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![DPC CONTRAINDICATED IN PRIMARY TEETH
Localization of infection & inflammation in primary teeth is poorer than in permanent teeth. [Mc
Donalds,1956]
Incidence of reparative dentin formation in primary teeth is more extensive than permanent Teeth.
[Sayegh , 1968]
Primary pulp contain high cellular content which might be responsible for failures. Primary pulp
responds more rapidly to the effects of dentinal caries then the perm. Teeth. [Rayner & Southam,
1979]
Undifferentiated mesenchymal cells may differentiate into osteoclasts in response to caries or pulp
capping material which could lead to internal resorption. [Kennedy,1985]](https://image.slidesharecdn.com/pulpcapping-200118101826/75/Pulp-capping-21-2048.jpg)
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Pulp capping
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- 2. INTRODUCTION The treatmentof pulpally involved teeth in primary dentition poses an unique challenge Young dental pulp in primary teeth , has a high potential for repair High degree of cellularity and vascularity is seen in these tissues in stages prior to advanced physiological resorption of roots The young pulp lends itself more readily to procedures concerned with preservation of pulp vitality
- 3. PULP is definedas soft tissue forming inner structure of tooth and containing nerve and blood vessel , also called as tooth pulp. The dental pulp occupies the center of each tooth and shapes itself to a maturation of the tooth .
- 4. VITAL PULP THERAPY Indirect pulp capping Directpulp capping NON-VITAL PULP THERAPY Pulpotomy Pulpectomy
- 5. PULP TREATMENT CONSERVATIVE Indirectpulp therapy Direct pulp therapy Pulpotomy RADICAL Pulpectomy Treatment modalities
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- 7. Defined asa procedure where a small amount of carious dentin is retained in deep areas of cavity to avoid exposure of pulp, followed by placement of a suitable medicament and restorative material that seals off the carious dentin and encourages pulp recovery – Ingle A procedure in which only the gross caries is removed from the lesion and the cavity is sealed for a time with a biocompatible material – McDonald DEFINITION
- 8. OBJECTIVES: Arresting thecarious process Promoting dentin sclerosis Stimulating formation of tertiary dentin Remineralization of carious dentin
- 9. INDICATIONS: CLINICAL EXAMINATION: Largecarious lesion Absence of lymphadenopathy Normal appearance of adjacent gingiva Normal colour of tooth RADIOGRAPHIC EXAMINATION Large carious lesion in close proximity to the pulp Normal lamina dura Normal periodontal ligament space No interradicular or periapical radiolucency When pulp inflammation is judged to be minimal and complete removal of caries would cause pulp exposure HISTORY: o Mild discomfort from chemical and thermal stimuli o Absence of spontaneous pain
- 10. CONTRAINDICATIONS CLINICAL EXAMINATION: Excessivetooth mobility Soft leathery dentin covering a large area of the cavity, in a non- restorable tooth Parulis approximating the affected tooth Tooth discoloration Non-responsiveness to pulp testing RADIOGRAPHIC EXAMINATION: Pulp exposure Interrupted or broken lamina dura Widened PDL space Radiolucencies in the root apices or furcation areas Any signs of pulpal or periapical pathology & Soft leathery dentin covering a very large area of the cavity HISTORY: o Sharp, penetrating pain persisting after withdrawal of stimulus o Prolonged spontaneous pain(nocturnal)
- 11. Treatment procedure Administer LAand isolate with rubber dam Prepare outline cavity and remove the infected dentin(caries detector dye may be used) Stop excavation after firm resistance of sound dentin is felt Cavity flushed with saline and dried with cotton pellet Site covered with Ca(OH)2 and remainder with ZOE S I N G L E A P P T
- 12. 6-8 WEEKS LATER Finalrestoration is then placed Cover the floor with Ca(OH)2 and base is built with reinforced ZOE or GIC Cavity is washed out and dried gently The area around the potential exposure will appear whitish, may be soft, which is predentin, don’t disturb this area Previous remaining carious dentin will have become dried out, flaky and easily removed But if caries remain on re-entry, remove the caries If a reparative dentin is formed, permanent restn followed by full coverage restoration is chosen Between the appointment, history must be negative and temp restn should be intact S E C O N D A P P T
- 13. Factors affecting successof IPC RDT – 0.5-2mm Choice of IPC agent
- 14. OUTCOME 3 newtypes of dentin are formed Cellular fibrillar dentin – first 2 months Globular dentin – 3 months Tubular dentin – (uniform mineralized dentin) 1/5th of reparative dentin formation occurs in less than 30 days After 3 months, 0.1mm is formed
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- 16. DEFINITION: It isthe placement of the calcium hydroxide preparation on a small (pinpoint) pulpal exposure – Mathewson It consists merely of placing a protective material over the site of the exposed pulp prior to restoring the tooth - Finn
- 17. OBJECTIVES Preservation ofvitality of the radicular pulp. Relief of pain in patients with acute pulpagia. Ensuring the continuity of normal apexogenesis in immature permanent teeth
- 18. INDICATIONS: Accidental pinpoint exposure of pulp when excavating deep caries, less than 1 sq. mm. surrounded by clean dentin for (<24hours) Traumatic fracture of tooth(<24 hours) with pin point exposure Iatrogenic exposure during cavity preparation & crown preparation Bleed if touched but not excessively and controlled easily with cotton pellet Normal vitality tests without tender to percussion No radiographic evidence of periradicular pathology Young patient
- 19. CONTRAINDICATIONS History ofsevere spontaneous tooth aches at night Excessive tooth mobility Periodontal ligament thickening Intraradicular radiolucency Excessive bleeding at exposure site Purulent , serous exudate from exposure External or internal resorption Swelling and fistula with associated tooth
- 20. Treatment procedure Final restorationis done under determining the success by determination of dentin bridge, maintenance of pulp vitality, lack of pain and minimal inflammatory response Place temporary restoration Place the pulp capping material on exposed pulp with application of minimal pressure so as to avoid forcing the material into pulp chamber Hemorrhage is arrested with light pressure from sterile cotton pellet Cavity irrigated with saline / chloramine T / distilled water Once exposure is encountered, further manipulation of pulp is avoided
- 21. DPC CONTRAINDICATED INPRIMARY TEETH Localization of infection & inflammation in primary teeth is poorer than in permanent teeth. [Mc Donalds,1956] Incidence of reparative dentin formation in primary teeth is more extensive than permanent Teeth. [Sayegh , 1968] Primary pulp contain high cellular content which might be responsible for failures. Primary pulp responds more rapidly to the effects of dentinal caries then the perm. Teeth. [Rayner & Southam, 1979] Undifferentiated mesenchymal cells may differentiate into osteoclasts in response to caries or pulp capping material which could lead to internal resorption. [Kennedy,1985]
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