Pulp Therapy in Pediatric Dentistry

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Differences
Pulp – Dentin Complex
 Zones of pulp
• Odontoblastic zone
• Cell free zone
• Cell rich zone
• Pulp proper
N
Responses of the Primary Pulp
• Responses to Caries
• Responses to dental procedures
• Responses to Trauma
 Responses to caries
• Size of the dentinal tubules
• Proximity of the pulp horns
• Greater chance of pulpal involvement
• Larger pulp chamber, increased size of
tubules, thin canals
• Furcal Abscess
Pulp reaction to dental caries
Reaction to operative
procedures
 Goals
• Successful treatment of the cariously
involved pulp, allowing the tooth to remain
in the mouth in a nonpathologic state
• Maintenance of arch length and tooth
space
• Restoration of comfort and the ability to
chew
• Prevention of speech abnormalities and
abnormal habits
 The factors which influence the
success of pulp therapy are:
• Type and amount of pulpal hemorrhage
• Depth of penetration of bacteria from the
carious process into the pulpal tissue I
• Speed of carious attack on the pulp
 Diagnosis
• Visual and tactile examination of carious dentin and
associated periodontium
• Radiographic examination of
a. Periradicular and furcation areas
b. pulp canals
c. Periodontal space
Er
d. Developing succedaneous teeth

I
 Diagnostic signs
• History of spontaneous unprovoked pain
• Pain from percussion
• Pain from mastication sidesthiidamobity
pathlogial Myers
• Degree of mobility Norma w seer carires Badly
mobity
pathological
physiognomy
• Palpation of surrounding soft tissues
• Size, appearance, and amount of
hemorrhage associated with pulp
exposures
c
 Diagnosis
• Clinical Assessment
IN
History 503 of diagnosis
Clinical signs
• Clinical examination
• Radiographic examination
• Operative diagnosis
no
provoked
Toothw caries
 Radiographic Assessment
• Extent of Carious Process

a
caries
• Calcified Bodies (Pulp Stones)
• Bone Radiolucency
• Root Resorption

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 Tx depand of Depth of caries
Types of pulp therapy
• Indirect pulp capping
• Direct Pulp Capping onlyin Perment
Think about
• Pulpotomy conservite
I
• Pulpectomy
• Pulp therapy for the young permanent
teeth
nonfat Indirect Pulp Therapy
petyoom No peri apical change
• Indicated when a deep carious lesion is
encroaching on, but not actually into, the
pulp.
• Single step or two step
to u with pain
patient come
when drinking cold well 31
on examiner 7 yes compling pain
on occlusal
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prove x x rays superfalcers
verydeep caries reening No pathelgial
To save pulp Bez Yong Change
permat has 4 capacity of heeling

Procedure
• CaOH2 or MTA or Glc
• Action
• Dentin Bridge formation
• Antimicrobial
• High pH

Just Remove soft Dentien

 Objectives
• reverse the bacterial invasion
• treat the carious dentin
• maintain a normal and healthy pulp
i
 Indications
• Type of pain Proveked Peremenat

• Clinical Evaluation
• Radiographic:

O
Tooth restored with ZOE or amalgam

Restoration

Protective base

Calcium hydroxide
 Not in primary teeth
Direct Pulp Capping
• Objectives
• Not in Primary teeth
• Internal Resorption
No Radiographic
AN operiapral No furation
 PULP THERAPY
 GOALS:
 Retain the tooth free of infection
 Biomechanically cleanse and obturate root canals
 Promote physiologic root resorption
 Maintenance of arch length and tooth space
 Hold space for erupting permanent tooth
 Restoration of comfort with ability to chew
 Prevention of speech abnormalities
 Prevention of abnormal habits

To eliminate infection and retain the tooth in a functional

state until it is normally exfoliated, without endangering
the permanent dentition or health of child
Case
pain
Provoked
Pulpotomy
primaryTooth wi very deepcaries
reaching pulp nos paina noaincalergraphic
pontius
crane

• Defined as the amputation of the cornal

portion of the pulp and the placement of a
medicament so as to preserve the vitality
of the radicular pulp.
 Indications Shadow of put

• Teeth: primary teeth

• Pain history: no extremes Provoked

• Clinically:
no abscess/fistula
no extreme mobility
large carious lesion
Mobity
Nopain on percation
M 9 A

thirty
 Materials Used
Carcinogenic
• Formocresol formotwater

• Ferric Sulfate Sent

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if
•
•
Gluteradldehyde
MTA Best But isvery expensive
• Bone Morphogenetic Protein
• Electrocoagulation
JNotased
• Lasers
 Formocresol
• 35% Cresol, 19% Formalin in aqueous
glycerine
• acts by direct contact
O
• 1/5 dilution produces equivalent results
as full strength
Yaron
X
 Mechanism of Action
J
Fixation
• Formocresol acts by
direct contact
2
• Three zones in
radicular pulp
• fixation
• coagulation necrosis q first Zone
• vital tissue of Radialorpulp
is fixation Zon
Zend Zone zone ofinflowetion
Armamentarium
LA
Step 1 Administer Local
Anesthesia

LA
Step 2 Isolate tooth with rubber
Dam
Step 3- Remove Caries and
dentermine site of exposure
us
RemovefromWall

my bib em

O wat
Step 4- De-roof the pulp
chamber
Round diamond Bar
punch of
Step 5- Remove coronal Pulp
by spÉ Ii spit
not
speed
high
Visualize the radicular pulp
 Step 6- Place a formocresol
Cotton with
11M18 pellet for 5 minutes Water saline
or
3 a formocrosol

PRETTY
Step 7- Check the radicular
stumps if hemorrhage has
stopped
Fill the pulp chamber with ZnOE
severeBleeding
pypectomy orextraction
Procedure
 bi 99
g
is Pulpectomy
É
oblerdapet

1 am
• Is the complete extirpation of the pulp
followed by the placement of an inert,
resorbable material in the pulp space
Indications
• Infected radicular
pulp.

• Necrotic pulp
• Furcal
Radiolucency

• Presence of an
abscess

Apex locator on

primary teeth give

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Ete
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 Contraindications
– A non-restorable tooth

– A tooth with a mechanical

or carious perforation of
the floor of the pulp
chamber

– Pathologic loss of bone

support resulting in loss
of the normal periodontal
attachment
– Pathologic root resorption
involving more than one-
third of the root
– The presence of a
dentigerous or follicular
cyst
– Radiographically visible
internal root resorption
 Technique
• Step 1 : Isolation with rubber dam
Step 2 remove caries and identify site
of exposure
Step 3- Deroof the pulp
chamber
Step 4 : The working length X ray(optional)
beganfrom
size 15K
ZO K
25 K
301
Step 5 – pulp extirpation and cleaning the
canals
Step 6: dry the canals with paper points and
place formocresol
Step 7 - Obturation-

Cao't t idoform
Lefty Ati f
Abass and I AntiBiot

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it irrevisble
 Fill the chamber with cement and
restore with a stainless steel crown
Postoperative Radiograph
j
DIFFERENT TREATMENT MODALITIES

Pulp not exposed INDIRCT PULP CAPPING

Pulp exposed DIRECT PULP CAPPING

on permentonly

Infection confined to pulp chamber PULPOTOMY

Any signs of Periapical

PULPECTOMY
inflammation or abscess
 Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy--
• Criteria for an ideal pulpectomy obturant
(treatment paste)

– Antiseptic
– Resorbable
– Harmless to the adjacent tooth germ
– Radiopaque
– Non-impinging on erupting permanent tooth
– Easily inserted
– Easily removed
 Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy--
• Evaluation of Success

– Asymptomatic
– Radiographic absence of pathology
– Continued root development
– Hard tissue barrier at apex
– Responsive pulp
 Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy--
• In Review. . .