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Pulp capping
This document discusses pulp capping, which involves placing a biocompatible material over exposed dental pulp to avoid pulp tissue exposure and promote healing. It describes indirect pulp capping, which leaves decayed dentin behind to avoid pulp exposure, and direct pulp capping, which dresses small pulp exposures with calcium hydroxide or resin bonding agents. Successful pulp capping requires maintaining pulp vitality without pain or pathology and promoting dentin bridge formation. Calcium hydroxide is commonly used but can degrade over time, while resin bonding agents may provide a better seal but with less evidence of success.
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Pulp capping
- 1. PULP CAPPING Submitted by: RockeyShrivastava Xth Batch BDS Roll - 30 Guided by: Dr. J N Shukla Dr. Rahul Mishra Dr. Madhulika Srivastav
- 2. CONTENTS 1. INTRODUCTION 2. TREATMENTMODALITIES 3. TYPES OF PULP CAPPING 4. INDIRECT PULP CAPPING 5. PATENT DENTIN MEASURING DEVICE 6. DIRECT PULP CAPPING 7. FEATURES OF SUCCESSFUL PULP CAPPING 8. PULP CAPPING MATERIALS 9. CONCLUSION 10.REFERENCES
- 3.
- 4. TREATMENT MODALITIES PULP TREATMENT CONSERVATIVERADICAL 1. Protective base 1. Pulpectomy 2. Indirect pulp therapy 2. Root filling 3. Direct pulp therapy 4. Pulpotomy
- 5. PULP CAPPING • DIRECTPULP CAPPING • INDIRECT PULP CAPPING
- 6. Definition The procedure involvinga tooth with a deep carious lesion where carious dentin removal is left incomplete, and the decay process is treated with a biocompatible material for some time in order to avoid pulp tissue exposure is termed as indirect pulp capping. INDIRECT PULP CAPPING THERAPY
- 7. INDICATIONS When pulp inflammationhas been judged to be minimal and complete removal of caries would cause pulp exposure
- 8. • Any signsof pulpal or periapical pathology • Soft leathery dentin covering a very large area of the cavity, in a non restorable tooth CONTRAINDICATIONS
- 9. PROCEDURE The tooth isanesthetized and isolated with rubber dam All the caries except that immediately over the pulp is removed (use large round bur at low speed) A zone of AFFECTED demineralized dentin is left behind Not all undermined enamel is removed A sedative dressing of either zinc oxide eugenol or calcium hydroxide is placed
- 10. CONTD.. The tooth maythen be restored with ZOE or amalgam The formation of reparative dentin beneath the caries (average rate – 1.4 microns per day) The treated tooth is re entered after 6 to 8 weeks and the remaining caries is excavated Pulpal protection with adequate base and permanent restoration (If the restoration has a good margin and at the recall visit a layer of secondary dentin is evident , reentry is not necessary)
- 12. PATENT DENTIN MEASURINGDEVICE 1. Electronically measures the thickness of dentin layer above the pulp chamber during crown preparation with a simple touch of probe 2. Color coding: Green light – safe zone Orange light - limit of safe zone Red light – danger of penetrating through the dentin 3. Allows the safe preparation of delicate cases (elongated , tilted or deciduous tooth)
- 13. Definition: The procedure inwhich the small exposure of the pulp which is encountered • During cavity preparation or • Following a traumatic injury or • Due to caries, with a sound surrounding dentin, is dressed with an appropriate biocompatible radio-opaque base in contact with the exposed pulp tissue prior to placing a restoration is termed as a direct pulp capping DIRECT PULP CAPPING
- 15. LIMITATIONS IN PRIMARYTEETH • Internal resorption • Calcifications • Chronic pulp inflammation • Necrosis • Intraradicular involvement
- 16. INDICATIONS • Small mechanicalexposures less than 1 mm which is surrounded by sound dentin • Light red bleeding from the exposure site that can be controlled by cotton pellet • Traumatic exposures in a dry, clean field, which report to the dental office within 24 hours
- 17. CONTRAINDICATIONS • Pain atnight • Spontaneous pain • Tooth mobility • Thickening of periodontal membrane • intraradicular radiolucency • Excess bleeding at the exposure site • Purulent or serous exudate
- 18. CALCIUM HYDROXIDE TECHNIQUE • Hemostasis •Disinfect cavity • Calcium hydroxide IRM resin modified GIC dentin bonding system Restoration DENTIN BONDING SYSTEM • Hemostasis • Disinfect cavity • Bonding system • Adhesive • Restoration PULP EXPOSURE
- 21. FEATURES OF SUCCESSFULPULP CAPPING • Maintenance of pulp vitality • Lack of undue sensitivity or pain • Minimum inflammatory response • Lack of internal resorption and intraradicular pathosis
- 22. PULP CAPPING AGENTS •Calcium hydroxide • Isobutyl cyanoacrylate • Resin bonding agents (hybridization) • Laser • Propolis • Other materials ( antibiotics, corticosteroids, polycarboxylate cements, dentin, albumin, acid, alkaline phosphatase, chondroitin sulfate, collagen, calcium – eugenol cement, calcitonin, barium and strontium hydroxide, native enriched collagen solution, hydroxyapatite)
- 23. CALCIUM HYDROXIDE • Calciumhydroxide is the material of choice. • Herman in 1930 1st introduced Ca(OH)2 for pulp capping. • Ca(OH)2 causes necrosis of adjacent pulp tissue and inflammation of contiguous tissue. • Dentin bridge formation occurs at the junction of necrotic and inflamed tissue Pure calcium hydroxide
- 24. ADVANTAGES AND DISADVANTAGESOF CALCIUM HYDROXIDE A D V A N T A G E S • Initially bactericidal then bacteriostatic. • Promotes healing and repair • High pH stimulates fibroblasts • Neutralization of acids • Stops internal resorption • Inexpensive and easy to use • Particles may obturate open tubules D I S A D V A N T A G E S • Doesn’t exclusively stimulate Dentinogenesis • May dissolve after 1yr • May degrade during acid etching and tooth flexure • Marginal failure with amalgam condensation • Doesn’t adhere to dentin or resin restoration
- 25. 3 MAIN CALCIUMHYDROXIDE PRODUCTS • Pulpdent paste:52.5% calcium hydroxide suspended in aqueous methyl cellulose sol. • Hydrex : two paste system - calcium hydroxide, barium sulfate, titanium dioxide and a selected resin. • Dycal.
- 26. ISOBUTYL CYANOACRYLATE • Hemostaticand bacteriostatic properties. • Less inflammation than calcium hydroxide • Doesn’t produce continuous barrier of reparative dentin.
- 27. RESIN BONDING AGENTS •Suggested as means to achieve a hermetic seal at the dentin/pulpal interface by means of resinous ‘’hybrid’’ layer. • 4-methacryloxyethyl trimellitate anhydride(4- META) bond can be used on exposed pulp.
- 28. LASER • Andreas Moritzin 1998 evaluated the effect of Co2 laser on direct pulp capping. • Success rate-89%
- 29. PROPOLIS • Recently usedmaterial. • Equally effective as calcium hydroxide. • Sabir et al (2005) conducted experiments. Partial dentinal bridge formation was seen in rats after application of propolis in their study.
- 31. CONCLUSION Pulp capping isa procedure that maintains pulp vitality and function, promotes healing/repair, prevents breakdown of peri radicular supporting tissues, and promotes formation of secondary dentin
- 34. BIBLIOGRAPHY • Textbook ofpedodontics - Shobha Tandon 2nd edition (2009) • Chawla HS et al. Calcium Hydroxide as a root canal filling material in primary teeth – A pilot study . J. Indian Soc Pedo Prev Dent: 16 (3); 90 – 91, 1998 • Suneda YT et al . A histopathological study of direct pulp capping with adhesive resins. Oper Dent: 20; 223 – 229,1995 • Sabir A, Tabbu CR, Agustiono P, Sosroseno W. Histological analysis of rat dental pulp tissue capped with propolis. J Oral Sci. 47(3): 135 – 8, Sep, 2005 • Stewart DJ and Kramer IRH. Effects of calcium hydroxide on the unexposed pulp, J. Dent. Res: 37;758,1958