The document discusses various techniques for vital pulp therapy in children's teeth, including indirect pulp capping, direct pulp capping, and pulpotomy. Indirect pulp capping involves excavating caries near the pulp and covering the remaining dentin with a protective material like zinc oxide-eugenol. Direct pulp capping covers a small exposed pulp directly with calcium hydroxide and other materials. Pulpotomy removes coronal pulp but caps the radicular pulp to maintain vitality. Factors like the size and age of an exposure, symptoms, and radiographic findings help determine which technique may be most suitable. Maintaining pulp vitality avoids needing root canals or extractions in children's teeth.
Endodontic emergencies include Pre-treatment emergency of which hot tooth is a commonly encountered situation.
This ppt is contains concise pickup notes on Hot tooth.
Endodontic emergencies include Pre-treatment emergency of which hot tooth is a commonly encountered situation.
This ppt is contains concise pickup notes on Hot tooth.
Dentine hypersensitivity / /certified fixed orthodontic courses by Indian den...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Pulp vitality test is the one of the diagnosing method in DENTISTRY....this presentation deals about the best methods for diagnosting the vitality of the tooth.
Introduction
Classification of endodontic emergency
According to P Carrotte
According to Walton and Torabinejad
According to Weine
Importance of diagnosis in endodontic emergency
Types of diagnostic Aids needed
Emergency treatment of pulp and periapical related diseases
Acute pulpitis
Acute pulpitis with apical periodontitis
Pulp necrosis
Acute periapical abscess
Emergency treatment of traumatic injuries
Crown fracture
Root fracture
Avulsion
Andreasen’s criteria
Summer’s criteria
Emergency therapy for intratreatment pain
Endodontic emergency after treatment
Medication in endodontic emergency
Conclusion
References
In this brief lecture I will discuss most common endodontic emergencies that occur while practicing endodontics. The lecture is directed to the mind of undergraduate level.
I hope you enjoy it.
Dentine hypersensitivity / /certified fixed orthodontic courses by Indian den...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Pulp vitality test is the one of the diagnosing method in DENTISTRY....this presentation deals about the best methods for diagnosting the vitality of the tooth.
Introduction
Classification of endodontic emergency
According to P Carrotte
According to Walton and Torabinejad
According to Weine
Importance of diagnosis in endodontic emergency
Types of diagnostic Aids needed
Emergency treatment of pulp and periapical related diseases
Acute pulpitis
Acute pulpitis with apical periodontitis
Pulp necrosis
Acute periapical abscess
Emergency treatment of traumatic injuries
Crown fracture
Root fracture
Avulsion
Andreasen’s criteria
Summer’s criteria
Emergency therapy for intratreatment pain
Endodontic emergency after treatment
Medication in endodontic emergency
Conclusion
References
In this brief lecture I will discuss most common endodontic emergencies that occur while practicing endodontics. The lecture is directed to the mind of undergraduate level.
I hope you enjoy it.
Lecture 3 Facial cosmetic surgery
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 1 Facial cosmetic surgery
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Facial neuropathology Maxillofacial SurgeryLama K Banna
Lecture 4 facial neuropathology
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 2 Facial cosmetic surgery
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 12 general considerations in treatment of tmdLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name 12 general considerations in the treatment of TMJ
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name TMJ temporomandibular joint
Lecture 10
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 11 temporomandibular joint Part 3Lama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name TMJ temporomandibular joint Part 3
Lecture 11
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name TMJ anatomy examination 2
Lecture 9
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 7 correction of dentofacial deformities Part 2Lama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Correction of dentofacial deformities Part 2
Lecture 7
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 8 management of patients with orofacial cleftsLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name management of patients with orofacial clefts
Lecture 8
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 5 Diagnosis and management of salivary gland disorders Part 2Lama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Salivary gland 2
Diagnosis and management of salivary gland disorders Part 2
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 6 correction of dentofacial deformitiesLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Correction of dentofacial deformities
Lecture 6
Al Azhar University Gaza Palestine
Dr. Lama El Banna
lecture 4 Diagnosis and management of salivary gland disordersLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Salivary gland
Diagnosis and management of salivary gland disorders
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery 1
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma Part 3
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma part 2
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- GENE THERAPY
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- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
3. Pulp exposure is caused most commonly by
caries but may also occur during cavity
preparation or by fracture of the crown. Pulp
exposures caused by caries occur more
frequently in primary than in permanent teeth
because primary teeth have relatively large pulp
chambers, more prominent pulp horns and
thinner enamel and dentine. In primary molars
with proximal cavities, pulp involvement occurs
in about 85 % of those with broken marginal
ridges.
3
4. • Exposure of the pulp by caries is invariably
accompanied by infection of the pulp. The
infected pulp becomes inflamed and necrosis
may result. If infection spreads to the alveolar
bone, the developing permanent tooth may be
affected. For these reasons, a primary tooth
with a pulp exposure should not be left
untreated. When these carious exposures could
be treated with consistently good results,
several problems in dentistry would be solved.
The clinical condition of the carious tooth and
its surrounding tissues is an important
diagnostic factor.4
6. • Diagnostic aids in selection of teeth for vital
pulp therapy:
1. History of pain:
The history of either presence or absence of
pain may not be as reliable in the differential
diagnosis of the condition of the exposed
primary pulp as it is in permanent teeth but it
should be taken into consideration in selection
of the teeth for vital pulp therapy. Information
may be taken from the parents and history may
be helpful in determining the status of a
painful tooth.6
7. • The dentist should distinguish between two
types of pain: provoked and spontaneous pain
(unprovoked).
• Provoked pain is precipitated by stimulus
(thermal, chemical or mechanical irritants) and
disappear after removal of the stimulus, this
denotes that the pulp is vital and protected by a
thin layer of dentine and can be treated
successfully with good prognosis (e.g. pain after
hot or cold drink, pain immediately after eating).
7
8. • Spontaneous pain is a throbbing constant pain
that may keep the patient awake at night. It
indicates advanced pulp damage, which means
that involvement of the pulp has progressed
too far for treatment preserving pulp vitality or
with even a successful pulpotomy.
8
9. 2. Clinical examination:
A careful intraoral examination is of extreme
importance in detecting the presence of a
pulpally involved tooth.
A. Tooth mobility:
Abnormal tooth mobility is a clinical sign
that may indicate a severely diseased pulp or
involvement of periodontal ligaments
(pathological mobility must be distinguished
from normal mobility in primary teeth near
exfoliation).
9
10. B. Sensitivity to percussion:
Percussion should start with a very gentle
and careful tap by the tip of the finger to
prevent exposing the child to uncomfortable
stimuli. If the tooth is sensitive to percussion,
this indicates' apical or pulpal inflammation or
both.
C. Examination of mucobuccal fold:
Presence of swelling, sinus, draining fistula
or chronic abscess associated with a deep
carious lesion is a sign of an irreversibly
diseased pulp (non vital pulp).10
12. D. Size of exposure and amount of pulpal
bleeding:
Size of exposure, appearance of the pulp and
amount of bleeding are the most valuable
observation in diagnosing the condition of the
primary pulp. The most favorable condition for
vital pulp therapy is the small pinpoint
exposure surrounded by sound dentine. If the
exposure is large and associated with watery
exudate or pus, the tooth is not suitable for
vital pulp therapy.12
13. 3. Radiographic interpretation:
The clinical examination should be followed
by a high quality periapical and bite-wing
radiograph to examine periapical area and
supporting bone. Pulp exposure cannot be
accurately detected from an xray film.
13
14. • Radiographic interpretation in children is more
difficult than adults due to:
Young permanent teeth with incompletely
formed root ends giving the impression of
periapical radiolucency.
The roots of primary molars undergoing
normal physiologic resorption often present
a misleading picture or one suggestive of
pathologic change.
Permanent teeth are superimposed on the
primary teeth.
14
16. • Radiographs are valuable for determining the
following:
Periapical changes such as thickening or
widening of periodontal membrane space.
Rarefaction in supporting bone.
Presence of calcified masses within the pulp
chamber and root canals.
Periapical and interradicular radiolucencies of
bone.
16
17. 4. Vitality tests:
The vitality tests are not reliable in the child
dental patient in diagnosing a deep carious
lesion but it should be taken into
consideration. It gives an indication of
whether the pulp is vital but it does not give
reliable evidence about the extent of the pulp
disease.
Pulp vitality tests may be used either thermal
or electrical.
17
18. • Thermal pulp vitality test:
The thermal test includes the application of
heat (hot gutta percha or hot instrument) or cold
(ethyl chloride or ice cone). The reaction of a
normal tooth with vital pulp is tested first
(Normal response: pain on application of hot or
cold stimulus, which disappears after removal of
the stimulus). If the pain persists, this indicates
pulpitis. If the pulp does not respond to thermal
stimuli, (the child does not feel any pain) this is
an indication of non vital pulp.
18
19. • Electric pulp tester:
It is an apparatus used to test pulp vitality.
Record the reading of a normal tooth with vital
pulp first, then record the reading of the
carious one. If the pulp of the affected tooth
responds at lower reading than normal this
denotes hyperemia or pulpitis. If it responds at
a higher reading than normal this is an
indication of pulp degeneration.
19
20. • Disadvantages of electric pulp tester:
Electric irritation to the pulp.
False positive result when content of pulp is
liquid in case of liquefaction necrosis (the
pulp is non vital although it responds at a
lower degree).
The child might be apprehensive and the
dentist lose child's confidence causing
disruptive behavior.
20
21. 5. Physical condition of the patient:
Successful pulp therapy is dependent in
some measures at least upon the absence of
systemic disturbance that might exert a
deleterious effect on the pulp. Seriously ill
children, suffering from heart disease, nephritis,
leukemia, tumors, cyclic neutropenia should
not be subjected to the possibility of acute
infection resulting from pulp therapy aside
from the fact that pulp might not possess
normal regeneration power. Extraction of the
involved tooth after proper premedication with
antibiotics is the treatment of choice in such
serious diseases.21
23. I. Indirect pulp capping.
II. Direct pulp capping.
III. Pulpotomy.
IV. Partial pulpectomy.
V. Complete pulpectomy (endodontic treatment).
Vital pulp therapy
23
24. Pulp capping:
The aim of pulp capping is to maintain pulp
vitality by placing a suitable dressing either
directly on the exposed pulp (direct pulp
capping) or on a thin residual layer of slightly
soft dentine (indirect pulp capping).
24
25. I. Indirect pulp capping:
Indications:
Indirect pulp capping is used when the tooth
has a deep carious lesion in which case the
total removal of all carious dentine would most
certainly result in large pulp exposure
necessitating complex and expensive
treatment. This procedure may be considered
successful provided that there is no root
resorption and absence of mobility or
periapical inflammation radiographically.25
26. Procedure:
First visit:
1. Without local anesthesia nor rubber dam
application, excavation of the superficial layer
of caries is done up to the last thin leathery
dentine layer.
26
27. 2. The remaining carious dentine is dried (the
capping material will not adhere on wet
surface) and a layer of zinc oxide- eugenol is
applied on the dentine surface. Zinc oxide-
eugenol is a germicidal agent which kills
bacteria present in carious lesions and prevent
progression of caries toward the pulp i.e. arrests
carious process. This gives the chance to the
pulp for healing and regeneration.
27
28. 3. The overhanging walls of enamel should be
left as such because it provides retention for
the dressing.
4. The cavity is filled with zinc phosphate
cement or fortified zinc oxideeugenol and
left as such for 6-8 weeks.
28
29. • Treatment can be judged successful if:
The restoration was intact.
The tooth was not sensitive to percussion.
No history of pain after treatment.
No radiographic evidence of radicular
diseases.
No radiographic evidence of root
resorption.
No clinical evidence of direct pulp exposure
when the tooth was reentered and the
residual carious dentine was examined or
excavated.29
30. Second visit: 6-8 weeks
During the waiting period, the caries process
in the deep layer will become arrested and soft
caries is hardened. A protective layer of
reparative dentine has been formed.
A. The tooth is anesthetized and isolated with
rubber dam.
B. Carefully remove remaining carious dentine,
which is somewhat hardened and the cavity
preparation is completed in the conventional
manner and the tooth is restored as usual.
30
32. II. Direct pulp capping:
Definition:
Direct pulp capping is the procedure of
covering the exposed vital pulp by a material,
which promote healing of the vital pulp
tissues.
32
33. Indications:
1. They should be limited to traumatic exposure
(during cavity preparation).
2. Small pinpoint exposure surrounded by sound
dentine.
3. Recent exposure.
4. Vital pulp free from infections.
5. No bleeding at the exposure site or an amount
that would be considered normal (No
hyperemia or inflammation).
6. Normal radiographic findings.
33
34. Technique:
1. If traumatic exposure occurs during cavity
preparation, the tooth previously anaesthetized
and isolated with rubber dam or cotton rolls.
2. When a pulp is exposed during the last stages
of caries removal, carious dentine chips will be
pushed into the pulp tissue. These dentine chips
and fragments in exposed pulp after capping
induce foreign body reaction. The necrotic
material introduced with numerous small chips
of contaminated dentine can result in pulpitis or
abscess.
34
35. 3. Enlarging the exposure site:
Enlarging the opening into the pulp tissue
are needed for the following reasons:
A. Allow carious and non-carious fragments
to be easily washed away.
B. Facilitates direct contact of capping
material with pulp tissues.
35
36. • Only non-irritating solution such as normal
saline or chloramine T should be used to cleanse
the area, to flush the exposure free of debris and
keep the pulp moist while the blood clot is
forming before the placement of the capping
material.
• Calcium hydroxide is the material of choice of
capping exposed vital pulp tissue, zinc oxide-
eugenol is placed over the calcium hydroxide
layer as a sealant then zinc phosphate cement
and the permanent restoration is inserted at the
same appointment.
36
37. • Direct pulp capping is not encouraging in
primary dentition. The success of pulp capping
depends upon the presence of young, active
undifferentiated mesenchymal cells, which can
be induced to transform into odontoblasts. In
primary dentition, pulp tissue ages early and
less cellular elements are available. Moreover,
some cells may transform to odontoclasts
causing internal resorption.
37
39. III. Pulpotomy:
Definition:
It is removal of the coronal pulp tissues
until the level of entrance of the pulp canals
and capping the radicular pulp tissues to
keep it in good condition.
39
41. Indications:
1. It is used in primary and young permanent
teeth with vital exposed pulps when the
tissues adjacent to exposure site show slight
evidence of inflammation.
2. Slight amount of bleeding at the exposure
site considered within normal.
3. Wide old exposure.
4. Normal clinical and radiographic signs.
41
42. Technique:
1. Anesthetize and isolate the tooth with rubber
dam.
2. Obtain outline form to ensure access to the pulp
chamber.
3. Removal of all carious material with round bur
and spoon excavator, this ensure a clean
operating field.
4. Remove the roof of pulp chamber using a sterile
fissure bur in a low speed hand piece. Insert it
into the exposure site and move it mesially and
distally as required to remove the roof of the
pulp chamber.
42
43. 5. Remove any overhanging ledges of dentine,
pulp tissues under ledges may not be easy to
remove.
6. Excavate the coronal pulp with a large spoon
excavator or with round bur (when bur is used
care must be taken not to perforate the floor of
pulp chamber).
7. Wash and flush the pulp chamber with sterile
water or saline solution. This washes away the
debris and pulp remnants from the pulp
chamber.
43
45. 8. Dry and control bleeding with sterile cotton
pellets for about 4 minutes. If bleeding
continues, look for remnants of coronal pulp
still adhering to the walls of the pulp chamber
and remove them.
9. According to the capping material used we are
going to call the procedure either calcium
hydroxide or formocresol pulpotomy.
45