Pulp

Question 1

Whats so special bout kid pulp

Answer 1

big

incomplete dentine deposition

Question 2

Best outcome of pulpal involvement

Answer 2

maintain vitality to allow continued physiologic development and formation of root apex

Question 3

pulp cap and pulpot

Answer 3

open apices, good blood supply, high success rate in young permanent teeth

Question 4

Protective base, indirect pulp cap, direct pulp cap

Answer 4

for primary teeth,
DPC for young perm teeth with smAll carious exposure
track with xrays to see root development

Question 5

partial pulpotomy how to do

Answer 5

inflammed pulp removed (2mm) to reach depth of healthy pulp tissue
pulpal bleeding controlled, calcium hydroxide or MTA placed
restore w good seal

Question 6

partial pulpotomy indications

two situations

Answer 6

young vital perm tooth with carious exposure <2mm, pulp hemorrhage controlled in 1-2min
young vital perm tooth with traumatic exposure, pulp haemorrhage controlled after removing superficial inflammed pulp tissue

Question 7

What happens if you remove caries, pulp expose and your bleeding doesnt stop

Answer 7

gg mean pulp hyperemic,

assess cave and amputate entire coronal pulp

Question 8

Pulpotomy

Answer 8

hemostasis achieved, then calcium hydroxide or MTA

cement base and final restoration w good seal

Question 9

timeline for follow-ups

Answer 9

1 wk: ensure no more discomfort
1 month: x-ray for apical pathology, EPT
3 month: see root development
6 monthly review for 3 years

Question 10

What to do after apex formation complete

Answer 10

elective RCT

observe for signs of pathosis

Question 11

why is it bad if apex not mature but tooth die liao

Answer 11

no apical stop to condense GP
“blunderbuss” apex
thin walls of root may fracture if you try do apicectomy

Question 12

what to aim for when doing non-vital pulp therapy for immature apex

Answer 12

promote formartion of hard tissue barrier at apex
apical closure
revascularisation

Question 13

steps of non-vital pulp therapy

Answer 13

x-ray working length determination
DO NOT instrument beyond apex later PDL cells die you cannot form apical barrier
DO NOT push mecrotic pulp through apex
file and clean and irrigate and dry
non-setting calcium hydroxide, cotton and TD
repear 1 month and 3 monthly till apical stop forms (3-18 months)
then thermoplastic root fill w GP

Question 14

How long does apical stop take to form with non-vital pulp therapy?

Answer 14

3-18 months, average 9

Question 15

how to use MTA as artificial barrier plug

Answer 15

remove caoh after 1 week, then place 305mm of MTA at apex, seal w wet paper point and TD
review after a week for MTA to set the root fill w thermoplastic GP is no signs and symptoms

Question 16

how to revascularise

Answer 16

disinfect canal with sodium hydroxide like xiao
dont instrument
put metronidazole and ciprofloxacin and minoclycine (minocycline stain teeth) for one month
then tooth reentered and file poked through to make blood clot to level of cej
put MTA over clot and restore with good seal

Question 17

why you wanna revascularise

Answer 17

tooth short root, large apex, very thin walls
so poor prognosis
MTA plug or apexification wont work
the clot is revascularised so canal wall will thicken and apex closed

Question 18

Do developing perm teeth with pulpal involvement have good prognosis?

Answer 18

no hahaha

its poor prognosis just to keep it there so to keep bone for dentures or implant.

Question 19

why we want to keep primary teeth

Answer 19

maintain arch length
prevent pain
restore aesthetics and function, prevent psychological effects
speech problems, aberrant tongue habits, adverse effect on underlying tooth

Question 20

medical history that’ll encourage you to do pulp therapy for primary tooth

Answer 20

bleeding disorders, coagulopathies, oligodontia

Question 21

medical history that’ll convince you to extract primary instead of pulp therapy

Answer 21

congenital heart disease later they subacute bacterial endocarditis
immunocompromised children
poor healing ability

Question 22

other considerations beside medical history that affect treatment plan of carious pulp involved primary

Answer 22

behavioral factors of patient and parent
general dental condition
restorability of tooth
life span of tooth
supporting bone
significance to dental arch
other pathology
abscence of successor

Question 23

how to diagnose pulp status in primary tooth

Answer 23

history and characteristic of pain
dont go and knock if its already painful, try asking child to bite down on cotton roll, observe guardedness
discolouration and mobility
redness swelling sinus tract
xray
nature of bleeding from exposed pulp during procedure

sensibility tests not very good: EPT no no, thermal still maybe

Question 24

what are the 3 treatment approaches for deep caries

Answer 24

preventive: rigorous caries preventive fluoride and discing
biological: incomplete caries removal, restore w good seal, arrests remaining caries eg. hall technique, interim therapeutic restoration

conventional surgical

Question 25

hall technique

Answer 25

pulp has to be vital and asymptomatic

unable to carry out conventional resto, no LA, caries removal and stainless steel crown

Question 26

protective base

Answer 26

pulp has to be vital and asymptomatic, after caries free, GIC/CaOH used to cover dentin tubule

Question 27

pulp capping

Answer 27

indirect pulp cap:
tooth is vital w no spontaneous pain
No PA lesion
>90% success rate at 3 year follow up

direct pulp cap: only for mechanical exposure or traumatic injury, not for carious pulp exposure (vital pulpotomy has much better outcomes)

Question 28

3 outcomes in pulpotomy

Answer 28

preserve radicular pulp in healthy state
render radicular pulp inert
encourage tissue regeneration and healing at site of radicular pulp amputation

Question 29

what to line pulpotomy with

Answer 29

ZOE

Question 30

possible complicationf of pulpot

Answer 30

premature exfoliation, pulpal calcification, internal resrption
possible enamel defects in succedaneus perm tooth

Question 31

medicament for pulpot

Answer 31

1/5 dilution buckley’s formocrestol,
2% buffered gluteraldehyde
ferric sulphate (acidic)
MTA (biocompatible, expensive)

Question 32

devitalising pulpot indications and techniques

Answer 32

when kid cannot LA
pulp hyperalgesic
pulp vital
devitalisation paste over pulp exposure and seal in for 1-2 weeks, then pulpot/pulpect

Question 33

root canal filling for primary tooth pulpectomy

Answer 33

ZOE, iodoform, CaoH w iodoform,

Question 34

pulpectomy for primary tooth complications

Answer 34

premature exfoliation, over retention, enamel defects in perm, flare up