This document discusses pulp therapy procedures for primary teeth, including diagnosis, conservative treatments like indirect pulp treatment and pulpotomy, and radical treatments like pulpectomy. It describes the characteristics of provoked and spontaneous pain, clinical examination techniques, materials used, and the goals and techniques for various procedures. Conservative treatments aim to maintain pulp vitality and stimulate dentin formation, while pulpectomy is for non-vital pulps and involves complete removal followed by root canal filling.

1. PULP THERAPY FOR THE
PRIMARY DENTITION

2. CLINICAL PULPAL DIAGNOSIS
 HISTORY AND CHARACTERISTICS
OF PAIN
 CLINICAL EXAMINATION
 RADIOGRAPHIC EXAMINATION

3. HISTORY AND CHARACTERISTICS OF PAIN
A.provoked
B.spontaneous

4. PROVOKED
• reduced or eliminated when the noxious stimulus
is removed
• frequently indicates dentin sensitivity due to a
deep carious lesion or a faulty restoration
• the condition is usually reversible

5. SPONTANEOUS
• throbbing, constant pain that may
keep the patient awake at night
• indicates advanced pulpal damage
• the pulp is usually non treatable

6. CLINICAL EXAMINATION
indicators of pulp involvement
redness
swelling of the vestibulum
grossly decayed teeth with draining parul
missing or fractured restorations
carious marginal breakdown

7. PALPATION
acute dentoalveolar abscess before
exteriorization
chronic dentoalveolar abscess

8. MOBILITY
If a significant difference is observed, pulpal
inflammation might be suspected

9. SENSITIVITY TO PERCUSSION
acute apical periodontitis

10. RADIOGRAPHIC EXAMINATION
Interradicular radiolucencies
high-quality bitewing radiograph

11. RADIOGRAPHS ARE VALUABLE AS AIDS IN VISUALIZING
THE PRESENCE OR ABSENCE OF THE FOLLOWING
l. Deep caries with possible or definite pulp
involvement.
2. Deep restorations close to a pulp horn.
3. Successful or failing pulpotomy or
pulpectomy.
4. Pulpal changes, such as pulp

12. 5. Pathologic root resorption
6. Periapical and interradicular radiolucencies of bone
7. The dentist should be familiar with the normal factors

13. OPERATIVE DIAGNOSIS
pulpotomy
color and the amount of bleeding from a direct exposure of the pulp tissue
Red color and hemostasis in less 5 min with mild cotton pellet pressure

14. pulpectomy
Excessive bleeding is an indication that the
inflammation has reached the radicular pulp

15. PULP TREATMENT PROCEDURES
•CONSERVATIVE TREATMENT
PROTECTIVE BASE
INDIRECT PULP TREATMENT
DIRECT PULP CAPPING
PULPOTOMY

16. PROTECTIVE BASE
 placement of a protective base or liner
on the pulpal and axial walls of a cavity preparation to act
as a protective barrier between the restorative material and
the tooth.
 resin cements, glass ionomers, and dentin-bonding agents

17. INDIRECT PULP TREATMENT
 Indirect pulp treatment (IPT) is recommended for teeth that
have deep carious lesions approximating the pulp but no
signs or symptoms of pulp degeneration. In this procedure,
the deepest layer of the remaining carious dentin is covered
with a biocompatible material. This results in the deposition
of tertiary dentin, increasing the distance between the
affected dentin and the pulp, and in the deposition of peritubular
(sclerotic) dentin, which decreases dentin permeability.

18. THE ULTIMATE OBJECTIVE OF THIS TREATMENT
 arresting the carious process
 promoting dentin sclerosis (reducing permeability)
 stimulating the formation of tertiary dentin
 remineralizing the carious dentin

19. THE MATERIALS MOST COMMONLY USED IN IPT
 calcium hydroxide
 mineral trioxide aggregate (MIA)
 glass ionomer
 Dentin-bonding agents

20. DIRECT PULP CAPPING
 Direct pulp capping is carried out when a healthy pulp has
been inadvertently exposed during an operative procedure.
The tooth must be asymptomatic, and the exposure site must
be pinpoint in diameter and free of oral contaminants. A
calcium hydroxide medicament is placed over the exposure
site to stimulate dentin formation and thus "heal" the wound
and maintain the vitality of the pulp.

21. PULPOTOMY
 The pulpotomy procedure is based on the rationale that the
radicular pulp tissue is healthy or is capable of healing after
surgical ampl.1tation of the affected or infected coronal
pulpY The presence of any signs and/or symptoms of
inflammation extending beyond the coronal pulp is a contraindication for
a pulpotomy.

22. CONTRAINDICATED

swelling.pulpal origin fistula, pathologic mobility, pathologic
external root resorption, internal root resorption, periapical or
interradicular radiolucency, pulp calcifications, or excessive
bleeding from the amputated radicular stumps. Other signs,
such as a history of spontaneous or nocturnal pain or tenderness to
percussion or palpation, should be interpreted
carefully .

23. THE IDEAL DRESSING MATERIAL
 (1) be bactericidal
 (2) be harmless to the pulp and surrounding structures
 (3) promote healing of the radicular
pulp
 (4) not interfere with the physiologic process of
root resorption

24. THE MOST COMMONLY USED PULP DRESSING MATERIALS
 formocresol (Buckley's solution: formaldehyde, cresol,
glycerol, and water)
 Glutaraldehyde (GA)
 ferric sulfate (FS)
 MTA

25. PULPOTOMY TECHNIQUE

26. RADICAL TREATMENT
PULPECTOMY AND ROOT FILLING
 The pulpectomy procedure is indicated in teeth that show
evidence of chronic inflammation or necrosis in the radicular pulp.
 pulpectomy is contraindicated in teeth
with gross loss of root structure, advanced internal or external
resorption, or periapical infection involving the crypt of
the succedaneous tooth.

27. IDEAL ROOT CANAL FILLING MATERIAL
 resorb at a rate similar to that of
the primary root, be harmless to
the periapical tissues and to the
permanent tooth germ,
resorb readily if pressed beyond
the apex, be antiseptic, fill the
root canals easily, adhere to their
walls, not shrink, be easily
removed if necessary, be
radiopaque, and not discolor the

28. PULPECTOMY TECHNIQUE