Chapter 12 - HIGH YIELD

What is the purpose of indirect pulp therapy?

Preserve pulp vitality

What action is taken at the enamel-dentin junction during indirect pulp therapy?

Remove all caries

What layer of dentin is left behind during indirect pulp therapy?

Thin layer of affected dentin

What is the first indication for indirect pulp therapy?

Deep carious lesions in permanent teeth

What is the second indication for indirect pulp therapy?

Normal pulp or reversible pulpitis

What is the third indication for indirect pulp therapy?

No clinical or radiographic signs of irreversible pulpitis or necrosis

What is the first procedure step of indirect pulp therapy?

Remove all caries at the DEJ

What is the second procedure step of indirect pulp therapy?

Judiciously remove soft, deep carious dentin using large round burs

What is the third procedure step of indirect pulp therapy?

Place a lining material

What lining material is commonly used in indirect pulp therapy?

Calcium hydroxide plus glass ionomer cement

What is the final procedure step of indirect pulp therapy?

Apply a definitive restoration with an optimal coronal seal

What is the primary factor determining success in indirect pulp therapy?

Quality of the coronal seal

What is the primary benefit of calcium hydroxide in indirect pulp therapy?

Reducing bacterial load

What is the purpose of direct pulp capping?

Directly cover a small, clean mechanical pulp exposure

What is the first indication for direct pulp capping?

Small mechanical exposure less than 1 mm during cavity preparation

What is the second indication for direct pulp capping?

Good isolation using a rubber dam

What is the third indication for direct pulp capping?

No signs of pulpal disease

What is the first procedure step of direct pulp capping?

Control hemorrhage using hemostatic solutions

What hemostatic solutions are used in direct pulp capping?

Sodium hypochlorite, saline, chlorhexidine

What is the second procedure step of direct pulp capping?

Place a capping material

What is the preferred capping material for direct pulp capping?

MTA

What is the alternative capping material for direct pulp capping?

Calcium hydroxide

What is the third procedure step of direct pulp capping?

Cover with a protective liner

What protective liner is used in direct pulp capping?

Glass ionomer cement

What is the final procedure step of direct pulp capping?

Restore with a permanent restoration ensuring a good marginal seal

What sodium hypochlorite concentration range is effective for hemostasis in direct pulp capping?

1.5% to 6%

What action should be taken if bleeding persists after 5 to 10 minutes in direct pulp capping?

Consider partial or complete pulpotomy

What is the purpose of a partial pulpotomy (Cvek pulpotomy)?

Remove a small portion of the vital coronal pulp

What is the first indication for a partial pulpotomy?

Carious pulp exposure in immature, asymptomatic permanent teeth

What is the second indication for a partial pulpotomy?

Traumatic pulp exposure within 14 days

What is the first procedure step of a partial pulpotomy?

Remove 2 mm of inflamed pulp tissue

What instrument is used for tissue removal in a partial pulpotomy?

Water-cooled diamond bur at high speed

What is the second procedure step of a partial pulpotomy?

Achieve hemostasis using a cotton pellet soaked in sodium hypochlorite

What is the hemostasis duration with sodium hypochlorite in a partial pulpotomy?

2 to 5 minutes

What is the third procedure step of a partial pulpotomy?

Place a capping material

What capping materials are used in a partial pulpotomy?

MTA or tricalcium silicate material

What is the final procedure step of a partial pulpotomy?

Restore with a definitive restoration

What is the required hemostasis timeframe in a partial pulpotomy?

4 to 10 minutes

What alternative treatment should be considered if bleeding persists in a partial pulpotomy?

Coronal pulpotomy

What is the purpose of a cervical pulpotomy?

Remove the coronal portion of the vital pulp to preserve radicular pulp

What is the first indication for a cervical pulpotomy?

Emergency procedure for temporary relief of symptoms

What is the second indication for a cervical pulpotomy?

Part of apexogenesis in vital teeth with open apices

What is the first procedure step of a cervical pulpotomy?

Amputate the coronal pulp

What is the second procedure step of a cervical pulpotomy?

Achieve hemostasis using ferric sulfate (15%) or formocresol

What is the third procedure step of a cervical pulpotomy?

Place a capping material

What capping material is used in a cervical pulpotomy?

Calcium hydroxide

What is the final procedure step of a cervical pulpotomy?

Restore with a definitive restoration

What is the purpose of pulp revascularization?

Stimulate the restoration of blood supply in the pulp space

What is the target tooth type for pulp revascularization?

Necrotic immature permanent teeth with wide-open apices and short root lengths

What is the first procedure step of pulp revascularization?

Debride the necrotic pulp space with minimal instrumentation

What is the second procedure step of pulp revascularization?

Irrigate with 1.5% sodium hypochlorite

What is the third procedure step of pulp revascularization?

Place a medicament paste

What medicament paste is used in pulp revascularization?

Triple antibiotic paste

What are the components of the triple antibiotic paste?

Ciprofloxacin, minocycline, and metronidazole

What is the fourth procedure step of pulp revascularization?

Seal the tooth temporarily for 1 to 4 weeks

What is the first step during the second visit of pulp revascularization?

Induce bleeding by introducing an instrument 1 to 2 mm past the apex

What is the second step during the second visit of pulp revascularization?

Place a resorbable collagen matrix

What is the third step during the second visit of pulp revascularization?

Place MTA or calcium hydroxide

What is the final step during the second visit of pulp revascularization?

Restore with a permanent restoration

What risk is associated with triple antibiotic paste in pulp revascularization?

Tooth discoloration

What must be obtained before using triple antibiotic paste due to discoloration risk?

Informed consent

What is an alternative medicament to triple antibiotic paste in pulp revascularization?

Calcium hydroxide

What is the first advantage of calcium hydroxide?

High pH stimulates dentinogenesis

What is the second advantage of calcium hydroxide?

Formation of reparative dentin bridge

What is the third advantage of calcium hydroxide?

Antibacterial properties

What is the first disadvantage of calcium hydroxide?

Poor marginal adaptation

What is the second disadvantage of calcium hydroxide?

Degradation over time (unstable)

What is the third disadvantage of calcium hydroxide?

Resorptive potential in primary teeth

What is the first advantage of MTA?

Excellent sealing ability

What is the second advantage of MTA?

Biocompatible

What is the third advantage of MTA?

Stimulates hard tissue formation (dentin, cementum, bone)

What is the first disadvantage of MTA?

High cost

What is the second disadvantage of MTA?

Potential for tooth discoloration

What is the third disadvantage of MTA?

Long setting time (2 to 3 hours)

What is the first advantage of glass ionomer cement?

Hydrophilic (setting not affected by moisture)

What is the second advantage of glass ionomer cement?

Non-resorbable

What is the third advantage of glass ionomer cement?

High pH (alkaline)

What is the fourth advantage of glass ionomer cement?

Fluoride release

What is the fifth advantage of glass ionomer cement?

Thermal insulation

What is the sixth advantage of glass ionomer cement?

Good marginal seal

What is the first disadvantage of glass ionomer cement?

Lower strength compared to other materials

What is the second disadvantage of glass ionomer cement?

May cause pulp irritation (no direct contact with pulp)

What is the pulp status for indirect pulp treatment in immature permanent teeth?

Normal pulp or reversible pulpitis

What is the main indication for indirect pulp treatment in immature permanent teeth?

Deep caries; deepest dentin is retained to avoid pulp exposure

What is the expected outcome of indirect pulp treatment in immature permanent teeth?

Maintains vitality and allows continued root development

What is the pulp status for direct pulp capping in immature permanent teeth?

Normal pulp

What is the main indication for direct pulp capping in immature permanent teeth?

Pinpoint carious or mechanical or traumatic pulp exposure

What is the expected outcome of direct pulp capping in immature permanent teeth?

Pulp healing and continued apexogenesis

What is the pulp status for partial pulpotomy (carious teeth) in immature permanent teeth?

Normal pulp or reversible pulpitis

What is the main indication for partial pulpotomy (carious teeth) in immature permanent teeth?

Greater than 1 mm pulp exposure; bleeding controlled within several minutes

What is the expected outcome of partial pulpotomy (carious teeth) in immature permanent teeth?

Preserves radicular pulp vitality and permits apexogenesis

What is the pulp status for partial pulpotomy (traumatic exposure/Cvek) in immature permanent teeth?

Normal pulp or reversible pulpitis

What is the main indication for partial pulpotomy (traumatic exposure/Cvek) in immature permanent teeth?

Traumatic pulp exposure (usually > 1 mm)

What is the expected outcome of partial pulpotomy (traumatic exposure/Cvek) in immature permanent teeth?

Preserves vitality and permits continued root formation

What is the pulp status for apexification in immature permanent teeth?

Necrotic or nonvital pulp

What is the main indication for apexification in immature permanent teeth?

Long root, thick dentinal wall, small open apex

What is the expected outcome of apexification in immature permanent teeth?

Creates a calcified or artificial apical barrier, commonly using an MTA plug

What is the pulp status for regenerative endodontic treatment in immature permanent teeth?

Necrotic pulp

What is the main indication for regenerative endodontic treatment in immature permanent teeth?

Short root, thin dentinal wall, large open apex

What is the expected outcome of regenerative endodontic treatment in immature permanent teeth?

Promotes apical closure, continued root length, and increased radicular dentin thickness