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BDS3.5 Endodontics > Vital Pulp Therapy > Flashcards

Vital Pulp Therapy Flashcards

(61 cards)

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1
Q

Vital pulp therapy vs vital pulp treatment

A

Terms can be used interchangeably

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2
Q

ESE definition of deep caries

A

Inner 1/4 dentine affected

Zone of hard dentine over pulp, Risk of pulpal exposure

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3
Q

ESE definition of extremely deep caries

A

Penetrates entire thickness of dentine

Pulp exposure unavoidable

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4
Q

What does a light yellow colour of caries indicate?

A

Actively progressing

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5
Q

What does a light brown colour of caries indicate?

A

Slowly progressing

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6
Q

What does a dark brown colour of caries indicate?

A

Slow progression / arrested

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7
Q

What is reparative dentinogenesis after pulp exposure?

A

If infection is removed, inflammation is controlled and tooth is restored, repair and regeneration is possible by reparative dentinogenesis after

Pulp cells release chemokines, cytokines, growth factors to initiate defensive response promoting cytodifferentiation and repair

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8
Q

What are the different types of vital pulp treatment?

A

Indirect pulp cap, Selective carious tissue removal, Stepwise excavation, Direct pulp cap, Partial pulpotomy, Full pulpotomy

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9
Q

Indirect pulp cap

A

Single stage caries removal to hard dentine

Biomaterial placement over thin layer of remaining dentine

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10
Q

Selective carious tissue removal

A

Selective caries removal to soft or firm dentine on pulpal wall

Biomaterial placement on pulpal wall of cavity

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11
Q

Stepwise excavation

A

First stage removal of caries to soft dentine on pulpal wall and temporisation

6-12m later caries removal to firm dentine, Biomaterial placement, and permanent restoration

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12
Q

Class 1 Direct pulp cap

A

No pre-op deep caries ie pulpal exposure due to trauma or iatrogenic damage

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13
Q

Class 2 direct pulp cap

A

Carious exposure, disinfectant and calcium silicate cement used

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14
Q

Partial pulpotomy

A

Removal of a small portion of coronal pulp

Placement of biomaterial and restoration

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15
Q

Full pulpotomy

A

Removal of all coronal pulp

Placement of biomaterial and restoration

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16
Q

Which vital pulp treatments relate to the endodontic treatment of the tooth?

A

Direct pulp cap, partial pulpotomy, full pulpotomy

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17
Q

What is conventional pulp capping?

A

Class 1 pulp capping

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18
Q

What material is used for class 1 pulp capping?

A

Calcium hydroxide usually

Can use hydraulic calcium silicate cement

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19
Q

Indications for class 1 pulp cap (3)

A

Complicated traumatic fracture involving superficial exposure of the pulp or after accidental injury, Clinically pulp is healthy and free from inflammation, Small exposures (less than 1mm in diameter) in coronal third of pulp chamber, corresponding to a pulp norm

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20
Q

How to do a class 2 pulpal exposure?

A

Magnification

Achieve haemostasis within 5 min, Clean with 5.25% NaOCl, Restore with hydraulic calcium silicate cement, Should be done under rubber dam

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21
Q

What percentage of sodium hypochlorite is advocated for by the literature?

A

5.25%

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22
Q

List three materials that can be used for direct pulp capping in cariously exposed pulps

A

Calcium hydroxide, MTA, biodentine

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23
Q

Which is the most effective material for direct pulp capping?

A

MTA or biodentine

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24
Q

What is an advantage of biodentine over MTA for direct pulp capping?

A

Biodentine does not cause any darkening due to no bismuth oxide

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25
What two treatments can be done when a pulp is exposed?
Direct pulp capping, RCT
26
When is direct pulp capping more cost effective than RCT?
Younger patients, Occlusal sites
27
When is RCT preferred over direct pulp capping?
Older patients (over 40y) with interproximal exposure sites
28
What does dark bleeding of a pulp indicate?
Considerable damage
29
What should we do if haemostasis is not achieved relatively quickly?
Remove some pulp (partial pulpotomy)
30
How long should it take (max) for haemostasis to be achieved?
10 mins
31
How to do a pulpotomy?
Remove damaged pulp tissue ## Footnote Haemostasis using pellet soaked in sodium hypochlorite for 10 mins, Gently flush out area with sodium hypochlorite for microbial control using 1-3%, Apply hydraulic calcium silicate cement in at least 3mm thickness, Definitive coronal restoration, Follow up for up to 4 years
32
What is a full pulpotomy?
Complete removal of coronal pulp ## Footnote Pulp within root canals remains
33
Success rates for partial pulpotomy
Good even for irreversible pulpitis, 43-100%
34
Success rates for full pulpotomy
Good, 82-100%
35
What is an indication of success for pulpotomies?
Haemostasis
36
Which cases can be selected for vital pulp therapy?
Pulp must be vital, Younger patients, Occlusal lesions, Traumatic lesions, No/minimal symptoms
37
What are the three treatment options for a permanent tooth with a carious pulp exposure and diagnosis of irreversible pulpitis?
Partial pulpotomy, full pulpotomy, RCT ## Footnote Main treatment option is RCT but may be circumstances where we do pulpotomy
38
What does hydraulic mean in relation to calcium silicate cements?
Requires water to set
39
Properties of calcium silicate cements (5)
Hydraulic, Non resorbable, Biocompatible (low or no host inflam response), Bioactive (able to create a hydroxyapatite layer), Favours regeneration of the pulp, bone, cementum and PDL
40
What is a first gen calcium silicate cement?
MTA - mineral constituents
41
What is a second gen calcium silicate cement?
Biodentine - lab chemical constituents
42
What is a third gen calcium silicate cement?
RRM - nano particles
43
Disadvantages of MTA
Difficult to manipulate and handle, Takes time to set, Can be washed out when rinsed, Difficult to take a PA to check prior to closure, Incr brittleness of adj dentine, Darkening of tooth (bismuth oxide), Expensive
44
How long does it take for the initial set of MTA?
4 hours
45
How long does it take for the initial set of biodentine?
12 mins
46
Advantages of biomaterials compared to traditional materials (7)
Hydraulic setting - therefore uninhibited by blood, Little or no host response, Collagen fibres can integrate with the material, When used for pulp capping, stim of odontoblasts encourages tertiary dentine, Regen of PDL and cementum possible, Useful in many endodontic situations
47
What is added to MTA for radiopacity?
Bismuth oxide
48
Disadvantage of bismuth oxide in MTA
Causes tooth to discolour (grey)
49
Why is the definitive restoration placed at a later visit after use of a calcium silicate cement?
The material continues to set for up to a month after placement
50
Properties of MTA
pH 12.5 therefore anti microbial, Good dimensional stability, Compressive strength develops over 28d, Needs to be placed in at least 2mm thickness, Little or no marginal leakage, Expands in moist environments, Denatures collagen so incr brittleness of adjacent dentine
51
What is biodentine?
Tricalcium silicate
52
What is used in biodentine for radiopacity?
Zirconium oxide
53
Properties of biodentine
Automix, Insoluble once set, Similar compressive strength to biodentine, Unaffected by blood contamination, Definitive restoration should be placed at a later date, Biocompatible
54
What are the essential aspects for all vital pulp therapy? (3)
Magnification, Aseptic technique, Caries free peripheral seal
55
What is the correlation of pulpal bleeding and treatment outcomes?
The longer and the more the pulp bleeds, the less likely we are to get a successful treatment outcome
56
What is the recommended treatment for a tooth with pulpitis?
Vital pulp treatment or RCT
57
What is the recommended treatment for non traumatic pulpitis with no pain or spontaneous pain?
Selective/stepwise caries removal without exposure ## Footnote If pulp exposure then direct pulp cap or pulpotomy
58
What is the recommended treatment for non traumatic pulpitis with permanent pain?
RCT or full pulpotomy
59
What is the recommended treatment for apical periodontitis?
RCT
60
What is the recommended treatment for emergency management of pulpitis?
Vital pulp treatment or root canal treatment
61
What indicates a favourable outcome for vital pulp therapy?
Absence of pain, Absence of swelling, Absence of other symptoms, No sinus tract, No loss of function, Normal PDL, Reduction in radiolucency

BDS3.5 Endodontics (17 decks)

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