogenic Age of px: pulp survival after 5 years was -70% for 50-80 year olds -85% for 30-50 years olds -92% for 10-30 year olds
57
Partial pulpotomy
Invasive surgical procedure Involves removal of inflamed coronal portion of pulp tissue Amputate diseased tissue with diamond bur until healthy tissue exposed and haemostasis achieved
58
Coronal pulpotomy
Invasive surgical procedure Removal of all coronal pulp Amputate diseased tissue with high speed diamond bur until healthy tissue exposed and haemostasis acheived In mature teeth, pulpotomy often carried out as temporary measure on emergency basis until time available for pulpectomy
59
Effect of trauma on teeth. Survival compromised if:
1. Exposure of dentine and or pulp to the mouth 2. Disruption of blood supply 3. Unpredictable pulp responses, precipitating unnecessary pulpectomy (of a recovering pulp) 4. Obliteration of pulp space by mineralised tissue (accelerated following trauma)
60
Determination of successful pulp management
1. Accurate diagnosis 2. Careful and appropriate planning 3. Effective isolation - avoid further contamination 4. Appropriate operative dentistry 5. Effective disinfection 6. Effective restoration with quality marginal seal 7. Review and reassess diagnosis and prognosis

Pulpal disease (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions