PEDO M3

1. medical conditions

2. overall assessment of the mouth

3. assessment of individual teeth

things to consider during the preoperative assessment:

1. physical condition of the patient

2. history of pain

3. clinical examination

4. radiographic interpretation

diagnosis:

provoked pain

stimulated by heat, cold, sweets, air

and chewing.

provoked pain

When the stimulus is

removed the pain is reduced or

disappears

spontaneous pain

usually wakes a child at night and

may not be relieved by analgesics

spontaneous pain

these signs usually indicate

advanced, irreversible pulp damage

PULP CAPPING

to maintain pulp vitally by placing a suitable dressing either

directly on the exposed pulp (direct pulp capping) or on a thin

residual layer of slightly soft dentine (indirect pulp capping)

PULP CAPPING

not recommended if the diameter of the exposure is greater

than a pin-point

indirect pulp capping

used when the tooth has a deep carious

lesion

indirect pulp capping

may be successful in the primary dentition

provided that the seal of the restoration is

intact

indirect pulp capping

a procedure in which a material is placed on a

thin partition of remaining carious dentin that, if

removed, might expose the pulp in immature

permanent teeth

indirect pulp capping

aim: To remove the infected dentin and

leaving intact the affected dentin, so

that the affected dentin will

remineralize and act as a barrier

above the healthy pulp.

indirect pulp capping

ind: absence of spontaneous

○

pain

indirect pulp capping

ind: large carious lesion in close

proximity to the pulp

indirect pulp capping

ind: absence of

lymphadenopathy

indirect pulp capping

ind: normal tooth color

indirect pulp capping

ind: where complete removal of

caries would probably cause

pulpal exposure

Affected dentin

Affected dentin

do not contain microorganisms and hence are sterile

Infected dentin

characterized by the presence of microorganisms

dyes

can be used to differentiate the infected

dentin from the affected dentin.

Direct pulp capping

the procedure of covering the exposed vital

pulp by a material which promotes healing of

the vital pulp tissues

placement of a medicament or a

nonmedicated material on a pulp that has

been exposed, in the course of excavating the

caries, due to fracture or due to mechanical

exposures during routine caries removal

Direct pulp capping

contraindicated for primary teeth

Direct pulp capping

ind: should be limited to traumatic

exposure during cavity preparation

(mechanical exposure).

Direct pulp capping

ind: Small pin point exposure surrounded

by sound dentine.

Direct pulp capping

Mechanical or carious exposures in

asymptomatic vital young permanent

teeth

Direct pulp capping

contra: Cariously exposed deciduous teeth

Direct pulp capping

contra: The diameter of the exposure is

greater than a pin-point

Direct pulp capping

contra: more than gentle bleeding

from the exposure site.

Debridement

peripheral carious

dentin from the walls should be

removed first followed by removal

from the floor of the cavity

blood clot

impedes the pulpal

healing

blood clot

does not allow the

capping material to

contact the pulp tissue directly

Normal saline or

chloramines

used for irrigation

of the exposure sites before

placement the capping

material

Calcium hydroxide

Calcium hydroxide

the material of choice of

capping exposed vital pulp

tissue

Calcium hydroxide

should not be forced into the

exposure site

Calcium hydroxide

plays a major role as an

inter-visit dressing in the

disinfection of the root canal

system

Calcium hydroxide

possesses antibacterial

property due to its high

alkalinity (pH 11) and helps

formation of a calcific barrier

Calcium hydroxide

has a high solubility, poor

seal, and low compressive

strength

Hydroxyl group

considered to be

the most important

component of

calcium hydroxide

Hydroxyl group

provides an

alkaline

environment and

activate alkaline

phosphatases

Alkaline

phosphatase

play an

important

role in

hard

tissue

formation

Osteodentine

the calcified product of

both odontoblasts and

connective tissue cells

Zinc oxid-eugenol

placed over the calcium

hydroxide layer as sealant

Zinc oxid-eugenol

should be placed over it to

provide a seal against

microleakage

Mineral trioxide aggregate

a new biocompatible pulp

capping agent

Mineral trioxide aggregate

a fine hydrophilic powder

Mineral trioxide aggregate

consists of tricalcium

silicate, tricalicum aluminate,

tricalcium oxide, silicate

oxide and bismuth oxide

Mineral trioxide aggregate

produced significantly more

dentinal bridge in a shorter

period of time

PULPOTOMY

Surgical removal of the entire coronal pulp