Pulp Therapy

Question 1

Take a thorough diagnosis

Based on?

Answer 1

1. History
   - pain-persistent or spontaneous PULP TX
2. Clinical exam
   - gum boil (non-vital teeth) XLA or PULPECTOMY
   - cellulitis ANTIBIOTICS
3. Radiographs
   - external and internal resorption
   - bone loss
   - pulp calcification
4. Vitality tests
   - don’t explain sensation
   - false negative from recently erupted teeth

Question 2

Classification of pulp states

Answer 2

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

Question 3

Treatment of Class III

Answer 3

Class III
- permanent tooth (XLA)
- primary tooth
• Class III a (normal bright red blood-PULPOTOMY)
• Class III b (little to no blood- PULPECTOMY)✂️

Question 4

Treatment of Class IV

Answer 4

Class IV

• permanent tooth (RCT/XLA)
• primary tooth (PULPECTOMY/XLA)

Question 5

Pulp therapy treatment options

IDPPE

Answer 5

1. IPC
2. DPC
3. Pulpotomy
4. Pulpectomy
5. XLA- Extraction

Question 6

1. IPC

Answer 6

When?

• Asymptomatic Class I or II
• Very deep various lesion

Why?
- to avoid pulpal exposure

Steps

1. LA
2. Remove lateral caries
3. Remove caries over pulp
4. 38% Silver Diamine Fluoride (SDF)/ Riva start
5. Calcium hydroxide
6. Temp
7. Leave for 6-8 weeks to arrest deepest caries
8. Repeat if needed
9. Hard dentine- permanent restoration

Question 7

1.a IPT

Answer 7

1. Steps 1-5 as for IPC
2. Fluoride releasing material (CGI/RMGI)
3. No entry
   - preservation of tooth structure
   - low pulpal exposure, cost and compliance

Question 8

2. DPC

Answer 8

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

Question 9

3. Pulpotomy (apexogenesis)

Answer 9

• 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

1. LA
2. Remove lateral caries
3. Remove ENTIRE roof of pulp chamber
4. Remove contents
5. Medicaments (Formocresol, Sodium hypochlorite)
6. Zinc oxide eugenol
7. Restore

Medicaments used

• ferric sulfate
• sodium hypochlorite
• MTA
• NEO MTA
• Biodentine

Question 10

4. Pulpectomy

Answer 10

• 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

Question 11

Pulpectomy procedure

Answer 11

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

1. Dry canal and use ZOE
2. Moisten canals with KRI 1 paste
3. Fill canals with hand files, paper points
4. Kalzinol + Ag