Vital Pulp Therapy

Question 1

what does AAE recommend for deep caries management

Answer 1

total caries removal, inspect pulp, disinfect, calcium silicate and restoration

pulpal reaction gauged after complete caries removal

Question 2

why is complete caries removal ideal

Answer 2

elimination of chronic inflammatory infiltrates and infected tissues
visualise and assess remaining coronal structure
gauge restorability
better adhesion

Question 3

if there’s no exposure - what now

Answer 3

indirect pulp capping

Question 4

indications for indirect pulp cap

Answer 4

reversible pulpitis, traumatic exposure, shadow of pulp left, no exposure, only see pink/red chamber shadow

Question 5

indirect pulp cap procedure

Answer 5

apply biomaterial = biodentine, theracal

Question 6

how does calcium silicate relate to biodentine and mta

Answer 6

it is the main component
provides biocompatibility, bioactivity and ability to form hydroxyapatite

Question 7

what are 3 VPT options if there is pulpal exposure

Answer 7

direct pulp cap
partial pulpotomy
complete pulpotomy

Question 8

indications for vital pulp therapy

Answer 8

signs/symp of RP/IP
incomplete root formation
carious exposure
traumatic exposure
controlled bleeding <10 mins

Question 9

contraindications of vital pulp therapy

Answer 9

uncontrolled bleeding >10mins
pulp necrosis
negative EPT + cold test
previous VPT attempt
presence swelling, pus, sinus tract, fistula
lack of experience

Question 10

what is the aim of VPT

Answer 10

retain pulp vitality after removing part or all of the pulp that has beeped impaired due to trauma or caries

mainly for reversible if pulpitis

Question 11

factors affecting VPT outcome

Answer 11

exposure type
- class 1 = traumatic, iatrogenic
- class 2 = carious
isolation
haemastasis
disinfection
therapeutic agent
coronal pulp amputation needed
coronal seal

Question 12

explain direct pulp capping

Answer 12

exposure of pulp
cleaned
promotion of pulpal healing and mineralised tissue barrier formation via biomaterial

must have normal EPT + sensibility

Question 13

explain partial pulpotomy

Answer 13

when = IP/RP, traumatic exposure

remove 1-3mm inflamed coronal tissue
saline + cotton wool
haemostasis 5 mins
biomaterial

Question 14

explain complete pulpotomy

Answer 14

when = RP/IP

complete removal of coronal pulp
saline + cotton wool
haemostasis within 10mins
biomaterial

Question 15

ideal biomaterial properties

Answer 15

sealing
antimicrobial
non-cytotoxic
solubility
anti-inflammaotry
good handling properties
radiopaque
setting time
application

Question 16

explain CaOH

Answer 16

non-setting
dycal
gold standard

adv =
pH 12.5
stimulates fibroblasts, inhibits microorganisms, encourages healing

disadv =
poor quality dentine bridge, poor resistance to microleakage, lack of antibacterial longevity
limited biocompatibility [72hrs]

Question 17

when would you use calcium silicate materials

Answer 17

direct/indirect pulp cap
pulpotomies
RC filling material
perforation repair
regenerative Endo

Question 18

explain biodentine

Answer 18

antimicrobial
bioinductive + osteoinductive
non-cytotoxic
hermetic seal
no discolouration
setting time 10-13 mins
radiopacity equal to dentine

Question 19

explain MTA

Answer 19

mineral trioxide aggregate

antimicrobial
bioinductive + osteoinductive
non-cytotoxic
better hermetic seal than CaOH
crown discolouration
more radiopaque than dentine

Question 20

biodentine vs MTA

Answer 20

biodentine faster setting, easier handling, stronger, no discolouration of crown, equal radiopacity to dentine

Question 21

what is hermetic seal

Answer 21

‘air tight’ prevents microorganism ingress
prevent reinfection

Question 22

unfavourable outcomes of VPT

Answer 22

clinical signs/symptoms
apical periodontitis
unresponsive EPT/cold
incomplete root formation
RR