Resident: Adam J. Bottrill
Date: 20OCT10
Region: Providence
Article title: Diagnosis Dilemmas in Vital Pulp Therapy: Treatment for the Toothache is Changing, Especially in Young, Immature Teeth
Author(s): Camp, Joe DDS MSD
Journal: Pediatric Dentistry
Page #s: 197-205
Date: May/Jun 2008, V30:No3
Major topic: Immature Tooth Vital Pulp Therapy
Minor topic(s): NA
Type of Article: Review of Literature
Main Purpose: Reviews the available literature and current techniques of indirect pulp therapy, pulp capping, and pulpotomy for primary teeth and permanent teeth with open apezx. The apical barrier with mineral trioxide aggregate followed by root strengthening with bonded composite is reviewed.
Key points in the article discussion:
I. General:
A. Most of the diagnostic tests used used with endodontic therapy are of little to no value on primary teeth or immature permanent teeth.
B. Much of our Tx decisions are based on Dx of root development age... therefore it is necessary to have thorough knowledge of the rot development timeline for primary and permanent teeth.
1. Root formation is not completed for 1-4 years after eruption into the oral cavity.
C. Radiographs cannot accurately depict apical closure due to the development of canals in the lingual-facial direstion.
D. During formation and closure, Tx must be oriented at maintaining vitality and allowing the completion of root formation.
II. Dx of Pulpal Status in Primary Teeth.
A. Differentiation between provoked and spontaneous pain is vital.
1. Provoked: deep caries, faulty restorations, soreness around exfoliation and erupting permanent teeth.
2. Spontaneous: extensive degenerative changes extending into the root canals... should NOT receive vital pulp Tx. There may be other evidence of pulpal pathosis as well... mobility, fistula, percussive sensitivity etc...
B. ELECTRIC PULP TESTS ARE NOT VALID ON PRIMARY TEETH.
C. THERMAL TESTS ARE USUALLY NOT CONDUCTED ON PRIMARY TEETH.
D. Radiographic exam is necessary
1. Calcified masses are a sign of advanced pulpal degeneration... Pulpectomization or Extraction.
2. Internal resorption is also associated with extensive inflammation... Extraction.
3. Keep in mind the lucency of the succedaneous follicle.
4. Other obvious pathosis... fracture, abscess, bone fractures etc...
E. Excessive or oddly colored hemorrhage is evidence of excessive inflammation.
F. Studies have shown that trauma LIKELY will result in pulpal necrosis or at least pulpal obliteration (depending on degree of trauma, luxation, mobility etc...)
G. AVULSED PRIMARY TEETH SHOULD NOT BE REIMPLANTED.
H. About half of traumatized primary teeth will undergo discoloration.
1. Correlation of type of color change to pulpal health is controversial and inconclusive.
III. Diagnosis of Pulpal Status in Permanent Immature Teeth
A. Loss of pulp vitality before completion of root formation leaves the tooth MUCH more susceptible to root fracture.
B. Again, a history should be taken WRT history of trauma and type of pain etc...
C. Clinical and radiographic examination MOST important when diagnosing immature permanent teeth.
D. Electric pulp test and thermal test not reliable for immature, open apex teeth... also for children.
E. Electrical and Thermal tests unreliable for traumatized teeth.
F. Laser doppler flowmetry reportedly very reliable to diagnose pulpal vitality.
G. Discoloration also usually indicative of pulpal changes but not completely accurate.
H. There is MUCH better potential for an immature tooth to heal after trauma.
I. If doubtful of diagnosis, DO NOT start treatment. Attempt to allow formation of the root until definitive diagnosis can be made.
J. Lately, MTA and composite resins have been replacing CaOH, pulp cappng and pulpotomy.
K. Vital treatment of teeth with MTA, once considered taboo, is being used much more often in order to allow continued root formation.
L. Revascularization of necrotic pulps has even been reported using combinations of AB's.
M. And of course... he had to mention stem cells.
Assessment of article: Good Summary
Showing posts with label 10/20/10. Show all posts
Showing posts with label 10/20/10. Show all posts
Tuesday, October 19, 2010
Vital Pulp Therapy with New Materials: New Directions and Treatment Perspectives - Permanent Teeth
Resident: Roberts
Date: 10/20/10
Article title: Vital Pulp Therapy with New Materials: New Directions and Treatment Perspectives - Permanent Teeth
Author: Witherspoon, David
Journal: Pediatric Dentistry
Volume: 30:3 pages: 220 - 224
Discussion:
The basic principle of vital pulpal treatment an be broken down in to two phases. The initial phase involves removing the diseased and bacterially contaminated tissue. The second phase involves establishing an environment that will prevent any further and future bacterial contamination. Calcium Hydroxide has been advocated as the material of choice for various forms of vital pulp therapy, but recently MTA has received a lot of attention as a potential replacement because of its ability to kill bacteria, induce mineralization and establish a tight bacterial seal.
MTA is composed of tricalicum silicate, bismuth oxide, dicalcium silicate, tricalcium aluminate, calcium sulfate and may contain other trace particles. It has a compressive strength equal to that of IRM and has been shown to have antibacterial effects on facultative but not anaerobic bacteria. Its ability to prevent long term leakage appears to be high and better than amalgam or IRM.
Compared with Calcium hydroxide, in animal studies, MTA consistently induces the dentin at a greater rate with superior structural integrity. There seems to be a greater effect of dentinal bridging, minimal effect on pulpal inflammation, and nominal hyperemia. The process by which this happens is not fully understood but it has been suggested that the tricalcium oxide reacts with the tissue fluids to form calcium hydroxide and works in a similar way as does strait calcium oxide.
Various studies have shown that the potential for success is higher than that of Ca. hydroxide. In one such study, MTA was assessed as a medicament for direct pulp cap therapy and proved to have a 98% success rate. In another study, where pulpotomies were assessed using MTA as its choice of medicament, it showed a lower percentage of failures than other techniques being applied. In short MTA is a good substitute for calcium hydroxide and would be an acceptable choice for replacement and may be desired where teeth are immature and root development is dependent and pulpal vitality.
Assessment: Good article, resonated with other studies that we have all read and heard about.
Monday, October 18, 2010
Guideline on Pulp Therapy for Primary and Young Permanent teeth
Department of Pediatric Dentistry
Resident’s Name:Murphy Program:Lutheran Medical Center - Providence
Article title: Guideline on Pulp Therapy for Primary and Young Permanent teeth
Author(s): Pulp therapy Subcommittee
Journal: Pediatric Dentistry Clinical Guidelines
Year. Volume (number). Page #’s: 2004
Major topic: Pulp therapy
Main Purpose: Describe the diagnosis of pulp pathosis and set forth the indication, objectives, and medications for pulp therapy in primary and young permanent teeth.
Overview of method of research: MEDLINE search for pulpotomy, pulpectomy, IPT, stepwise excavation, pulp therapy, pulp exposure, calcium hydroxide, formocresol, ferric sulfate, and glass ionomer.
Findings:
The primary objective of pulp therapy is to maintain the integrity and health of the teeth and the supporting tissues. Vitality is best if possible (duh), however non vital teeth can remain clinically functional. Every treatment plan, regardless of the tooth should include the patients medical history, the value of each tooth involved with regards to the child’s development, alternatives to pulp treatment, and restorability of the tooth. When all treatment options fail, bony support cannot be regained, there is not enough tooth structure left for a restoration, there is resorption, or complications, extraction should be considered.
Apexification, reimplantation, and post and cores are not indicated for primary teeth.
All pulpal therapy should be completed w/ RDI to minimize bacterial contamination of the site.
Primary Teeth
Vital Tx
Protective Base-Material placed on the pulpal surface of a prep covering exposed dentin tubules, acting as a barrier between the restorative material or cement and the pulp, sealed restoration.
Indications- Normal vital pulp, all caries removed
Objectives- Preserve vitality, promote pulp tissue healing and tertiary dentin formation, minimized micro-leakage, have no post op sensitivity.
IPT-Deep carious lesion close to the pulp is covered by a biocompatible material to stimulate healing and repair, sealed restoration.
Indications-Either normal or reversible pulpitis, deepest carious dentin is not removed to avoid exposure.
Objectives- Preserve vitality, promote pulp tissue healing, form a complete restorative seal, have no post op sensitivity, no evidence of resorption, no harm to permanent successor.
Direct Pulp Capping-Small mechanical exposure during prep or following traumatic injury to tooth is covered with Calcium Hydroxide, sealed restoration.
Indications- Normal pulp following small mechanical exposure of trauma when conditions are optimal. Direct pulp capping of carious exposed primary teeth is not indicated
Objectives- Preserve vitality, promote pulp tissue healing, form a complete restorative seal, have no post op sensitivity, no evidence of resorption, no harm to permanent successor.
Pulpotomy-Deep carious lesion adjacent to pulp is excavated, radicular pulp is left, treatment with formo, ferric, or electrocautery to preserve radicular pulp health, pulp chamber is filled, tooth sealed with restoration.
Indications-Carious pulp exposure with normal or reversible pulpitis, or after traumatic exposure.
Objectives-Maintain radicular pulp health, form a complete restorative seal, have no post op sensitivity, no evidence of resorption, no harm to permanent successor.
Non Vital Teeth
Pulpectomy- Irreversible pulpitis or necrotic pulps is removed and filled with resorbable material such as zinc oxide eugenol, restored with sealed restoration.
Indications- Irreversible pulpitis or necrotic pulps
Objectives-symptomes should resolve in 1-2 weeks, infectious process should resolve in +/- 6 months, radiographic evidence of no over/under filliing, no resoprtion, no harm to permanent successor.
Young Permanent Teeth
Vital Teeth
For Protective base, IPT see above.
Direct Pulp Capping
Same as for primary teeth except that a small carious exposure can be treated with DPC.
Partial Pulpotomy
Indications-small (<2mm) carious exposure in which enflamed tissue beneath the exposure is removed at a depth of 1-3mm, or until healthy tissue is reached. Bleeding must be controlled within 1-2 min and the site should be covered with CaOh or MTA, sealed with rest.
Objectives- Preserve vitality, promote pulp tissue healing, form a complete restorative seal, have no post op sensitivity, no evidence of resorption or canal calcification or periradicular radiolucency, tooth should continue to develop normally.
Cvek Pulpotmy
Same treatment for partial pulpotomy except it is indicated for traumatic exposures.
Apexogenesis (root formation)
Vital pulp procedure that allows the continued physiological development and formation of the roots apex by use of the treatment previously described .
Pulpectomy(Conventional RCT)
Indications- Traumatized, infected, exposed, or necrotic fully formed teeth. Entire pulpal tissue is debrided, irrigated, canal is shaped, obturation with non restorable filling material.
Objectives- symptoms should resolve in 1-2 weeks, infectious process should resolve in +/- 6 months, radiographic evidence of no over/under filling, no resoprtion, no further breakdown of periradicular tissue.
Apexification
Indications-Incompletely formed non vital tooth. Coronal and no vital tissue is removed just short of the root end, CaOh or MTA is placed. Once an apical closure is obtained RCT should be completed.
Objectives-Induce root end closure, no resoprtion, no further breakdown of periradicular tissue.
Key points/Summary:
Apexification, reimplantation, direct pulp capping of a carious pulp exposure, and post and cores are not indicated for primary teeth.
All pulpal therapy should be completed w/ RDI to minimize bacterial contamination of the site.
Assessment of Article: This article was tough to “summarize” as it is itself a summary of ALL pulpal tx. Good guideline overall. We should all know this stuff backwards and forwards.
Resident’s Name:Murphy Program:Lutheran Medical Center - Providence
Article title: Guideline on Pulp Therapy for Primary and Young Permanent teeth
Author(s): Pulp therapy Subcommittee
Journal: Pediatric Dentistry Clinical Guidelines
Year. Volume (number). Page #’s: 2004
Major topic: Pulp therapy
Main Purpose: Describe the diagnosis of pulp pathosis and set forth the indication, objectives, and medications for pulp therapy in primary and young permanent teeth.
Overview of method of research: MEDLINE search for pulpotomy, pulpectomy, IPT, stepwise excavation, pulp therapy, pulp exposure, calcium hydroxide, formocresol, ferric sulfate, and glass ionomer.
Findings:
The primary objective of pulp therapy is to maintain the integrity and health of the teeth and the supporting tissues. Vitality is best if possible (duh), however non vital teeth can remain clinically functional. Every treatment plan, regardless of the tooth should include the patients medical history, the value of each tooth involved with regards to the child’s development, alternatives to pulp treatment, and restorability of the tooth. When all treatment options fail, bony support cannot be regained, there is not enough tooth structure left for a restoration, there is resorption, or complications, extraction should be considered.
Apexification, reimplantation, and post and cores are not indicated for primary teeth.
All pulpal therapy should be completed w/ RDI to minimize bacterial contamination of the site.
Primary Teeth
Vital Tx
Protective Base-Material placed on the pulpal surface of a prep covering exposed dentin tubules, acting as a barrier between the restorative material or cement and the pulp, sealed restoration.
Indications- Normal vital pulp, all caries removed
Objectives- Preserve vitality, promote pulp tissue healing and tertiary dentin formation, minimized micro-leakage, have no post op sensitivity.
IPT-Deep carious lesion close to the pulp is covered by a biocompatible material to stimulate healing and repair, sealed restoration.
Indications-Either normal or reversible pulpitis, deepest carious dentin is not removed to avoid exposure.
Objectives- Preserve vitality, promote pulp tissue healing, form a complete restorative seal, have no post op sensitivity, no evidence of resorption, no harm to permanent successor.
Direct Pulp Capping-Small mechanical exposure during prep or following traumatic injury to tooth is covered with Calcium Hydroxide, sealed restoration.
Indications- Normal pulp following small mechanical exposure of trauma when conditions are optimal. Direct pulp capping of carious exposed primary teeth is not indicated
Objectives- Preserve vitality, promote pulp tissue healing, form a complete restorative seal, have no post op sensitivity, no evidence of resorption, no harm to permanent successor.
Pulpotomy-Deep carious lesion adjacent to pulp is excavated, radicular pulp is left, treatment with formo, ferric, or electrocautery to preserve radicular pulp health, pulp chamber is filled, tooth sealed with restoration.
Indications-Carious pulp exposure with normal or reversible pulpitis, or after traumatic exposure.
Objectives-Maintain radicular pulp health, form a complete restorative seal, have no post op sensitivity, no evidence of resorption, no harm to permanent successor.
Non Vital Teeth
Pulpectomy- Irreversible pulpitis or necrotic pulps is removed and filled with resorbable material such as zinc oxide eugenol, restored with sealed restoration.
Indications- Irreversible pulpitis or necrotic pulps
Objectives-symptomes should resolve in 1-2 weeks, infectious process should resolve in +/- 6 months, radiographic evidence of no over/under filliing, no resoprtion, no harm to permanent successor.
Young Permanent Teeth
Vital Teeth
For Protective base, IPT see above.
Direct Pulp Capping
Same as for primary teeth except that a small carious exposure can be treated with DPC.
Partial Pulpotomy
Indications-small (<2mm) carious exposure in which enflamed tissue beneath the exposure is removed at a depth of 1-3mm, or until healthy tissue is reached. Bleeding must be controlled within 1-2 min and the site should be covered with CaOh or MTA, sealed with rest.
Objectives- Preserve vitality, promote pulp tissue healing, form a complete restorative seal, have no post op sensitivity, no evidence of resorption or canal calcification or periradicular radiolucency, tooth should continue to develop normally.
Cvek Pulpotmy
Same treatment for partial pulpotomy except it is indicated for traumatic exposures.
Apexogenesis (root formation)
Vital pulp procedure that allows the continued physiological development and formation of the roots apex by use of the treatment previously described .
Pulpectomy(Conventional RCT)
Indications- Traumatized, infected, exposed, or necrotic fully formed teeth. Entire pulpal tissue is debrided, irrigated, canal is shaped, obturation with non restorable filling material.
Objectives- symptoms should resolve in 1-2 weeks, infectious process should resolve in +/- 6 months, radiographic evidence of no over/under filling, no resoprtion, no further breakdown of periradicular tissue.
Apexification
Indications-Incompletely formed non vital tooth. Coronal and no vital tissue is removed just short of the root end, CaOh or MTA is placed. Once an apical closure is obtained RCT should be completed.
Objectives-Induce root end closure, no resoprtion, no further breakdown of periradicular tissue.
Key points/Summary:
Apexification, reimplantation, direct pulp capping of a carious pulp exposure, and post and cores are not indicated for primary teeth.
All pulpal therapy should be completed w/ RDI to minimize bacterial contamination of the site.
Assessment of Article: This article was tough to “summarize” as it is itself a summary of ALL pulpal tx. Good guideline overall. We should all know this stuff backwards and forwards.
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