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Pulp Therapy
 

Pulp Therapy

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    Pulp Therapy Pulp Therapy Presentation Transcript

    • Pulp Therapy in Pediatric Dentistry Dr. Jeff Johnson Division of Pediatric Dentistry Department of Oral Health Science University of Kentucky
    • Pulp Therapy in Pediatric Dentistry --Vital Pulp Therapy--
      • Permanent Tooth Pulpotomy
        • Objectives
          • Maintain vitality of radicular pulp
          • Achieve root-end closure (Apexogenesis)
          • Eliminate need for apicoectomy
          • Facilitate GP obturation with apical stop
    • Pulp Therapy in Pediatric Dentistry --Vital Pulp Therapy--
      • Permanent Tooth Pulpotomy Agents
        • Formocresol
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • Objectives of Non-Vital Pulp Treatment (Primary Teeth)
        • Maintain tooth free of infection
        • Achieve biomechanical cleansing and canal obturation
        • Promote physiologic resorption
        • Maintain space and function
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • Non-Vital Pulp Treatment (Primary Teeth)
        • Choices
          • Pulpectomy (most are partial due to anatomy)
          • Extraction
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • Pulpectomy Indications/Considerations
          • Strategic importance of tooth (2 nd primary molar with unerupted 6-yr molar)
          • Sufficient remaining tooth structure
          • Poor chance of vital pulp treatment success
          • Adequate remaining root
          • Cooperative patient
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • Pulpectomy Contraindications
        • A non-restorable tooth
        • A tooth with a mechanical or carious perforation of the floor of the pulp chamber
        • Pathologic root resorption involving more than one-third of the root
        • Pathologic loss of bone support resulting in loss of the normal periodontal attachment
        • The presence of a dentigerous or follicular cyst
        • Radiographically visible internal root resorption
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • Pulpectomy Technique
        • Achieve adequate anesthesia and rubber dam isolation.
        • Remove all caries.
        • Remove the roof of the pulp chamber with a high-speed handpiece.
        • Amputate the coronal aspect of the pulp tissue with a large round bur in a slow-speed handpiece.
        • The remaining pulp tissue occupying the root canals is removed using endodontic files at a predetermined working length, approximately 1 to 2 mm short of the root apices.
        • The canals should be enlarged several sizes beyond the size of the first file that fits snugly into the canal to a minimum final size of 30 to 35.
        • Throughout root canal instrumentation, the canals should be irrigated with sodium hypochlorite to aid in debridement.
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • Pulpectomy Technique (continued)
        • 8. Dry the canals with sterile paper points.
        • 9. The canals are filled with a treatment paste (Zinc Oxide/Eugenol at UKCD) using a pressure syringe.
        • 10. The tooth is restored with a stainless steel crown.
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • Criteria for an ideal pulpectomy obturant (treatment paste)
        • Antiseptic
        • Resorbable
        • Harmless to the adjacent tooth germ
        • Radiopaque
        • Non-impinging on erupting permanent tooth
        • Easily inserted
        • Easily removed
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • Apexification (Young Permanent Teeth)
        • Apical closure of an incompletely formed root
        • Implemented when apexogenesis has failed
        • Necrotic tissue removal short of the apexification site
        • Agent is placed in canals to achieve closure/apical stop
      • Apexification Recall Schedule
        • Calcium Hydroxide Rotation
          • 3-6 month intervals (Andreasen, 1994)
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • Action of Calcium Hydroxide in Apexification
        • Bactericidal
        • Low grade irritation inducing hard tissue barrier formation
        • Dissolves necrotic debris
      • Forms of Calcium Hydroxide
        • Caliscept
        • Self-mixed (CaOH + sterile water or local anesthetic)
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • Evaluation of Success
        • Asymptomatic
        • Radiographic absence of pathology
        • Continued root development
        • Hard tissue barrier at apex
        • Responsive pulp
    • Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
      • In Review. . .
    • FYI
      • Comparison between File Size and Needle for Pressure Syringe
        • Standard File Needle Gauge
          • 15-30 30
          • 40 27
          • 50 25
          • 70-80 22
          • 90-100 18
    • References
      • Barr Elizabeth, Flaitz Catherine, Hicks John. “A retrospective radiographic evaluation of primary molar pulpectomies”. Pediatric Dentistry , Vol. 13, Number 1, 1991: 4-9.
      • Dummett, Cliff. “Pulp Therapy in Pediatric Dentistry”. Louisiana State University School of Dentistry, April 16, 2003.
      • Georig Albert C., Camp Joe H. “Root canal treatment in primary teeth: a review”. Pediatric Dentistry , Vol. 5, Number 1, 1983: 33-37.
      • Nash David A. “Pulpal Therapy, Module 6”. West Virginia University School of Dentistry.
      • Mink, John R. and Spedding, Robert. “Pediatric Pulp Treatment”. University of Kentucky College of Dentistry.
      • Pinkham, J. R., senior editor. Pediatric Dentistry, Infancy through Adolescence, Third Edition . W.B. Saunders Company, 1999.
      • Walton, Richard E. and Torabinejad, Mahmoud. Principles and Practice of Endodontics, Second Edition . W.B. Saunders Company, 1996.
      • The Handbook, Second Edition . American Academy of Pediatric Dentistry, 1999.