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Pulp protection
- 1. PULP PROTECTION DEPARTMENT OFCONSERVATIVE DENTISTRY AND ENDODONTICS THIRD YEAR SHUBHAM PARMAR
- 2. INTRODUCTION • Basic goalof conservative dentistry is to preserve the health of dental pulp • Dental pulp is a soft connective tissue of mesenchymal origin present within the pulp chamber and root canals of teeth • Pulp protection is important as most restorative materials themselves are not protective to pulp • Pulp is subjected to various insults due to caries, materials and operative procedures • Pulp protection also helps pulp recovery in case of deep defects • For this reason the use of pulp protecting agents such as sealers, liners and bases is important
- 3. PULPAL IRRITANTS • Diseaseprocess itself – Caries, trauma, attrition, abrasion • Mechanical Irritation – Excessive heat during cavity preparation • Chemical irritation – Phosphoric acid of zinc phosphate cement • Thermal Irritation – Due to heat conducted by metallic restorations • Microleakage
- 4. REMAINING DENTIN THICKNESS(RDT) • Dentine is the best insulator for pulp • Better to conserve as much as dentine as possible • Therefore the amount of RDT is the most important factor in deciding the best method of pulp protection RDT Effect of toxic substances on pulp 0.5mm 25% 1mm 10% 2mm Minimal or nil
- 5. PULP PROTECTION AGENTS •Pulp protection agents are selected on the basis of – • The restorative material being used • The RDTbetween the pulp and the pulpal or axial walls of the final tooth preparation • PULP PROTECTION AGENTS INCLUDE : • Cavity Sealers – Varnish and Bonding Agents • Cavity Liners • Cavity Bases
- 6. CAVITY SEALERS • Theseare materials that are applied to walls of prepared tooth and seal the interface between the tooth and the restoration • Liners are used to seal the dentinal tubules • Do not possess mechanical strength nor provide any significant thermal insulation • CAVITY VARNISH – Varnish his a natural gum or a synthetic resin dissolved in an organic solvent • The organic solvent evaporates leaving behind a protective film when applied to the tooth • Commonly used in amalgam restorations • Contraindicated under GIC restorations • Thickness if 2-5µm
- 7. CAVITY SEALERS • RESINBONDING AGENTS- currently accepted method of bonding composite to tooth structure • Also help in cavity sealing
- 8. CAVITY LINERS • Cementcoating of minimal thickness which serve as a physical barrier to bacteria • Applied only to the dentinal walls of preparation close to the pulp • Traditionally liners were used to medicate pulp in deep preparations • Liners are more fluid than bases,and used in thin layers (approximately 0.5 mm) • Currently used liners – Calcium Hydroxide, Glass Ionomer Cement
- 9. CAVITY LINERS • CALCIUMHYDROXIDE is used as a liner for the following reasons Pulpal compatibility Stimulate reparative dentine formation Antibacterial activity • Disadvantages of Calcium Hydroxide • Low strength • High solubility • Undergoes softening
- 10. CAVITY LINERS • GLASSIONOMER CEMENT • Advantages • Fluoride release • Chemical adhesion to tooth structure • Biocompatible
- 11. CAVITY BASES • Usedto replace missing dentine • Block out undercut for indirect restorations • Thickness usually 0.5-2mm • Applied on pulpal and axial walls of cavity • Provide thermal protection to pulp • Materials used – • Zinc Phosphate Cement • Zinc polycarboxylate • Glass ionomer cement (Type III)
- 12. CAVITY BASES Zinc Phosphate Traditionallymaterial of choice under metallic restorations Superior physical properties Excellent thermal insulation Zinc Polycarboxylate More biocompatible than Zinc Phosphate Adhesive to tooth structure Glass Ionomer Most popular base Fluoride releasing property Can be used under a variety of materials
- 13. GUIDELINES FOR PLACEMENTOF PULP PROTECTING AGENT RESTORATION SHALLOW CAVITY MODERATELY DEEP CAVITY DEEP CAVITY Amalgam Varnish/Dentine bonding agent Base Calcium Hydroxide Liner + Base Composite Resin Dentine bonding Agent Dentine Bonding agent Calcium Hydroxide liner + GIC base Glass Ionomer Cement - - Calcium Hydroxide liner Cast gold inlays and onlays Luting cement Base and Luting Cement Calcium Hydroxide liner, base and luting cement Ceramic inlays and onlays Dentine bonding agent and resin cement Dentine bonding agent and resin cement Calcium hydroxide liner+ GIC base+ dentine bonding agent
- 14. INDIRECT PULP CAPPING •A procedure wherein small amount of carious dentine is retained in deep areas of cavity to avoid pulp exposure, followed by placement of a suitable medicament and restorative material that seals of the carious dentine and encourages pulp recovery -Ingle
- 15. INDIRECT PULP CAPPING •OBJECTIVES OF INDIRECT PULP CAPPING • Given by Eidelman in 1965 • Arresting the carious process • Promoting dentine sclerosis • Stimulating tertiary dentine formation • Remineralization of carious dentine
- 16. INDIRECT PULP CAPPING •INDICATIONS Deep carious lesion near the pulp tissue but not involving it No mobility of tooth No history of spontaneous toothache No tenderness to percussion No radiographic evidence of pulp pathology No root resorption or radicular disease should be present radiographically
- 17. INDIRECT PULP CAPPING •CONTRINDICATIONS • Sharp penetrating pain • Spontaneous pain • Night pain • Mobility • Discoloured tooth • Break in lamina dura • Widened PDL space
- 18. DIRECT PULP CAPPING •Placement of a medicament or non medicament material on a pulp that has been exposed in course of excavating the last portion of deep dentinal caries or as a result of trauma -Kopel 1992
- 19. DIRECT PULP CAPPING •OBJECTIVES • Create new dentine in area of exposed pulp • Healing of pulp • RATIONALE – To achieve biologic closure of exposure site by formation of dentine bridge
- 20. DIRECT PULP CAPPING •INDICATIONS • Small mechanical exposure • Asymptomatic vital primary teeth • Bright red haemorrhage • Easily controlled • Pin point exposure • CONTRINDICATIONS • Night pain • Spontaneous pain • Mobility • Periapical lesion • Excessive haemorrhage • Root resorption
- 21. References • Sturvedant’s ArtAnd Science Of Operative Dentistry 6e • Clinical Operative Dentistry Principles And Practice By Ramya Raghu 2e • Textbook Of Paediatric Dentistry By Nikhil Marwah 4e • Google Images