Pulp Therapy Flashcards
1
Q
Take a thorough diagnosis
Based on?
A
- History
- pain-persistent or spontaneous PULP TX - Clinical exam
- gum boil (non-vital teeth) XLA or PULPECTOMY
- cellulitis ANTIBIOTICS - Radiographs
- external and internal resorption
- bone loss
- pulp calcification - Vitality tests
- don’t explain sensation
- false negative from recently erupted teeth
2
Q
Classification of pulp states
A
Class I- vital, asymptotic
Class II- reversible pulpitis, various lesion. Remove caries and place restorations
Class III- irreversible pulpitis, spontaneous pain, worse at night, heat ⬆️ pain
Class IV- non-vital tooth, necrotic pulp
3
Q
Treatment of Class III
A
Class III
- permanent tooth (XLA)
- primary tooth
• Class III a (normal bright red blood-PULPOTOMY)
• Class III b (little to no blood- PULPECTOMY)✂️
4
Q
Treatment of Class IV
A
Class IV
- permanent tooth (RCT/XLA)
- primary tooth (PULPECTOMY/XLA)
5
Q
Pulp therapy treatment options
IDPPE
A
- IPC
- DPC
- Pulpotomy
- Pulpectomy
- XLA- Extraction
6
Q
- IPC
A
When?
- Asymptomatic Class I or II
- Very deep various lesion
Why?
- to avoid pulpal exposure
Steps
- LA
- Remove lateral caries
- Remove caries over pulp
- 38% Silver Diamine Fluoride (SDF)/ Riva start
- Calcium hydroxide
- Temp
- Leave for 6-8 weeks to arrest deepest caries
- Repeat if needed
- Hard dentine- permanent restoration
7
Q
1.a IPT
A
- Steps 1-5 as for IPC
- Fluoride releasing material (CGI/RMGI)
- No entry
- preservation of tooth structure
- low pulpal exposure, cost and compliance
8
Q
- DPC
A
When?
Small exposure for a few hours on secondary teeth for a few hours
Permanent tooth
- calcium hydroxide
- dycal and life
Primary tooth
- never DPC
- always PULPOTOMY
9
Q
- Pulpotomy (apexogenesis)
A
- survival removal of entire coronal pulp
- treats affected tooth nerve to save it and maintain function and space
- I- class i, ii, iii only bright red blood
- CI- dark or no blood, gumboil, cellulitis, uncontrolled bleeding, mobile tooth, internal resorption, immune compromised
Technique
- LA
- Remove lateral caries
- Remove ENTIRE roof of pulp chamber
- Remove contents
- Medicaments (Formocresol, Sodium hypochlorite)
- Zinc oxide eugenol
- Restore
Medicaments used
- ferric sulfate
- sodium hypochlorite
- MTA
- NEO MTA
- Biodentine
10
Q
- Pulpectomy
A
- total removal of necrotic tissue
- space maintenance
- I- Non vital class III, IV, gumboil, uncontrolled bleeding, mobile teeth
- CI- crowding, cellulitis, HIV
- FILL CANALS WITH RESORBABLE MATERIAL NOT GP
- resorb at similar rate to tooth
- resorb readily beyond apex
- be strongly antiseptic
- easily removed
- radiopaque
- not discoloring tooth
Materials:
- ZOE
- kri paste
- vitapex
11
Q
Pulpectomy procedure
A
1st visit 1. X-ray 2. Remove caries 3. Gain access to canals 4. Length 2mm short of apex, H-files 5. File up and down with number 20/25 6. Irrigate with 2% CHX, no Milton 7. Dry canals with paper points 8. Medicaments •pain- ledermix/pulpomixine •no pain- KRI 3 liquid 9. Temp
2nd visit
- Dry canal and use ZOE
- Moisten canals with KRI 1 paste
- Fill canals with hand files, paper points
- Kalzinol + Ag
