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Vital pulp therapy
- 1. Prognosis of treatment usingEndocem MTA case report about direct pulp capping and partial pulpotomy
- 2. Seung Pil JungDDS • Seoul Pil Dental Clinic: Seoul • Private Practice Mar.2012 ~ • Seoul Leaders Dental Clinic: Seo-San • Private Practice Mar.2005~Sep.2010 • Korean Army Service: Seo-San • Public Health Dentist Mar.2001~Apr.2004 • Graduated from Seoul National Univ. Feb.2000
- 3. • Vital pulptherapy • Pulp capping using MTA • Endocem MTA • Pozzolanic reaction • Characteristics • Indication • Directions for use • Case • Conclusion • Discussion
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- 9. vital pulp therapy •pulp capping • partial pulpotomy • full pulpotomy
- 10. pulp capping, partial pulpotomy,and full pulptomy pathways of the pulp - 10th edition 625~630
- 11. Vital pulp therapy: Requirementsfor Success • Treatment of a noninflammed pulp • Bacteria-tight seal • Pulp dressing
- 12. MTA as acapping agent • high pH similar to calcium hydroxide when unset • after setting, will create an excellent bacteria-tight seal • hard enough to act as a base for a final restoration • need a moist environment for at least 6 hours to set properly—> two step procedure • cause discoloration in the tooth crown • high cost
- 13. Calcium Hydroxide success rate pulp capping withoutany removal of the sort tissue 80% partial pulpotomy the removal of coronal pulp tissue to the level of healthy pulp 95% full pulpotomy the removal of the entire coronal pulp to a level the root orifices 75%
- 14. partial pulpotomy technique •anesthesia,possibly without a vasoconstrictor • rubber dam • superficial disinfection • 1-to 2-mm deep cavity into the pulp using a high-speed hand piece with a sterile diamond bur • If bleeding is excessive, the pulp is amputated deeper until only moderate hemorrhage is seen • excess blood is carefully removed by rinsing with sterile saline and the area is dried with a sterile cotton pellet • 5% NaOCl is recommended to rinse the plural wound • chemical amputation of the blood coagulum • remove damaged pulp cells, dentin chips, and other debris • provide hemorrhage control with minimal damage the normal pulp tissue underneath • do not allow blood clot to develop
- 15. partial pulpotomy technique •1-to 2-mm deep cavity into the pulp • using a high-speed hand piece with a sterile diamond bur • until only moderate hemorrhage is seen • excess blood is carefully removed • 5% NaOCl • do not allow blood clot
- 18. • little orno history of pain • absence of radiographic signs, percussion sensitivity, swelling, or mobility • exposures exceeding 2mm, bleeding could not controlled within 1~2minutes excluded • 93.5%, 91.4% healing Partial pulpotomy on asymptomatic young permanent posterior teeth(calcium hydroxide)
- 19. pulpotomy on symptomaticyoung permanent (calcium hydroxide) • 6 teeth • temporary pain • widened PDL ligament space • condensing osteitis • 66.7% healed
- 20. pulpotomy on symptomaticyoung permanent teeth(calcium hydroxide) • 26 permanent vital molars with caries pulp exposures and apical periodontitis • 16~ 72 months observed • 24 teeth (92.3%)
- 22. methods • 40 patients(7~45 years) • pulp-capping treatment • no more than reversible pulpits (cold test, radiographic examination)
- 23. first visit • removecaries using a caries detector • hemostasis using NaOCl • place Pro-root MTA over the exposures and all surrounding dentin • restore provisionally with un-bonded Clearfil Photocore
- 24. second visit • sensibilitytest • confirm MTA curing • restore with bonded composite
- 25. results • observation period:9 years • followed : 49/53 teeth • favorable outcome: 97.96% • all teeth having open apexes showed completed root formation(15/15)
- 26. MTA • Biocompatibility • Odontogenicity •Sealing effect • Anti-bacterial effect • Long setting time • Dentin discoloration
- 27. Endocem MTA • mineraltrioxide aggregate-derived pozzolan cement
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- 29. MTA surface aftersetting calcium hydroxide calcium silicate hydrate active silica calcium silicate hydrate
- 30. • minimize pulpchamber calcification Clinical Significance of Pozzolanic Reaction
- 31. 17 2012 10 18 16mlater
- 32. • minimize pulpchamber calcification • Bond strength does not vary significantly across surface treatments (Shin et al, J Endod 2014;40:1210–1216) Clinical Significance of Pozzolanic Reaction
- 35. • minimize pulpchamber calcification • Bond strength does not vary significantly across surface treatments (Shin et al,J Endod 2014;40:1210–1216) • not discolor dentinal tubule (Jang et al. J Endod 2013;39:1598–1602) Clinical Significance of Pozzolanic Reaction
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- 38. Endocem MTA • Biocompatibility(Choi et al. J Endod 2013;39(4); 467-72)
- 39. • MG63 cell •3days • cytoplasmic extension
- 40.
- 41. Endocem MTA • Biocompatibility(Choi et al. J Endod 2013;39(4); 467-72) • Odontogenic effect (Park et al. J Endod 2014;40(8); 1124-31)
- 42. Odontogenic Effect of aFast-setting Pozzolan-based Pulp Capping Material Su-Jung Park, DDS, PhD,* Seok-Mo Heo, DDS, PhD,† Sung-Ok Hong, DDS, MSD,* Yun-Chan Hwang, DDS, PhD,jj Kwang-Won Lee, DDS, PhD,‡ and Kyung-San Min, DDS, PhD‡§
- 44. Our results indicatethat ProRoot and Endocem have similar biocompatibility and odontogenic effects. Therefore, Endocem is as effective a pulp capping material as ProRoot. (J Endod 2014)
- 45. Endocem MTA • Biocompatibility(Choi et al. J Endod 2013;39(4); 467-72) • Odontogenic effect (Park et al. J Endod 2014;40(8); 1124-31) • Sealing effect (Choi et al. J Endod 2013;39(4); 467-72)
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- 48. Endocem MTA • Biocompatibility(Choi et al. J Endod 2013;39(4); 467-72) • Odontogenic effect (Park et al. J Endod 2014;40(8); 1124-31) • Sealing effect (Choi et al. J Endod 2013;39(4); 467-72) • Discoloration(Jang et al. J Endod 2013;39:1598– 1602)
- 49. Endocem MTA • Biocompatibility(Choi et al. J Endod 2013;39(4); 467-72) • Odontogenic effect (Park et al. J Endod 2014;40(8); 1124-31) • Sealing effect (Choi et al. J Endod 2013;39(4);467-72) • Discoloration(Jang et al. J Endod 2013;39:1598–1602) • Anti-Bacterial Effect (Shin et al. not published)
- 50. •Shin et al.not published Joo-Hee Shin, DDS, MSD, PhD Department of Conservative Dentistry, Korea University Medical Center, Korea University, Seoul, Korea
- 51. • Streptococcus mutans;dental caries • Enterococcus faecalis; failed endodontic lesion • porphyromonas gingivalis; periodontitis
- 53. Endocem MTA • Biocompatibility(Choi et al. J Endod 2013;39(4);467-72) • Odontogenic effect (Park et al. J Endod 2014;40(8); 1124-31) • Sealing effect (Choi et al. J Endod 2013;39(4);467-72) • Discoloration(Jang et al. J Endod 2013;39:1598–1602) • Anti-Bacterial Effect (Shin et al. not published) • Fast setting Time (Choi et al. J Endod 2013;39(4);467-72)
- 55. Indication • Lining ofcavity in pulp capping • Lining of cavity in partial pulpotomy • Lining of cavity after pulpotomy of deciduous teeth • Canal filling for apical closure in apexogenesis • Restoration of root canal perforation • Restoration of internal resorption lesion • Root end filling • Endodontic sealer
- 56. Indication • Lining ofcavity in pulp capping • Lining of cavity in partial pulpotomy • Lining of cavity after pulpotomy of deciduous teeth • Endodontic sealer
- 57.
- 58. partial pulpotomy technique •anesthesia,possibly without a vasoconstrictor • rubber dam • superficial disinfection • 1-to 2-mm deep cavity into the pulp using a high-speed hand piece with a sterile diamond bur • If bleeding is excessive, the pulp is amputated deeper until only moderate hemorrhage is seen • excess blood is carefully removed by rinsing with sterile saline and the area is dried with a sterile cotton pellet • 5% NaOCl is recommended to rinse the plural wound • chemical amputation of the blood coagulum • remove damaged pulp cells, dentin chips, and other debris • provide hemorrhage control with minimal damage the normal pulp tissue underneath • do not allow blood clot to develop
- 59. partial pulpotomy technique •1-to 2-mm deep cavity into the pulp • using a high-speed hand piece with a sterile diamond bur • until only moderate hemorrhage is seen • excess blood is carefully removed • 5% NaOCl • do not allow blood clot
- 60. • isolation • removedecay closest to pulp tissue with a new sterilized high speed diamond bur Directions for use
- 62. • isolation • removedecay closest to pulp tissue with a new sterilized high speed diamond bur • rinse thoroughly with 5.25% NaOCl until bleeding stops Directions for use
- 64. • isolation • removedecay closest to pulp tissue with a new sterilized high speed diamond bur • rinse thoroughly with 5.25% NaOCl until bleeding stops • mix Endocem with distilled water and apply a thin layer • remove excess moisture with a sterile cotton pellet, and gently pack it avoid dead space • before Endocem hardens, add the rest of Endocem to filled the cavity Directions for use
- 66. • isolation • removedecay closest to pulp tissue with a new sterilized high speed diamond bur • rinse thoroughly with 5.25% NaOCl until bleeding stops • mix Endocem with distilled water and apply a thin layer • remove excess moisture with a sterile cotton pellet, and gently pack it avoid dead space • before Endocem hardens, add the rest of Endocem to filled the cavity • remove part of the exterior Endocem Directions for use
- 68. • isolation • removedecay closest to pulp tissue with a new sterilized high speed diamond bur • rinse thoroughly with 5.25% NaOCl until bleeding stops • mix Endocem with distilled water and apply a thin layer • remove excess moisture with a sterile cotton pellet, and gently pack it avoid dead space • before Endocem hardens, add the rest of Endocem to filled the cavity • remove part of the exterior Endocem • apply resin Directions for use
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- 72. Precautions • depth andwidth is important
- 73. Precautions • depth :3 mm • width: to cover all dentinal tubule
- 75. Precautions • depth andwidth is important • use undercut in narrow and shallow area
- 76. Precautions • depth andwidth is important • use undercut in narrow and shallow area • After setting is complete, apply a strong stream of water with a 3way syringe check for wash-out
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- 78. #3 direct pulpcapping 42 M 20m #5 direct pulp capping 25 F 30m #2, #14 direct pulp capping 30 M 25m #31 partial pulpotomy 38 F 14m #30 partial pulpotomy 23 F 23m #6,#7,#8,#9,#29 partial pulpotomy 48 F 15m deciduous teeth pulpotomy 8 F 3m,16m,22m endodontic sealer
- 79. #3 direct pulpcapping follow–up (42 male)
- 80. 2012 12 03 20mlater 2013 01 19
- 81.
- 82. 2012 12 03 20mlater
- 83. #5 direct pulpcapping follow– up (25 female)
- 84. 2012 07 31 30mlater
- 85.
- 86. 2012 07 31 30mlater
- 87. #2, #14 directpulp capping follow-up (30 male)
- 88. 2012 09 18 201209 18 25m later
- 89. 20 2012 09 202012 09 27
- 90. 2012 09 18 25mlater 8m later
- 91. 2012 09 18 8mlater 25m later
- 92. #31 partial pulpotomy follow-up (38 female)
- 93. 2005 03 192005 09 28 2007 07 31 48m later
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- 95. 2012 11 22 14mlater
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- 97. #30 Partial pulpotomy follow-upcase (23 female)
- 98. 2013 01 26 201210 13 23m later
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- 102. 2013 05 20 31 201305 20
- 103. 2013 06 28 201305 20 15m later
- 104. 2013 06 12 15mlater
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- 108. 2013 06 04#6,#8
- 109. 2013 06 13#29
- 110. 2013 05 20 15mlater
- 111. 38 2013 05 20 201306 12 15m later
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- 117.
- 118. 2014 10 15 #54 #74 #84 22mlater 16m later 3m later
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- 122. 2014 11 102014 11 18 2014 11 19 2015 02 26
- 123. conclusion • decrease therisk of endodontic treatment • shorten chair time of removing infected dentin • safer material in deciduous teeth pulpotomy than FC • reduce treatment expenses • improve treated tooth’s prognosis
- 124. discussion • long-term follow-up •need to examine cytotoxity and calcinogenicity over longer duration • need to study treating inflamed pulp tissue
- 125.