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Open apex
Absence of apical constriction
Apicalpart of canal is wider than
coronal part
High possibility of hypochlorite
accident.
Why?
Caries in deciduous
teeth
?When
Indication for vital pulp
therapy:
1. Teeth with open apex.
2. Primary teeth.
3. Teeth that would be
difficult to perform root
canal ttt.
4. Teeth involved in simple
restoration.
?When
Contraindication for vital pulp
therapy:
1. Teeth involved in a complex
restoration .
2. Teeth in which the root
canal space is needed to
hold a post and core.
3. Teeth involved in a complex
periodontal therapy.
Criteria must be fulfilled to
undergo vital pulp therapy
1. Pulp is asymptomatic or show
symptoms of reversible pulpitis.
2. Plupotomy
How to decide which
?procedure is needed
:Procedure selection dep. on
.Tooth is primary or permanent-1
.Tooth is mature or immature-2
.Pulp is vital or not-3
.Bleeding control-4
.Exposure is traumatic or pathologic-5
.Size of exp-6
Prescence of aseptic conditions. (rubber-7
(dam
Involvment of tooth in complex restoration-8
Pulp capping
Direct Indirect
Indirect pulp capping
A mean of protecting an injured pulp.
Materials used in pulp
capping
calcium hydroxide-1
:A-Usage
In both direct and indirect pulp
capping
:B-Effect on pulp
necrosis of adjacent pulp tissue-
.stimulate dentin bridge formation-
Mechanism of action-
Experiments carried with radioactive
calcium show that calcium ions used for
dentin bridge formation come from blood
.and not from CAH
It was suggested that its action
A-alkaline ph 12
.B-low grade irritation to pulp
Disadvantages
.complet Canal calcification-1
.Int resorption-2
Deficient physical properties might-3
lead to microleakage
Resulted dentin bridge is thought to-4
.be incomplete
:ZNO-E-2
.Its usage is controversial-
.No dentin bridge is formed
Pulp tissue adjacent to it show mass of
red blood cells and PMNL, with
underlying tissue show zone of
.fibrosis and infl. cells
ANTIBIOTICS-3
Eliminate infection
CORTICOSTEROIDES-4
.Decrease inflamn
:Isobutyl cyanoacrylate-5
.Hemostatic, bacteriostatic
:Tricalcium phosphate-6
.Show dentin bridge formation
:adhesive resins-7
Are recently used for direct pulp capping due to it Provide
.better seal than CAH
(:MTA(mineral trioxide aggregate-8
It is a biocompatible material used in
.direct pulp capping
It was detected to induce dentin bridge
formation…so is recommended in
DIRECT pulp capping procedure and
.many other usages
Mechanism of action of
:MTA
MTA act by up-regulation of bone
morphogenic protein which is
responsible for bone, collagen
formation and help pulp cells to
differentiate into odontoblasts.
Clinical case showing dentin
bridge formation in direct pulp
:capping using MTA
:Procedure
(.diag,anaesth.,isoln(RUBBER DAM-1
all caries removed, except in case of-2
.ind. pulp capping
.swab cavity with antiseptic agent-3
apply CAH over cavity floor in case of-4
ind.pc
.And over pulp in case of direct pc
cover CAH with ZNO-E-5
.seal cavity with permanent restoration-6
.follow up the case-7
Success of pulp capping
:depends on
.size of exp-1
In case of direct pulp capping…not more
.than 1mm
.type of exp-2
Traumatic not pathologic
.bleeding controlled-3
Note.. it was discov. That pulpal
contamination by oral env. for 24 hrs has
little or no effect on pulpal and hard
.tissue contamination
How to judge success of
?pulp capping
1. tooth has vital pulp and dentin
bridge formation within 75 to 90
days.
2. absence of pain.
3. absence of any signs of pulpal or
periapical lesions.
4. completion of root dev. (in case of
immat. teeth).
Failure of pulp capping
:Detected clinically in form of
.continous pain-1
.abscess formation-2
.periapical radiolucency can be detected in RG-3
.internal resorption can be detected in RG-4
:Causes
(.non-sterile procedure (absc. of rubber dam-1
.bacterial microinfilteration-2
:This is due to
.contam.of pulp prior to or during cav.preprn-1
.improper seal of cavity-2
.improper case selection-3
Pulpotomy
Definition:
The surgical amputation of the coronal portion of an exposed
vital pulp, usually as a mean of preserving the vitality of the
remaining radicular portion.
Indication:
1. Immature teeth with exposed pulp.
2. Primary teeth.
3. Emergency treatment in posterior teeth.
Contraindication:
Tenderness to percussion or
1.
palpation.
2. Swelling or fistula.
3. Mobility.
4.Non-restorable teeth.
5.Prefuse hemorrhage.
6.Necrotic pulp.
7.Spontaneous pain.
Materials used:
1.Calcium hydroxide:
(The most common dressing used)
it is anti bacterial-1
high ph 12.5 which cause liquefaction-2
.necrosis in super facial layer
cause coagulative necrosis at junction of- 3
necrotic and vital tissue cause mild
.irritation to the pulp
mild irritation lead to inf response in-4
absence of bacteria will heal with a hard
tissue barrier
disadvantage
Not seal fractured surface )an additional material must be used
.to ensure complete sealing of pulp
Formocresol.
• composition
cresol 35%-1
formalin 19%-2
in aquous glycerin-3
• formocresol Toxicity.
There is possible spread to distant sites )it is found that 5 minutes
exposure of pulpal tissue to FC result in systemic absorption of
about 1% of the dose
Plus:
its allergenicity, carcinogenicity
and mutagenicity
Actions:
)Three zones in radicular pulp (
1. Fixation zone
2. Coagulation necrosis
3. Vital tissue
steps
1. Remove the roof of the
pulp chamber
3. Control hemorrhage
1. Anesthesia
diamond stone
5. Pulp champer is flushed with sterile water or saline
6. Hemorrhage control either by saline or NaOCl
b.Unsuccessful cases:
1.failure of root development
2. pain & swelling
3. radiographic radiolucency
Prognosis of pulpotomy:
2-Exposure to saliva
3- Microleakage
4- Systemic factors
• If all trails are failed to retain pulp vitality
aggressive technique-1
•Material used
tri calcium phosphate-1
Athick mix is made &packed into the apical 2 mm of the canal
against which gutta percha is condensed in one visit with help
of radiographs
dentin chips-2
collagen&hydroxy appatite gel-3
MTA-4
M T A & abarrier technique
.Procedure
root canal is cleaned &-1
.shaped
medicated with Ca)OH(2 for-2
.1 week
on reentry into the canal it- 3
irrigate with NaOCl then
.dried
aplug of MTA is packed-4
.into the apical end
moist cotton pellet is- 5
inserted against MTA.&
.access is sealed for 4-6 hrs
.then canal is obturated- 6
apexification- 2
Def: induction of apical closure of an immature tooth in which pulp is
.non vital
.Materials used
calcium hydroxide-1
.calcium hydroxide. & camphorated mono chloro phenol-2
MTA-3
Diagnosis
clinical Radiographic
1. History )as trauma is the most •Is complicated
common cause of pulp necrosis because of the
2. Pulp vitality tests not provide normal
reliable information due to open radiolucency
apex
present at the apex
3. Presence of pain with percussion, as the root develop
mobility or discoloration of crown
are indication of pulp necrosis
Procedure for apexification
Ca)OH(2
First appointment
.tooth isolation rubber dam application-1
.access preparation &tooth length determination-2
.thorough cl&sh with irrigation using naocl or saline-3
root canal is dried with sterile paper point &partially medicated-4
.withCMCP
.the cavity is sealed with temporary cement- 5
•Second appointment )1-2 week later(
place sterile cotton pellet in the pulp chamber & seal the-4
.access cavity& final restoration