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VITAL PULP THERAPY
- 2. Vital pulpal is treatment initiated on exposed pulp to repair and maintain the pulp vitality AIM : Treat reversible pulpal injuries in order to maintain pulp vitality in both primary and permanent teeth. This is a conservative treatment
- 5. The procedure involving a tooth with a deep carious lesion where carious dentin removal is left incomplete and decay process is treated with biocompatible material to avoid pulp exposure JUSTIFICATION •Reduction of pulpal hyperemia •Remineralization of carious / precarious dentin •Reduction of anaerobic bacteria •Formation of reparative dentin •Pulp vitality is maintained
- 6. Preserve pulp vitality by removal of carious infected dentin followed by placement of material that would enable affected dentin to remineralize by stimulating the underlying Odontoblast to form tertiary dentin
- 7. Physiological Remineralization occur if affected dentin layer contain Sound collagen fibre & living odontoblastic process Sound collagen function as base-attach appetite crystals Living odontoblastic process supply CaP from vital pulp for physiologic Remineralization Infected dentin is removed (i.e. outer layer of carious dentin) Bacteria are eliminated Lesion is sealed & substrate which bacteria produce acid is also removed With arrest of carious lesion, reparative mechanism is able to lay down additional dentin & avoid pulp exposure
- 8. Pulpal inflammation is minimal and complete removal of caries cause pulp exposure
- 9. HISTORY: Patient c/o tolerable , dull pain with mild discomfort associated with eating. Mild – moderate pain is experienced on thermal stimulation CLINICAL EXAMINATION: Large carious lesion without frank pulpal exposure. Positive response to EPT,thermal stimulation, test cavity Gingiva is normal & asymptomatic on palpation
- 10. Large carious lesion with possible pulp exposure Extension of caries up to 3/4th of entire thickness of dentin or more Lamina dura is normal
- 11. Can be performed as SINGLE/TWO-STEP approach FIRST APPOINTMNT: Step wise excavation is a technique in which caries removed in increments in 2 or more appointment over a period of few months instead of single sitting
- 12. Use local anesthesia Isolate with rubber dam Cavity outline established using high speed air turbine •A slow speed hand piece with large #6 0r #8 round burs is used to remove superficial debris & majority of soft infected dentin without exposing pulp Peripheral carious dentin is removed with sharp-spoon excavator(31 and 33L) Cavity is flushed with saline Dried with cotton pellets
- 13. Exposure site is covered with commercial hard- set CaOH preparation(DYCAL) Sealed with an overlying base of reinforced zinc oxide eugenol preparation(IRM) Each time the caries is removed a hard setting CaOH is placed followed by an intermediate restoration is placed The sealed cavity is not disturbed for 6-8 weeks
- 14. Between the two appointments, history must be negative and intermediary restoration should be intact Cavity preparation is washed out and dried gently Entire floor is covered with hard –set CaOH preparation. Clinical and radiographic findings are negative, place final restoration All temporary fillings are removed, especially the calcium over the pulp horn are removed carefully Soft, deep brownish red color dentin will change to lighter brownish gray color & harder in nature A bitewing radiograph of treated tooth is obtained Use local anesthesia and rubber dam isolation
- 17. Iatrogenic mechanical exposure of pulp in an asymptomatic vital tooth with sound dentin at periphery Small carious exposure in an asymptomatic permanent tooth with incomplete root formation. The main objective is to maintain the pulp vitality
- 18. • Pain at night • Tooth mobility • Thickening of the periodontal membrane • Intra radicular radiolucency • Excessive bleeding from the exposure site • Pus discharge
- 20. Mechanical exposure has better prognosis than carious exposure(carious exposure is associated with pulpal inflammation and necrosis) Larger exposure with lower healing is less prognostic Bacterial contamination can occur when exposure and pulp capping time is longer and also with micro leakage Mechanical exposure should be pulp capped immediately
- 21. HEAT PRESSURE DAMAGE TO PULP TISSUE HEMORRHAGE INTRUSION OF DENTIN CHIPS Physical phenomenon associated with Mechanical pulp exposure
- 22. PROCEDURE PULP EXPOSURE ANAESTHESIA AND RUBBER DAM ISOLATION HEMOSTASIS WITH NaOCl CaOH technique MTA technique
- 23. CaOH Ca(OH )2 is placed over exposed pulp followed by GIC lining IRM FINAL RESTORATION( in next sitting) MTA A minimum thickness of 1.5mm MTA is placed over exposure site & moist cotton is placed over it A non- bonded composite material is placed over this Visit after 5-10 days for placement of bonded composite Flowable light cure compomer / GIC lining Remaining cavity is etched with 37% phosphoric acid, washed and dried and bonded composite restoration given One sitting
- 27. I D E A L PULP CAPPING AGENT Adhere well to dentin and restorative material Resist the forces under restoration for lifetime sterile Preferably radio opaque Maintain pulp vitality Stimulate reparativ e dentin formation Bactericidal/ bacteriostatic P R O P E R T Y
- 28. Pulp capping agent MTA CaOH ISOBUTYL CYANOACRYLATE RESIN BONDED AGENTS LASERS PROPOLIS ANTIBIOTICS
- 29. MTA CaOH
- 30. Zinc Polycarboxylate cement Resin bonding agent
- 31. LASER – CO2 laser
- 34. Without luck ability is nothing. அதிர்ச்டம் இல்லையேல் திறலையும் இல்லை
- 35. T Y