1. Describe definition, rationale and goal of apexogenesis in young permanent teeth.

- Young permanent teeth are those recently erupted teeth in which normal apical physiological root
closure has not occurred (2-3 years after eruption)

- The proliferation and differentiation of various cells are activated in the apical region of young tooth to
make it complete

Definition

- Apexogenesis is defined as the treatment of a vital pulp by capping or pulpotomy in order to permit
continued growth of the root and closure of the open apex

Rationale

- Maintainance of integrity of the radicular pulp tissue to allow continued root growth

- Root end development occurs in a tooth with a normal pulp and minimal inflammation

- Revascularization and repair occurs more efficiently in tooth with an open apex

- Poor long term prognosis of an endodontically treated immature teeth

- Relative thin in obturated canals of immature roots and open apex are prone to fracture

Goal of apexogenesis

- Sustaining a viable Hertwig’s heath to allow continued development of root length for a favorable
crown- root ration

- Maintaining pulp vitality to help maturation of root

- Promoting root-end closure to create a natural apical constriction

- Generating a dentinal bridge at the site of pupotomy

2. Describe definition, indications, contraindications, procedure of indirect pulp capping.

 Definition:
o Indirect pulp capping is defined as a procedure where in small amount of carious dentin
is retained in deep areas of cavity to avoid exposure of pulp, followed by placement of a
suitable medicament and restorative material that seals off the carious dentin and
encourages pulp recovery.(Ingle).
o A procedure in which only the gross caries is removed from the lesion and the cavity is
sealed for a time with a biocompatible material (McDonald).
 Indications:
o History: Mild pain associated with eating, negative history of spontaneous, extreme
pain.
o Clinical: Deep carious lesion, which are close to, but not involving the pulp in vital
primary or young permanent teeth. No mobility. Pulp inflammation is nominal and there
is a definite layer of affected dentin after removal of infected dentin.
 o Radiograph: Normal lamina dura and PDL space. No radiolucency in the bone around the
apices of the roots or in the furcation.
 Contraindications:
o History: Sharp, prolonged spontaneous pain particularly at night.
o Clinical: Tooth mobility. Discoloration. Electric pulp test: Negative reaction.
o Radiograph: Definite pulp exposure. Interrupted lamina dura. Radiolucency about the
apices of the roots. Widened periodontal ligament space.
 Procedure:
o Local anesthesia and rubber dam isolation.
o Establish cavity outline with high-speed handpiece
o Remove all infected dentin.
o Stop the excavation when reach to the sound dentin( a firm resistance of sound dentin
is felt)
o Cavity flushed with saline and dried with cotton pellet.
o Cover the entire floor with CaOH2, MTA hoặc Biodentine
o Build-up with GIC
o Final restoration( SSC or pre-fabricated ceramic crown…)
o Follow –up: Lack of pain or inflammatory response, pulp vitality. X- ray: New dentin
formation.

3. . Describe definition, indications, contraindications, procedure of direct pulp capping.

o Definition:
It is defined by Kopel (1992) as the placement of a medicament or nonmedicated
material on a pulp that has been exposed in course of excavating the last portions of
deep dentinal caries or as a result of trauma.
o Indications:
 Small mechanical exposure surrounded by sound dentin in asymptomatic vital
primary teeth or young permanent teeth.
 Exposure should have bright red hemorrhage that is easily controlled by dry
cotton pellet with minimal pressure.
 True pin point exposure
o Contraindications:
 Severe toothache at night
 Spontaneous pain
 Tooth mobility
 Radiographic appearance of pulp, periradicular degeneration.
 Excess of hemorrhage at the time of exposure
 Serous exudate from the exposure
 External/internal root resorption
 Swelling/fistula
o Procedure:
 Isolation with rubber dam.
 Cavity irrigation with saline or distilled water.
 Hemorrhage is arrested with light pressure from sterile cotton pellets.
 Place biomaterial on the exposed pulp with minimal pressure to avoid pushing
the material into pulp chamber.
 Build-up with GIC.
 Final restoration (SSC/ pre-fabricated ceramic crown…)
 Follow-up: Clinical: lack of pain, minimal inflammatory response, pulp vitality. X-
ray: Dentinal bridge presentation.