pulp therapy in young permanent teeth

Question 1

what is the follow up timings for pulpotomy in young permanent teeth

Answer 1

1/52: check for any discomfort

1/12: take xray to check for apical pathology, ensure no s/s, perform sensibility testing

3/12: xray to check for continued root development (compare), presence of calcific barrier (not necessary)

review every 6m, for at least 3y until apex closed?

Question 2

what to do once apex formation completed, after pulpotomy?

Answer 2

• elective RCT
  OR
  observe and do
• RCT only when pathology arises, presence of s/s

Question 3

partial vs cvek pulpotomy in young perm teeth

Answer 3

partial: for carious exposure (need to amputate more coronal pulp)

cvek: for traumatic exposure, removes less coronal pulp

Question 4

how to carry out partial pulpotomy in young perm teeth?

Answer 4

• remove superficial inflammed pulp to ~2mm, to reach deeper healthy pulp
• control pulp bleeding; irrigate w bactericidal solution – NaOCl/ CHX
• place MTA/ biodentine/ CaOH base over site
• place cement base and proper seal to prevent microleakage

Question 5

indications for partial pulpotomy in young permanent teeth

Answer 5

• vital young permanent tooth
• carious exposure <2mm, hemostasis achieved
• traumatic exposure <4mm, hemostasis achieved

Question 6

indications for complete pulpotomy

Answer 6

• if cannot achieve hemostasis during partial pulpotomy
• large carious exposure >2mm

pulp must be vital !!!!!!

partial/ full depends on how inflamed pulp is

Question 7

indications for vital pulp therapy

Answer 7

• vital/ no spontaenous pain
• pain from thermal tests doesnt linger (but unreliable tho)
• nttp, nttpp, mobility wnl
• no soft tissue lesion (sinus tract)
• no PARL

Question 8

explain pulpotomy procedure

Answer 8

1. baseline xray and sensibility testing (not v consistent due to incomplete apical development, but good to compare after tx whether it becomes NR)
2. LA, RDI, caries free
3. for small exposures, remove <2mm depth of pulp and surrounding dentine
4. irrigate w bactericidal soln (CHX/ NaOCl)
5. assess bleeding:
   - if healthy red & hemostasis –> stop
   - if dark red & no hemostasis –> amputate remaining coronal pulp
6. place MTA/ biodentine/ CaOH over remaining healthy pulp tissue
7. place cement base and resto w good seal!!! RMGIC

Question 9

3 non-vital pulp therapy for young permanent teeth

Answer 9

1. revasculatisation w triple antibiotic paste
2. apexification/ apex closure
3. MTA plug/ apical plug

Question 10

how does revascularisation work?

Answer 10

• aims to induce continued root development
• for teeth w poor prognosis where MTA plug/ apexification will not work
  –> short root
  –> large open apex
  –> v thin walls

now we use double antibiotic paste: metronidazole and ciprofloxacin

Question 11

what is apexification/ apical closure/ root end closure?

Answer 11

Procedure designed to induce root end closure for open apex, allowing for proper placement of RF material

*FOR NON VITAL TEETH!!!

Procedure:
- remove necrotic pulp, clean & irrigate canal
- place biocompatible CaOH, promote root end closure and hard tissue (dentine bridge) formation
- repeat 1m later, then 3m until apical stop forms
- once apical barrier forms (6-18m), fill canal w GP

need many visits, compliance needed

Question 12

what is apical / MTA plug ?

Answer 12

aims to seal open apex , rather than to stimulate furhter root growth

• remove CaOH from canal
• if no exudate, place MTA plug 3-5mm thick
• TD seal for 1 week and let MTA set
• if no s/s , fill with thermoplastic GP and restore tooth