Pulp Therapy In Pediatric Dentistry Revised 2

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presentation abt pulpotomy pulpectomy apexiogenesis

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Pulp Therapy In Pediatric Dentistry Revised 2

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

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