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8/6/2019 Pulpal Therapy Handout
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Pulpaltherapy
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CariousLesionProducingPain
Spontaneous
Nocturnal
Prolonged
IRREVERSIBLE
Extrac=onNonvitalPulpTherapy
Thermal
Induced
IntermiAent
REVERSIBLE
VitalPulpTherapy
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CandidatesforVitalPulpTherapy
Cariousortrauma=cpulpexposure Transitorypain Normalso=ssues Nopercussionsensi=vity Con=nousligamentspace Nofurcalinvolvement Lessthan1/3physiologicalrootresorp=on Toothisrestorable
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VitalPrimaryToothTherapyOp=ons
Indirectpulptreatment Directpulpcapping Pulpotomy
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IndirectPulpTreatment
Indica=ons:deepcariouslesion,vitalpulp,restorabletooth
Objec=ves:arrestcariesadvance,allowforma=onofter=aryden=n,preservevitality Technique:excavatemostofthecaries. *musthavesoundmargins*andnopulpalexposure
Restora=onmustsealcompletely!!!!
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IPCTechnique
Indica=on:asymptoma=cteethonly! Incompleteexcava=onofcariesleavealayerofleatheryden=n,12mm.
Layerofglassionomer Musthaveagoodseal Re-evaluateevery6monthswitharadiograph
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DirectPulpCap
26%CaOH HighpH(>11)Protectspulp
Supportsforma=onofsecondaryden=ne
radiopaque
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MTasapulpcap
BeAersuccessratethanCaOH
Cementcomposedoftricalciumsilicate,
dicalciumsilicate,tetracalciumaluminoferrite,calciumsulfate,andbismuthoxide
Mixedwithwater 4hourstosetNairetal,2009
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PulpotomyMedicamentOp=ons
Formocresol FerricSulfate MineralTrioxideggregate
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FormocresolPulpotomytheGold
StandardBuckleysFormocresol19%formaldehydeand35%cresoland15%glycerininawaterbase
35minuteapplica=onResultsin3zones1 Fixa=on(coronal1/3)2 trophy(middle1/3)3 Inflamma=on(apical1/3)6297%successusedsince1904
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FerricSulfate
15.5%FSinanaqueousbasepH1 Hemosta=c ggressiveinflammatoryreac=on pplica=on=me1015seconds Mustwashawaythecoagulumtodecreasechanceofresorp=on
Bonus:resorp=onwithoutpain
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SummaryMechanismofc=on
Formocresoldenaturespulpal=ssue,rendering
itinert
FerricSulfateformsaclotbarrierpreservingthe
deeper=ssue
MTleadstopulpalhealingbyforminga
den=nalbridge
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MethodforPulpotomy
PreparetoothforStainlesssteelcrown Removemajorityofcariesbeforeenteringthepulpchamber
Removetheroofofthepulpchamberwithawideaccess
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CandidatesforNonVitalPulpTherapy
orExtrac=on Cariousortrauma=cpulpexposure SpontaneouspainPersistentpain
Inflamedso=ssueie.Parulisorpustule Percussionsensi=vity Widenedordiscon=nuousligament Furcalinvolvement Externalorinternalrootresorp=on
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SignsandSymptomsofIrreversible
Pulpi=s 1.inabilitytoachievehemostasisaercoronalpulpamputa=onornobleedingaer
exposureofcoronalpulp.
2.thepresenceofanyswelling(duetoinfec=on),fistula,orradiographicevidenceof
pathologicalperiapicalboneresorp=on.
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LSTRforprimaryteeth
LSTRlesionsteriliza=onand=ssuerepair
Usedforendodon=ctreatmentofprimary
teethwithirreversiblepulpi=s.
nalterna=vetopulpectomy.
Suppliedinliquidform.
combina=onofmetronidazole3%,ciprofloxacin1%,andminocycline3%in
propyleneglycolandpolyglycol
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MethodforLSTR
1) Completepulpotomywithoutex=rpa=ngthepulpcanals.
2) Flushwithchlorhexidinegluconate.3) Mix1dropofthean=bio=cliquidwith1scoopIRMpowder.
4) PlacemixtureattheboAomofthepulpchamber.
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Indica=onsforPulpectomy
Chronicinflamma=onornecrosisintheradicularpulp.
Effortstoretainthetoothbyendodon=ctherapyshouldbemadetomaintainesthe=csandfunc=on.
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Contraindica=ons
Extremelossofcoronaltoothstructuremakingfuturerestora=ondifficult
dvancedinternaland/orexternalrootresorp=on Periapicalinfec=oninvolvingthecryptofthesuccedaneoustooth
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ChoiceofPulpectomyFillingMaterials
Zincoxideandeugenolresistancetoresorp=on
Iodoformpasteresorbableandhavelong-las=ngan=bacterialproper=es CH CH/iodoformpaste(Vitapex,Calcimol*)
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VitalPrimaryRootCanalTherapy
orPulpectomy Technique:eradicatetheradicularpulp,irrigatewithNaOH,obturatewithresorbable
cement(IEViatpex:iodoformandCaOHina
glycerinbase),sealrestora=oncompletely
fullcoverage!!!
Technicallyverydifficult Very=meconsuming