Vital pulp therapy
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This document discusses different types of vital pulp therapy including indirect pulp capping, direct pulp capping, pulpotomy, apexogenesis, apexification, and revascularization. It provides definitions, indications, contraindications, techniques, and criteria for success or failure for each procedure. The document also includes examples of cases and references an endodontist, Dr. Ashraf Refai, who specializes in these types of vital pulp therapies.
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Vital pulp therapy
- 1. AshrafRefaiSamirBDS MSc DD HMD Associate Professor of Endodontics Al-Azhar University ashraf_refai@hotmail.com Ashraf Samir Refai www.arefai.edublogs.org www.idclinics.com +201001434323
- 2. Vital PulpTherapy Dr. Ashraf Refai (BDS MSc DD HMD) Associate Professor of Endodontics ashraf_refai@hotmail.com
- 3. DifferentTypes of Vital PulpTherapy Indirect pulp capping Direct pulp capping Pulpotomy
- 4. Indirect Pulp Capping ✤ Definition “Technique to avoid pulp exposure in teeth with deep carious lesions” ✤ Theory ✤ Outer infected layer ✤ Deeper affected layers ✤ Sedative dressing
- 5. Indirect Pulp Capping ✤ Indications ✤ Minimal pulp inflammation ✤ Complete removal could cause exposure ✤ Contraindications ✤ Teeth with history of pain ✤ Teeth with inflamed pulp or periapical disease
- 6. Indirect Pulp Capping ✤ Capping agents ✤ Ca(OH)2 ✤ Zinc Oxide & Eugenol ✤ Technique
- 7. Indirect Pulp Capping Re-Entry ✤ Caries color changes from deep red to light grey ✤ Caries texture changes from spongy wet to hard ✤ Radiograph: Deposition of reparative dentin ✤ Clinically: Asympotmatic
- 8. DifferentTypes of Vital PulpTherapy Indirect pulp capping Direct pulp capping Pulpotomy
- 9. Direct Pulp Capping ✤ Definition “Application of medicament on exposed pulp in an attempt to preserve vitality” ✤ Objective To activate healthy pulp to initiate dentin bridge to “Wall off” the exposure site
- 10. Direct Pulp Capping ✤ Indications ✤ Accidental mechanical exposure “Trauma” ✤ Exposure caused by removal of caries Case by Dr. Domenico Ricucci MD DDS
- 11. Direct Pulp Capping ✤ Contra-indications ✤ History of pain ✤ A lot of bleeding ✤ Periapical pathosis ✤ Primary teeth with carious exposure ✤ Aged dental pulp
- 12. Direct Pulp Capping Criteria for Selection ✤ Minute pulp exposure surrounded by sound dentin ✤ Asymptomatic ✤ Vital pulp ✤ Controllable hemorrhage ✤ Absence of spontaneous pain (irreversible pulpitis)
- 13. Direct Pulp Capping ✤ Technique
- 14. Direct Pulp Capping Criteria for Succes ✤ Clinically: ✤ Pulp is vital ✤ Tooth is asymptomatic ✤ No sinus tract ✤ Radiographically: No periapical changes Formation of dentin bridge alone is not indicative of success
- 15. Direct Pulp Capping Historically ✤ Corticosteroids & Antibiotics ✤ Isobutyl cyanoacrylate ✤ Polycarboxylate cement ✤ Zinc Oxide Eugenol ✤ Tricalcium phosphate & hydroxyapatite Currently ✤ Ca(OH)2 ✤ Mineral Trioxide Aggregate (MTA) Pulp Capping Agents
- 16. DifferentTypes of Vital PulpTherapy Indirect pulp capping Direct pulp capping Pulpotomy
- 17. Pulpotomy ✤ Indications ✤ Young permanent teeth (Immature apex) ✤ Deciduous teeth (with coronal pulp inflammation) ✤ Emergency treatment for permanent teeth (Not definitive treatment)
- 18. Pulpotomy Criteria for Selection ✤ Pulp exposed ✤ Vital pulp ✤ No pain on percussion ✤ Absence of periapical lesion ✤ Controllable hemorrhage (3-4 min)
- 19. Pulpotomy ✤ Radiographically: ✤ Periapical lesion ✤ Incase of deciduous (no bone separating successor & roots resorbed) ✤ Contra-indications ✤ Clinically: ✤ Spontaneous pain ✤ Swelling or fistula ✤ Uncontrollable hemorrhage ✤ Purulent exudate ✤ Non-restorable tooth
- 20. Pulpotomy ✤ According to level of pulp amputation ✤ Shallow (Cvek pulpotomy) ✤ Deep pulpotomy Classification
- 21. Pulpotomy ✤ According to type of dentition ✤ Deciduous teeth ✤ Young permanent teeth (open apex) ✤ Permanent teeth (emergency) Classification
- 22. Pulpotomy ✤ According to capping material used ✤ Ca(OH)2 ✤ MTA ✤ Formocresol ✤ Glutaraldehyde Classification
- 23. Pulpotomy ✤ According to method of pulp amputation ✤ A bur ✤ Spoon excavator ✤ Electro-surgery ✤ Laser Classification
- 25. Pulpotomy ✤ Radiographically: ✤ Periapical lesion ✤ Internal resorption ✤ Calcifcation ✤ Clinically: ✤ Spontaneous pain ✤ Swelling ✤ Discoloration Criteria for Failure
- 26. DifferentTypes of Vital PulpTherapy Indirect pulp capping Direct pulp capping Pulpotomy
- 27. Management ofTeeth with Open Apices Dr. Ashraf Refai (BDS MSc DD HMD) Lecturer of Endodontics ashraf_refai@hotmail.com
- 29. Apexifcation ✤ Definition “It is the procedure by which apical closure is induced at the apex of an immature tooth”
- 30. Historical Alternative… CR RatioWeak root walls Difficulty in dealing with children
- 32. Apexification Periodic Recall (Every 3 months) ✤ Apical closure between 6-24 months ✤ Success is judged radiographically ✤ Clinical testing could perforate the barrier (done with care) ✤ If no closure re-application of Ca(OH) 2 ✤ With MTA re-entry not required
- 34. Apexifcation ✤ Histology ✤ Calcific material “cementoid” or “osteoid’ in nature forms and covers the apical foramen ✤ Not from the root sheath of hertwig x
- 35. Irregular space difficult to obturate (Thermoplasticized GP) Thin root thickness (Posts & reinforcement)
- 36. “Weak root structure sometimes makes restoration impossible even after apical closure”
- 37. Regenerative Endodontics (Revascularization) ✤ Definition They are “Biologically-based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as cells of the pulp-dentin complex.”
- 38. Revascularization ✤ 1st Visit: ✤ Root canal preparation (Light preparation) ✤ Triple antbiotic paste application (Mitronidazole, Ciprofloxacin & Monocyline) ✤ Coronal Seal (Not with temporary filling ✤ 2nd Visit: (4 weeks) ✤ Initiation of blood clot ✤ Application of MTA in end of coronal third on clot ✤ Coronal seal (Permanent filling) Technique
- 42. AshrafRefaiSamirBDS MSc DD HMD Associate Professor of Endodontics Al-Azhar University ashraf_refai@hotmail.com Ashraf Samir Refai www.arefai.edublogs.org www.idclinics.com +201001434323