Permanent young teethDefinition- permanent teeth with incompletly formed apices arecalled young permanent teeth. Features- 1.pulpchamber anatomy approximatessurface shape of the crown more closely than inpermanent teeth.2.Pulp are larger than permanent teeth3.pulp protecting dentine thickness between the pulp andDEJ is less than permament teeth.
Comparison of root canals in primary teeth with those of young permanent teeth1. Roots are more longer and slender in primary teeth2. Primary roots canals are more ribbon like &have multiple pulp filaments with more numerous accessory canals.3. Roots of primary molar flare outward from the cervical part of tooth to greater degree than permanent teeth.4. In anterior teeth mesiodistal width is narrower than permanent teeth
INDIRECT PULP CAPPING• Defined as the application of medicament over a thin layer of remaning carious dentine,after deep excavation with no pulp exposure.• Objectives-1. To avoid pulp exposure2. Stimulate the pulp to generate reparative dentin
Advantages: 1. arrest of caries progression 2. preservation of vitality of non exposed pulp 3.One or two sitting proceduresResponse to treatment:• Cellular fibrillar dentin at 2 months post treatment• Presence of globular dentin during 1st 3months• Tubular dentin is more uniformly mineralised pattern
IndicationsHistory: 1. absence of spontaneous painClinical examination: 1. large carious lesion 2. absence of lymphadenopathy 3. normal colour of toothRadiographs: 1. large carious lesion in close proximity to pulp 2. normal lamina dura 3. normal periodontal ligament space 4. no interradicular or periapical radiolucency
contraindicationso History : 1. sharp penetrating pain that persists after withdrawing stimulus 2. prolonged spontaneous paino Clinical examination: 1. excessive tooth mobility 2. tooth discolouration 3. non responsiveness to pulp testing techniqueo Radiographic examination 1. large carious lesion with apparent pulp exposure 2. interupped or broken lamina dura 3. widened periodontal ligament space 4. radiolucency at the root apices or furcation areas
Direct pulp cappingDefinition: It is a placement of abiocompatible that has beinadvertently exposedfrom caries excavation ortraumatic injury.
objectives • Seal the pulp against bacterial leakage • Initiate a dentin bridge • Maintain the vitality of underlying pulp Indications: pin point mechanical exposures that are surrounded withsound dentin
contraindications• Spontaneous and nocturnal tooth aches• Excessive tooth mobility• Thickening of periodontal ligament• Radiographic evidence of furcal and periradicular degeneration• Uncontrollable hemorrhage at the time of exposure• Purulent or serous exudate from the exposureNote: Direct pulp capping tends to be more successful in young permanent teeth
PulpotomyDefinition: surgical removal of entire coronal pulp leaving intact the vital radicular pulp.Objectives: 1. to preserve the vitality of tooth 2. relief of pain in pts with acute pulpagia
Indications• Carious exposed teeth when retention is more advantageous than extraction• Clinical and radiographic signs of radicular pulp vitality• Absence of pathological changes• restorability
Contraindications• Root resorption exceeds more than one third of the root length• Non restorable tooth crown• Marked tenderness on percussion• Mobility with locally aggravated gingivitis• Radiolucency exist in the furcal or periradicular areas
Pulpectomy• Definition: Removal of necrotic pulp tissue followed by filling the root canals with a resorbable cement• Objectives: 1. maintains tooth free of infection 2. biomechanically cleanse and obturate the root canals 3. promote physiologic root resorption 4. hold the space for erupting permanent teeth