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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