Whats so special bout kid pulp
big
incomplete dentine deposition
Best outcome of pulpal involvement
maintain vitality to allow continued physiologic development and formation of root apex
pulp cap and pulpot
open apices, good blood supply, high success rate in young permanent teeth
Protective base, indirect pulp cap, direct pulp cap
for primary teeth,
DPC for young perm teeth with smAll carious exposure
track with xrays to see root development
partial pulpotomy how to do
inflammed pulp removed (2mm) to reach depth of healthy pulp tissue
pulpal bleeding controlled, calcium hydroxide or MTA placed
restore w good seal
partial pulpotomy indications
two situations
young vital perm tooth with carious exposure <2mm, pulp hemorrhage controlled in 1-2min
young vital perm tooth with traumatic exposure, pulp haemorrhage controlled after removing superficial inflammed pulp tissue
What happens if you remove caries, pulp expose and your bleeding doesnt stop
gg mean pulp hyperemic,
assess cave and amputate entire coronal pulp
Pulpotomy
hemostasis achieved, then calcium hydroxide or MTA
cement base and final restoration w good seal
timeline for follow-ups
1 wk: ensure no more discomfort
1 month: x-ray for apical pathology, EPT
3 month: see root development
6 monthly review for 3 years
What to do after apex formation complete
elective RCT
observe for signs of pathosis
why is it bad if apex not mature but tooth die liao
no apical stop to condense GP
“blunderbuss” apex
thin walls of root may fracture if you try do apicectomy
what to aim for when doing non-vital pulp therapy for immature apex
promote formartion of hard tissue barrier at apex
apical closure
revascularisation
steps of non-vital pulp therapy
x-ray working length determination
DO NOT instrument beyond apex later PDL cells die you cannot form apical barrier
DO NOT push mecrotic pulp through apex
file and clean and irrigate and dry
non-setting calcium hydroxide, cotton and TD
repear 1 month and 3 monthly till apical stop forms (3-18 months)
then thermoplastic root fill w GP
How long does apical stop take to form with non-vital pulp therapy?
3-18 months, average 9
how to use MTA as artificial barrier plug
remove caoh after 1 week, then place 305mm of MTA at apex, seal w wet paper point and TD
review after a week for MTA to set the root fill w thermoplastic GP is no signs and symptoms
how to revascularise
disinfect canal with sodium hydroxide like xiao
dont instrument
put metronidazole and ciprofloxacin and minoclycine (minocycline stain teeth) for one month
then tooth reentered and file poked through to make blood clot to level of cej
put MTA over clot and restore with good seal
why you wanna revascularise
tooth short root, large apex, very thin walls
so poor prognosis
MTA plug or apexification wont work
the clot is revascularised so canal wall will thicken and apex closed
Do developing perm teeth with pulpal involvement have good prognosis?
no hahaha
its poor prognosis just to keep it there so to keep bone for dentures or implant.
why we want to keep primary teeth
maintain arch length
prevent pain
restore aesthetics and function, prevent psychological effects
speech problems, aberrant tongue habits, adverse effect on underlying tooth
medical history that’ll encourage you to do pulp therapy for primary tooth
bleeding disorders, coagulopathies, oligodontia
medical history that’ll convince you to extract primary instead of pulp therapy
congenital heart disease later they subacute bacterial endocarditis
immunocompromised children
poor healing ability
other considerations beside medical history that affect treatment plan of carious pulp involved primary
behavioral factors of patient and parent general dental condition restorability of tooth life span of tooth supporting bone significance to dental arch other pathology abscence of successor
how to diagnose pulp status in primary tooth
history and characteristic of pain
dont go and knock if its already painful, try asking child to bite down on cotton roll, observe guardedness
discolouration and mobility
redness swelling sinus tract
xray
nature of bleeding from exposed pulp during procedure
sensibility tests not very good: EPT no no, thermal still maybe
what are the 3 treatment approaches for deep caries
preventive: rigorous caries preventive fluoride and discing
biological: incomplete caries removal, restore w good seal, arrests remaining caries eg. hall technique, interim therapeutic restoration
conventional surgical
