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Flashcards in Pulp Deck (54)
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What is a pulpotomy?

removal of inflamed coronal pulp tissue leaving the intact radicular pulp, medicament then placed on top


When the coronal pulp is removed in a pulptomy how should you stop the bleeding of the radicular pulp?

direct pressure with sterile saline soaked cotton wool pledget


What is the potential problem if bleeding of the radicular pulp fails to halt following application of cotton wool and sterile saline? What are the options following this?

the radicular pulp is likely to be irreversible inflamed

vital pulpectomy or XLA/GA


What will happen if a pulpotomy is carried out on an inflamed radicular pulp?

internal resorption will occur


Which two things would indicate the need for pulpectomy or extraction following opening up of the pulp chamber?

no pulp in the canal and unable to get haemostasis


Which medicatments can you use for a pulpotomy?

ferric sulphate (15.5%)
formocresol used to be used no longer now


How do you perform a ferric sulphate pulpotomy?

Apply ferric sulphate on cotton wool to the pulp and obtain haemostasis
apply once for 15 seconds and then again for 15 seconds, if bleeding not controlled with this then need to perform pulpectomy or XLA


By what method does formocreosol work?

It works by fixing the pulp tissue


What is the success rate for ferric sulphate pulpotomy?

Coll et al 2008

70-95% success


Which material should be used to fill then pulp chamber?

Doyle et al 2010
Zn O Eugenol

CaOH (high failure rate)

MTA shows the best outcome with 2 year survival median value. DOyle et al 2010


What should be placed over the crown following the Zn O Eugenol?


Waterhouse et al 2000


What is essential after pulpotomy and SSC placement?

follow up

absence of signs and symptoms
radiograph shows no evidence of bone loss in the furcation
no evidence of internal resorption


When should you do further treatment on a tooth which has had a pulpotomy and internal resorption is now present radiologically?

If the resorption extends on to the external root surface
if the patient is experiencing any signs and symptoms


What is a desensitising pulpotomy?

hyperalgesic pulp
poor compliance


What is the rationale behind a desensitising pulpotomy?

Reduce pulpal inflammation symptoms to facilitate pulp therapy later on


How do you perform a desensitising pulpotomy?

ledermix and GIC temp


How do you perform a pulpectomy? When is it indicated?

extirpate the soft tissue contents from the coronal pulp chamber and root canal

indicated when there is evidence of irreversible pulpitis or necrosis
hyperaemic pulp


What material is placed in the root canals following pulpectomy?

resorbable dressing

Pure ZOE


What is the success rate for pulpectomy?

86% at 36months

Casas et al 2004


What is a potential complication following pulpectomy?

Savage et al 1986

well recognised complication is that a radicular cyst can develop therfore need radiographic monitoring


What is the success rate for an indirect pulp cap?

CaOH 94% Al Zayer at al 2003


How far from the radiographic apex do you instrument in a pulpectomy?


Welbury 2012


What is the evidence behind the toxicity of formocreosol? paper?

IACR (international agency for cancer reserach) 2004 showed a causal relationship between creosol and nasophryngel cancer

generally accepted that formaldehyde is toxic at the site of contact


What are the two options for performing a pulpectomy?

Carrotte and waterhouse 2008

one stage: if the root canals are irreversibly inflamed but no evidence of peri-radicular inflammation then one stage
two stage: if the root canals are necrotic and evidence of peri-radicular root resorption, then need to do a two stage