The document discusses various topics related to indirect pulp capping, direct pulp capping, and pulpotomy procedures. Indirect pulp capping involves sealing a tooth with a deep carious lesion using a protective material to stimulate healing and repair, avoiding direct pulp exposure. It is aimed at maintaining pulp vitality. Direct pulp capping places a material directly on an exposed pulp to encourage reparative dentin formation. Pulpotomy involves removing part of the coronal pulp as an emergency procedure to preserve the remaining radicular pulp. Various materials used and techniques for each procedure are described.

2. INDEX SNO. TOPIC PAGE NO. 1) INDIRECT PULP CAPPING A) DEFINITION B)OBJECTIVES C)INDICATIONS D) CONTRAINDICATIONS E) INDIRECT PULP THERAPY F) INDIRECT PULP CAPPING TECHNIQUE 14 16 19 20 21 26 2) DIRECT PULP CAPPING A)DEFINITION B) OBJECTIVES C) INDICATIONS D) CONTRAINDICATIONS E) DIRECT PULP CAPPING TECHNIQUE 43 45 46 48 54

3. SNO. TOPIC PAGE NO. F) HISTOLOGIC CHANGES AFTER PULP CAPPING G)MATERIALS USED IN DIRECT PULP CAPPING H)LIMITATIONS OF DIRECT PULP CAPPING IN PRIMARY TEETH 59 65 79 3) PULPOTOMY A)DEFINITIONS OF PULPOTOMY B) CLASSIFICATION OF PULPOTOMY C) OBJECTIVE,INDICATIONS CONTRAINDICATIONS D) PULPOTOMY IN PRIMARY TEETH 84 86 88 90

4. SNO. TOPIC PAGE NO. E) FORMOCRESOL PULPOTOMY,HISTORY, COMPOSITION OF FORMOCRESOL,PREPARATION, MECHANISM OF ACTION,HISTOLOGIC FEATURES DEVITALIZATION DISADVANTAGES OF FORMOCRESOL F) ELECTROSURGICAL PULPOTOMY,PROCEDURE 91 100

5. SNO. TOPIC PAGE NO. G) LASER PULPOTOMY,TWO VISIT DEVITALIZATON, INDICATIONS,CONTRAINDICATIONS, MATERIAL USED, PROCEDURE H) MODIFIED FORMOCRESOL PULPOTOMY, PRESERVATION, GLUTARALDEHYDE PULPOTOMY I) ADVANTAGES OF GLUTARALDEHYDE OVER FORMOCRESOL,ATTRIBUTES OF GLUTARALDEHYDE 104 106 107

6. SNO. TOPIC PAGE NO. J) DISADVANTAGES,FERRIC SULPHATE,REGENERATION K) CALCIUM HYDROXIDE PULPOTOMY,INDICATIONS L) CVEK’S PULPOTOMY,PROCEDURE M) PARTIAL PULPOTOMY,PROCEDURE N) COMPLETE PULPOTOMY 109 110 111 117 118

7. SNO. TOPIC PAGE NO. O) CALCIUM HYDROXIDE:ADVANTAGES AND DISADVANTAGES,BONE MORPHOGENIC PROTIEN MINERAL TRIOXIDE AGGREGRATE,COMPOSITION,USES P) MORTAL PULPOTOMY PROCEDURE 115 122

8. INTRODUCTION Ref:20

10. Ref 16, page 22 DEFINITION OF THE PRINCIPAL TERMS USED IN PULPAL PROTECTION AND VTAL PULP THERAY TERM DEFINITION Pulp cap Treatment of an exposed vital pulp in which the pulpal wound is sealed with a dental material, such as calcium hydroxide or MTA, to facilitate the formation of reparative dentine and maintenance of vital pulp. Direct pulp cap A dental material placed directly on a mechanical or traumatic vital pulp exposure. Step wise caries excavation A material is placed on a thin partition of remaining carious dentin that if removed might accidentally expose the pulp (for immature permanent tooth) Pulpectomy (pulp extirpation) The complete surgical removal of the vital pulp Pulpotomy( pulp amputation) The surgical removal of the coronal portion of the vital pulp as a means of preserving vitality of the remaining radicular portion is usually is performed as an emergency procedure for temporary relief of symptoms or therapeutic measure.

11. Partial pulpotomy(shallow pulpotomy; cvek pulpotomy) The surgical removal of the small diseased portion of vital pulp as the means of preserving the remaining corona and radicular pulp tissue. apexification Inducing a calcified or artificial barrier in a root with an open apex or the continued apical development of an incompletely formed root in teeth with a necrotic pulp. apexogenesis A vital pulp therapy procedure performed to enable continued physiologic development and formation of the root end; term frequently used to describe vital pulp therapy that encourages the continuation of this process. Ref 16, page 22

12. INDIRECT PULP CAPPING

18. Ref no. 1,pg 400

30. (Ref 20)

34. Gross caries was removed and calcium hydroxide was placed over the remaining caries. Tooth was restored with amalgam and not reentered for complete caries removal for 3 months Sclerotic dentine can be seen below the remaining caries and the covering of calcium hydroxide . The tooth was reentered and the remaining caries was removed a sound dentine barrier is observed at the base of the cavity. A new amalgam restoration was placed after complete caries removal. RADIOGRAPH OF THE FIRST PERMANENT MOLAR (Ref 4, pg 395)

35. INDIRECT PULP CAPPING Ref 6, Pg 287

36. A) CARIOUS LESION APPROACHING PULP B) GROSS CARIES EXCAVATION D) EVALUATION AFTER 6-8 WEEKS C )MEDICAMENT PLACED E) PERMANENT RESTORATION (Ref 2, pg 338)

37. INDIRECT PULP CAPPING Ref 20

38. INDIRECT PULP CAPPING Ref 20

39. INDIRECT PULP CAPPING Ref 20

40. ▪ Highly demineralized ▪ Unremineralizable ▪ Superficial layer ▪ Lacking sensation ▪ Stained by 0.5% fuschin or i.e. 1.0% acid red solution Ultrastructure : intertubular dentin greately demineralized, with irregular scattered crystals. Presence of deteriorated collagen fibers that have only distinct cross bands and no interbands. ▪ Should be excavated ▪ Intermediately demineralized ▪ Remineralizable collagen ▪ Deeper layer ▪ Sensitive ▪ Does not stain Ultrastructure : intertubular dentin Partially demineralized, but apatitie crystals bound like fringes to the Sound fibers with distinct Cross bands and interbands. ▪ Should be left remineralize. Ref 1, pg 401 Infected dentin Affected dentin

41. INFECTED DENTIN AFFECTED DENTIN www. Cudental.com www. Cudental.com

42. DIRECT PULP CAPPING

53. Exposure to bleeding of molar Hard tissue Formation of the exposure Histological section showing hard tissue Formation following 90 days with a calcium Hydroxide cement DIRECT PULP CAPPING Ref 20

55. DIRECT PULP CAPPING Ref 6,pg289

57. DIRECT PULP CAPPING (Ref2, pg 339)

58. Calcium Hydroxide Technique Dentin Bonding System Hemostasis Hemostasis Disinfect Cavity Disinfect Cavity Calcium Hydroxide Bonding Agent Restoration Adhesive IRM Dentin Bonding System Restoration Resin-modified GIC Ref 1,pg 402 PULP EXPOSURE

61. After 2- 3 weeks After 4-5 Weeks After 8 weeks HISTOLOGICAL CHANGES AFTER PULP CAPPING (Ref 5, pg 181)

62. DIRECT PULP CAPPING Ref 20

66. Ref 8,pg 640

68. Ca(OH)2 : Ref 20

70. Materials used in direct pulp capping Ref 20

77. www. Cudental.com

83. PULPOTOMY

93. (ref.2,pg no.341)

94. Composition of formocresol :Buckley’s formula Cresol – 35% Glycerol – 19% Formaldehyde – 19% Water – 31% Preparation: currently we use 1/5th conc.of Buckley’s formula,which is prepared by the following method: 3 parts glycerine (90ml)+1 part distilled water (30ml)=Diluent (120ml) 4 parts Diluent (120ml)+1 part Buckley’s formocresol of 1/5th strength [Ref.5,pg.185] To prepare a 1:5 concentration of this formula,first thoroughly mix 3 parts of glycerine with1 part of distilled water,then add 4 parts of this preparation to 1 part Buckley’s formocresol,and thoroughly mix again [Ref.1,pg.405]

98. STEPS OF FORMOCRESOL PULPOTOMY (ref.1,pg no.405)

99. (Ref.20)

101. (ref.8,pg no.651)

113. (ref.2,pg no.342)

114. (ref.8,pg no.645)

119. (ref.13,pg no.435)

120. (ref.13,pg no.435)

124. (ref.1,pg no.406)