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Pulp Therapy in Pediatric Dentistry

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Pulp Therapy in Pediatric Dentistry ... in Pediatric Dentistry --Vital Pulp Therapy-- Permanent Tooth Pulpotomy Objectives Maintain vitality of radicular ... – PowerPoint PPT presentation

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Title: Pulp Therapy in Pediatric Dentistry


1
Pulp Therapy in Pediatric Dentistry
  • Dr. S.E.Jabbarifar
  • Pediatric Dentistry
  • Department Isfahan Dental School

2
Pulp Therapy in Pediatric Dentistry--Vital Pulp
Therapy--
  • Permanent Tooth Pulpotomy
  • Objectives
  • Maintain vitality of radicular pulp
  • Achieve root-end closure (Apexogenesis)
  • Eliminate need for apicoectomy
  • Facilitate GP obturation with apical stop

3
Pulp Therapy in Pediatric Dentistry--Vital Pulp
Therapy--
  • Permanent Tooth Pulpotomy Agents
  • Formocresol

4
Pulp Therapy in Pediatric Dentistry--Non-Vital
Pulp Therapy--
  • Objectives of Non-Vital Pulp Treatment (Primary
    Teeth)
  • Maintain tooth free of infection
  • Achieve biomechanical cleansing and canal
    obturation
  • Promote physiologic resorption
  • Maintain space and function

5
Pulp Therapy in Pediatric Dentistry--Non-Vital
Pulp Therapy--
  • Non-Vital Pulp Treatment (Primary Teeth)
  • Choices
  • Pulpectomy (most are partial due to anatomy)
  • Extraction

6
Pulp Therapy in Pediatric Dentistry--Non-Vital
Pulp Therapy--
  • Pulpectomy Indications/Considerations
  • Strategic importance of tooth (2nd primary molar
    with unerupted 6-yr molar)
  • Sufficient remaining tooth structure
  • Poor chance of vital pulp treatment success
  • Adequate remaining root
  • Cooperative patient

7
Pulp Therapy in Pediatric Dentistry--Non-Vital
Pulp Therapy--
  • Pulpectomy Contraindications
  • A non-restorable tooth
  • A tooth with a mechanical or carious perforation
    of the floor of the pulp chamber
  • Pathologic root resorption involving more than
    one-third of the root
  • Pathologic loss of bone support resulting in loss
    of the normal periodontal attachment
  • The presence of a dentigerous or follicular cyst
  • Radiographically visible internal root resorption

8
Pulp Therapy in Pediatric Dentistry--Non-Vital
Pulp Therapy--
  • Pulpectomy Technique
  • Achieve adequate anesthesia and rubber dam
    isolation.
  • Remove all caries.
  • Remove the roof of the pulp chamber with a
    high-speed handpiece.
  • Amputate the coronal aspect of the pulp tissue
    with a large round bur in a slow-speed handpiece.
  • The remaining pulp tissue occupying the root
    canals is removed using endodontic files at a
    predetermined working length, approximately 1 to
    2 mm short of the root apices.
  • The canals should be enlarged several sizes
    beyond the size of the first file that fits
    snugly into the canal to a minimum final size of
    30 to 35.
  • Throughout root canal instrumentation, the canals
    should be irrigated with sodium hypochlorite to
    aid in debridement.

9
Pulp Therapy in Pediatric Dentistry--Non-Vital
Pulp Therapy--
  • Pulpectomy Technique (continued)
  • 8. Dry the canals with sterile paper points.
  • 9. The canals are filled with a treatment paste
    (Zinc Oxide/Eugenol at UKCD) using a pressure
    syringe.
  • 10. The tooth is restored with a stainless steel
    crown.

10
Pulp Therapy in Pediatric Dentistry--Non-Vital
Pulp Therapy--
11
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

12
Pulp Therapy in Pediatric Dentistry--Non-Vital
Pulp Therapy--
  • Apexification (Young Permanent Teeth)
  • Apical closure of an incompletely formed root
  • Implemented when apexogenesis has failed
  • Necrotic tissue removal short of the
    apexification site
  • Agent is placed in canals to achieve
    closure/apical stop
  • Apexification Recall Schedule
  • Calcium Hydroxide Rotation
  • 3-6 month intervals (Andreasen, 1994)

13
Pulp Therapy in Pediatric Dentistry--Non-Vital
Pulp Therapy--
  • Action of Calcium Hydroxide in Apexification
  • Bactericidal
  • Low grade irritation inducing hard tissue barrier
    formation
  • Dissolves necrotic debris
  • Forms of Calcium Hydroxide
  • Caliscept
  • Self-mixed (CaOH sterile water or local
    anesthetic)

14
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

15
Pulp Therapy in Pediatric Dentistry--Non-Vital
Pulp Therapy--
  • In Review. . .

16
FYI
  • Comparison between File Size and Needle for
    Pressure Syringe
  • Standard File Needle Gauge
  • 15-30 30
  • 40 27
  • 50 25
  • 70-80 22
  • 90-100 18

17
References
  • Barr Elizabeth, Flaitz Catherine, Hicks John. A
    retrospective radiographic evaluation of primary
    molar pulpectomies. Pediatric Dentistry, Vol.
    13, Number 1, 1991 4-9.
  • Dummett, Cliff. Pulp Therapy in Pediatric
    Dentistry. Louisiana State University School of
    Dentistry, April 16, 2003.
  • Georig Albert C., Camp Joe H. Root canal
    treatment in primary teeth a review.
    Pediatric Dentistry, Vol. 5, Number 1, 1983
    33-37.
  • Nash David A. Pulpal Therapy, Module 6. West
    Virginia University School of Dentistry.
  • Mink, John R. and Spedding, Robert. Pediatric
    Pulp Treatment. University of Kentucky College
    of Dentistry.
  • Pinkham, J. R., senior editor. Pediatric
    Dentistry, Infancy through Adolescence, Third
    Edition. W.B. Saunders Company, 1999.
  • Walton, Richard E. and Torabinejad, Mahmoud.
    Principles and Practice of Endodontics, Second
    Edition. W.B. Saunders Company, 1996.
  • The Handbook, Second Edition. American Academy
    of Pediatric Dentistry, 1999.
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