Date post: | 15-Dec-2015 |
Category: |
Documents |
Upload: | renee-appling |
View: | 216 times |
Download: | 0 times |
PULP CAPPULP CAP
KAMLOOPSKAMLOOPS
APRIL 14, 2012APRIL 14, 2012
RETROSPECTIVE STUDIESRETROSPECTIVE STUDIES
1.1. Bogan G et alBogan G et al JADA 2008:39 (3) 305- JADA 2008:39 (3) 305-315 315 97%97%
2.2. Fuks ABFuks AB, Pediatr Dent 1982,4: 240-, Pediatr Dent 1982,4: 240-244 244 81%81% success on permanent success on permanent incisors incisors
3.3. Barthel CRBarthel CR ,J Endod 2000; 26: 525- ,J Endod 2000; 26: 525-528 528 37%37% @ 5 years, @ 5 years, 13%13% @10 years @10 years
PULP CAP MATERIALS ?PULP CAP MATERIALS ?CR NEWS Jan 2010CR NEWS Jan 2010
RMGIRMGI Vitrebond Plus Vitrebond Plus or GC Fuji Lining LCor GC Fuji Lining LC Indirect 40% Indirect 40% Indirect 68%Indirect 68%
Calcium HydroxideCalcium Hydroxide 28% Direct,28% Direct, 14% Indirect14% Indirect
Bonding agentBonding agent Direct 7% Direct 7% Indirect 5%Indirect 5%
LaserLaser 2% Direct 2% Direct GluteraldehydeGluteraldehyde
Indirect 3%Indirect 3% MTA MTA 3% Direct3% Direct PolycarboxylatePolycarboxylate – no – no
mentionmention Glass IonomerGlass Ionomer – no – no
mentionmention English sparrow poopEnglish sparrow poop
CR NewsCR News Jan 2010 vol 3 issue 1 Jan 2010 vol 3 issue 1
1.1. CR respondents; CR respondents; success ratessuccess rates
1.1. 3 years: Direct 3 years: Direct 58%,58%, Indirect Indirect 70%70%
2.2. 5 years: Direct 5 years: Direct 48%,48%, Indirect Indirect 61%61%
0102030405060708090
100
3 5 10
DIRECTINDIRECTBOGANFUKSBARTHEL
MTA MTA Bogan G et alBogan G et al JADA 2008:39 (3) 305-315 JADA 2008:39 (3) 305-315 Direct pulp capping with Mineral Trioxide Direct pulp capping with Mineral Trioxide
aggregate – an Observational Study.aggregate – an Observational Study. Over an observation period of Over an observation period of nine nine
years, the authors followed years, the authors followed 49 of 53 49 of 53 teethteeth and found that and found that 97.96%97.96% percent percent had favorable outcomes on the basis of had favorable outcomes on the basis of radiographic appearance, subjective radiographic appearance, subjective symptoms and cold testing.symptoms and cold testing.
0
1020304050607080
90100
BarthelFuksCRA indirectCRA directBogan
MTABOGAN
PEDOFUKS
PULP CAP SUCCESS RATESPULP CAP SUCCESS RATES
0
10
20
30
40
50
60
70
INDIRECT DIRECT
RMGICA(OH)2GLUTBONDMTA
SUCCESSFUL PULP CAPSSUCCESSFUL PULP CAPS
Healthy patient
Recoverable pulp
Flawless caries removal
Disinfection
Histological repair
seal
Inflammationmanagement
SUCCESSFUL PULP CAPSSUCCESSFUL PULP CAPS
Healthy patientRecoverable pulp
Flawless caries removal
DisinfectionHistological repair
seal
Inflammationmanagement
SUCCESSFUL PULP CAPSSUCCESSFUL PULP CAPS
Healthy patient
Recoverable pulp
Flawless caries removal
Disinfection
Histological repair
seal
Inflammationmanagement
RADIOGRAPHIC RADIOGRAPHIC CONTRAINDICATIONSCONTRAINDICATIONS
APICAL RADIOLUCENCY
APICAL DETERIORATION -CONDENSING OSTEITIS
THREADLIKE PULP
PULP STONES PROBABLE
FUTURE PULP OCCLUSION E.G. CLASS VCLASS V
RADIOGRAPHICLY EVIDENT CARIOUS INVASION OF PULP CHAMBER
DIAGNOSTIC DIAGNOSTIC CONTRAINDICATIONS = CONTRAINDICATIONS = HISTORY OF HISTORY OF ++ PAIN++ PAIN
APICAL TENDERNESSAPICAL TENDERNESS SPONTANEOUS SPONTANEOUS LONG STANDING LONG STANDING NOCTURNAL NOCTURNAL THROBBING THROBBING ENDURING ENDURING SICKENING SICKENING CONSTANT NEED OF MEDICATIONSCONSTANT NEED OF MEDICATIONS
OPERATIVE OBSERVATIONS OPERATIVE OBSERVATIONS CONTRAINDICATIONS AT CONTRAINDICATIONS AT
EXPOSURE EXPOSURE EXUDATE – SEROUSEXUDATE – SEROUS PUSPUS PROLONGED CLOTTING TIME > 5 PROLONGED CLOTTING TIME > 5
MINSMINS >3MM EXPOSURE >3MM EXPOSURE EXPLORER INTO THE PULP EXPLORER INTO THE PULP
(OPERATOR ERROR)(OPERATOR ERROR)
SUCCESSFUL PULP CAPSSUCCESSFUL PULP CAPS
Healthy patient
Recoverable pulp
Flawless caries removal
Disinfection
Histological repair
seal
Inflammationmanagement
FORMULA FOR CARIES FORMULA FOR CARIES DETECTORDETECTOR
ACID RED 52 2% IN PROPYLENE ACID RED 52 2% IN PROPYLENE GLYCOLGLYCOL
COMPOUNDING PHARMACYCOMPOUNDING PHARMACY $30 FOR 200 CC.= 5 YEARS’ SUPPLY$30 FOR 200 CC.= 5 YEARS’ SUPPLY
ref
CARIES DETECTOR - NO CARIES DETECTOR - NO EFFECT ON BOND STRENGTHEFFECT ON BOND STRENGTH
El-Housseiny and Jamjoum, J Clin El-Housseiny and Jamjoum, J Clin Pediat Dent 200Pediat Dent 200
Kazemi et al, Oper Dent 2002Kazemi et al, Oper Dent 2002
AFFECTED DENTIN
INFECTED DENTIN
SETTING THE STAGE FOR SETTING THE STAGE FOR PULPAL HEALINGPULPAL HEALING
EXPOSURE ZONE:EXPOSURE ZONE: LOW/NIL BACTERIAL COUNT LOW/NIL BACTERIAL COUNT
CONTIGUOUS ZONECONTIGUOUS ZONE BIOCOMPATIBLE AND BIOCOMPATIBLE AND
CALCIGENIC AGENTCALCIGENIC AGENT VISIBLE DELINEATION FORVISIBLE DELINEATION FOR
FUTURE INTERVENTIONSFUTURE INTERVENTIONS
PERIPHERAL ZONEPERIPHERAL ZONE SEAL (ZERO MICROLEAKAGE)SEAL (ZERO MICROLEAKAGE)
TUBULESTUBULES % AREA% AREA
NUMBER/ MMNUMBER/ MM22
DIAMETERDIAMETER
PRESSUREPRESSURE NILNIL POSITIVEPOSITIVE
SE BONDS LESS EFFECTIVE THAN ETCH AND RINSE IN DEEP SE BONDS LESS EFFECTIVE THAN ETCH AND RINSE IN DEEP DENTINDENTIN
20 K
58K
1u 3u
10% 88%
SUCCESSFUL PULP CAPSSUCCESSFUL PULP CAPS
Healthy patient
Recoverable pulp
Flawless caries removal
Disinfection
Histological repair
seal
Inflammationmanagement
LEAVING CARIES?LEAVING CARIES?
REFERENCEREFERENCE
2 APPLICATIONS 2 APPLICATIONS
ONE MINUTE EACHONE MINUTE EACHref
CR CR
JAN 2010JAN 2010
CR News Jan 2010 vol 3 issue 1CR News Jan 2010 vol 3 issue 1 http://www.cliniciansreport.org/produhttp://www.cliniciansreport.org/produ
cts/dental-reports/january-2010-volucts/dental-reports/january-2010-volume-3-issue-1.php me-3-issue-1.php
Subscription requiredSubscription required
OTHER INTRAORAL OTHER INTRAORAL DISINFECTANTSDISINFECTANTS
ENDODONTICENDODONTIC SILVER NITRATESILVER NITRATE IODINEIODINE FORMOCRESOLFORMOCRESOL CA(OH)2CA(OH)2
PULPALPULPAL HYPOCHLORITE - HYPOCHLORITE -
KANCAKANCA CHLORHEXEDINE-CHLORHEXEDINE-
MANYMANY
ref
CHLORHEXEDINE NO EFFECTCHLORHEXEDINE NO EFFECTON BOND STRENGTHON BOND STRENGTH
Santos et al, JOE, 2006Santos et al, JOE, 2006 Perdiao et , Am J Dent 1994Perdiao et , Am J Dent 1994
WHAT ABOUT SURFACE WHAT ABOUT SURFACE DISINFECTANTS?DISINFECTANTS?
70% ALCOHOL WITH PHENOLS 70% ALCOHOL WITH PHENOLS 70% ALCOHOL WITH CHX 70% ALCOHOL WITH CHX ACCELERATED PEROXIDEACCELERATED PEROXIDE HYPOCHLORITEHYPOCHLORITE
ref
NaOClNaOCl
IS A STRONG OXIDIZING AGENTIS A STRONG OXIDIZING AGENT REDUCES BOND STRENGTH OF REDUCES BOND STRENGTH OF
DENTIN BONDING AGENTSDENTIN BONDING AGENTS Ari et al, JOE, 2003Ari et al, JOE, 2003 Erdemir et al, JOE, 2004Erdemir et al, JOE, 2004 Santos eta l JOE, 2006Santos eta l JOE, 2006 Lai et al, J Deny Res 2001Lai et al, J Deny Res 2001
REVERSING NaOCl EFFECTS ON REVERSING NaOCl EFFECTS ON DBASDBAS
A reducing agent, such as ascorbic acid, or A reducing agent, such as ascorbic acid, or sodium ascorbate, can reverse the effect of sodium ascorbate, can reverse the effect of NaOCl on bonding strengthNaOCl on bonding strength
Morris et al, JOE, 2001Morris et al, JOE, 2001
Lai et al, J Dent Res, 2001Lai et al, J Dent Res, 2001
Yiu et al, J Dent Res, 2002Yiu et al, J Dent Res, 2002
Weston et al JOE, 2007: 10% Na ascorbate for Weston et al JOE, 2007: 10% Na ascorbate for 1 min restored the origonal bond strenghts1 min restored the origonal bond strenghts
EDTA reverses effect of EDTA reverses effect of NaOClNaOCl
Doyle t al, JOE, 2006Doyle t al, JOE, 2006 A final rinse with EDTA reversed the A final rinse with EDTA reversed the
effects of NaOCl on bondingeffects of NaOCl on bonding
H2O2 reduces bond strength of H2O2 reduces bond strength of DBAsDBAs
Erdemir et al JOE, 2004Erdemir et al JOE, 2004 Nikaido et al, Am J Dent 1999Nikaido et al, Am J Dent 1999
DEEP CARIES DISINFECTIONDEEP CARIES DISINFECTION
Optim 33TB Sci CanOptim 33TB Sci Can One minute kill One minute kill
==10 Log 10 Log -6-6
TB effectiveTB effective CR tested April 2007CR tested April 2007 Excellent surface Excellent surface
cleanercleaner Tissue compatible Tissue compatible
WALFORD DEEP CARIES / WALFORD DEEP CARIES / EXPOSURE PROTOCOLEXPOSURE PROTOCOL
GET CLOSEGET CLOSE OPTIM 33TB ONE MINUTEOPTIM 33TB ONE MINUTE NO DETECTORNO DETECTOR CAREFUL ECAVATIONCAREFUL ECAVATION
SLOW RPMSSLOW RPMS SPOONSPOON
SMEAR CLEAR ONE MINUTESMEAR CLEAR ONE MINUTE REMOVE SMEAR LAYERREMOVE SMEAR LAYER
OPTIM 33 ONE MINUTEOPTIM 33 ONE MINUTE PENETRATE TUBULESPENETRATE TUBULES
REMOVING SMEAR LAYER &REMOVING SMEAR LAYER &PENETRATING TUBULESPENETRATING TUBULES
EDTAEDTA SmearClear (SybronEndo)SmearClear (SybronEndo) QMix (Tulsa/Dentsply)QMix (Tulsa/Dentsply) Acid etchAcid etch
WALFORD DEEP CARIES / WALFORD DEEP CARIES / EXPOSURE PROTOCOLEXPOSURE PROTOCOL
GET CLOSE: OPTIM 33TB GET CLOSE: OPTIM 33TB ONE MINUTEONE MINUTE
NO DETECTORNO DETECTOR CAREFUL ECAVATIONCAREFUL ECAVATION
SLOW RPMSSLOW RPMS SPOONSPOON
SMEAR CLEAR ONE SMEAR CLEAR ONE MINUTEMINUTE REMOVE SMEAR LAYERREMOVE SMEAR LAYER
OPTIM 33 ONE MINUTEOPTIM 33 ONE MINUTE PENETRATE TUBULESPENETRATE TUBULES
SMEAR CLEAR (as SMEAR CLEAR (as reducer)reducer)
EXPOSE if still cariousEXPOSE if still carious MTA DIRECT CAPMTA DIRECT CAP OVERSEAL WITH GLASS OVERSEAL WITH GLASS
IONOMER or CA(OH)2IONOMER or CA(OH)2 ALLOW TO SETALLOW TO SET ETCH PRIME BONDETCH PRIME BOND OVERSEAL OVERSEAL
FLOWABLE/CURE FLOWABLE/CURE FLOWABLE /CUREFLOWABLE /CURE RESTORE FOLLOWING RESTORE FOLLOWING
LOW CONTRACTION LOW CONTRACTION STRESS PRINCIPLESSTRESS PRINCIPLES
MTA: SUPPLIERMTA: SUPPLIER
CLINICAL RESEARCH DENTALCLINICAL RESEARCH DENTAL LONDON ONTARIOLONDON ONTARIO 1800 265 34441800 265 3444
““MTA ANGELUS WHITE”MTA ANGELUS WHITE”
MTA MECHANISMMTA MECHANISM
Silviera CMM et al.Silviera CMM et al. Repair of Furcal Repair of Furcal Perforation with Mineral Trioxide Perforation with Mineral Trioxide Aggregate: Long-Term Follow-Up Aggregate: Long-Term Follow-Up of 2 Cases of 2 Cases JCDA October 2008 Vol JCDA October 2008 Vol 74 #8 729-73274 #8 729-732
http://www.cda-adc.ca/jcda/vol-74/isshttp://www.cda-adc.ca/jcda/vol-74/issue-8/729.htmlue-8/729.html
MTA MECHANISMMTA MECHANISM
Saidon J et al.Saidon J et al. OSOMOPOR Endod OSOMOPOR Endod 2003:95:483-2003:95:483-489 “Cell and tissue 489 “Cell and tissue reactions to mineral trioxide reactions to mineral trioxide aggregate (MTA) and Portland aggregate (MTA) and Portland cement.”cement.”
MTA and Portland cement show MTA and Portland cement show comparative biocompatibility when comparative biocompatibility when evaluated in vitro and in vivo. The evaluated in vitro and in vivo. The Portland cement was sterilized by Portland cement was sterilized by ethylene oxide.ethylene oxide.
MTA MENTE ET ALMTA MENTE ET AL
Johannes Mente, DMD, et al J. Endo May 2010 806-814
Mineral Trioxide Aggregate or Calcium Hydroxide Direct Pulp Capping: An Analysis of the Clinical Treatment Outcome
5 years, 167 teeth 78% success MTA, 60% Ca(OH)2
i.e. Twice as much failure with Ca(OH)2
Mente, DMD, et al J. Endo May 2010
Dentin bridge formation with MTA seems to be more homogenous (fewer tunnel defects) and more localized than that formed with Ca(OH)2 (20–24). caries was excavated from the cavity walls.
Near to the pulp, except for one carious spot, the removal of which resulted in exposure of the pulp, the cavities were routinely disinfected with 0.12% chlorhexidine solution (Glaxo Smith Kline GmbH, Buhl, Germany).
Resolution of bleeding from the exposed pulp in less than 5minutes was considered to be indicative of reversible inflammation
The MTA pulp cap was overlaid with a thin protective layer of resin modified glass ionomer cement (Vitrebond; 3M Espe)
The reduction in clinical success if a direct pulp capping is not followed immediately with permanent restoration has been shown in other clinical studies (11, 12)
The longer the follow-up period, the more evident the trend became to a decline in the success rate of the teeth in the Ca(OH)2 group compared with the MTA group.
SUCCESSFUL PULP CAPSSUCCESSFUL PULP CAPS
Healthy patient
Recoverable pulp
Flawless caries removal
Disinfection
Histological repair
seal
Inflammationmanagement
RESIN BIOCOMPATIBILITY???RESIN BIOCOMPATIBILITY???
Volk,J, Volk,J, Engelmann,J.,Leyhausen,G.,Engelmann,J.,Leyhausen,G.,Geurtsen,WGeurtsen,W..
Dental Materials 2006 22:499-505Dental Materials 2006 22:499-505 Effects of three resin monomers on the Effects of three resin monomers on the
cellular glutathione concentration of cellular glutathione concentration of cultured human fibroblastscultured human fibroblasts
SeeSee Website: Home>MODXYZ> Website: Home>MODXYZ> BiocompatibilityBiocompatibility
ref
DYRACT AND DYRACT-CEM DYRACT AND DYRACT-CEM AND VITREBONDAND VITREBOND
J Dent Res. 1998 Dec;77(12):2012-9.J Dent Res. 1998 Dec;77(12):2012-9.Residual monomer/additive release and variability in Residual monomer/additive release and variability in
cytotoxicity of light-curing glass-ionomer cements and cytotoxicity of light-curing glass-ionomer cements and compomers. Geurtsen W, Spahl W, Leyhausen G. compomers. Geurtsen W, Spahl W, Leyhausen G. Severe Severe cytotoxic effects were observed in response to both of cytotoxic effects were observed in response to both of these materialsthese materials
Mutat Res. 1996 Jul 5;368(3-4):181-94.Mutat Res. 1996 Jul 5;368(3-4):181-94. Genotoxicity of dental materials. Heil J, Reifferscheid G, Genotoxicity of dental materials. Heil J, Reifferscheid G,
Waldmann P, Leyhausen G, Geurtsen W. Waldmann P, Leyhausen G, Geurtsen W. Genotoxic effects Genotoxic effects were found for Vitrebond and AH 26were found for Vitrebond and AH 26 (since upgraded to (since upgraded to AH26 Plus)AH26 Plus)
GLASS IONOMER GLASS IONOMER BIOCOMPATIBILITYBIOCOMPATIBILITY
Biomaterials. 1998 Mar;19(6):559-64.Biomaterials. 1998 Mar;19(6):559-64.Biocompatibility of various light-curing Biocompatibility of various light-curing and one conventional glass-ionomer and one conventional glass-ionomer cement.cement.Leyhausen G, Abtahi M, Karbakhsch M, Leyhausen G, Abtahi M, Karbakhsch M, Sapotnick A, Geurtsen W.Sapotnick A, Geurtsen W.
Two GIs was found to be very Two GIs was found to be very biocompatiblebiocompatible, while Vitrebond was , while Vitrebond was found to be cytotoxic. found to be cytotoxic.
MTA THERAPIESMTA THERAPIES
Indirect Pulp cap (Pink Dentin)Indirect Pulp cap (Pink Dentin) Direct pulp cap (Direct Exposure)Direct pulp cap (Direct Exposure) Pulpotomy (Coronal extirpation)Pulpotomy (Coronal extirpation) Pulpectomy (Coronal and radicular Pulpectomy (Coronal and radicular
extirpation)extirpation) Root canal therapy Root canal therapy
Perforation repairPerforation repair ApicoectomyApicoectomy
NEW - BIODENTINENEW - BIODENTINE
SEPTODONTSEPTODONT $17 PER APPLICATION$17 PER APPLICATION REQUIRES TRITURATORREQUIRES TRITURATOR IS MEANT TO BE A COMPLETE IS MEANT TO BE A COMPLETE
TEMPORARY FILLINGTEMPORARY FILLING STICKY HANDLINGSTICKY HANDLING INDEPENDENT REVIEW YET TO BE SEENINDEPENDENT REVIEW YET TO BE SEEN
PEDODONTIC PULPOTOMYPEDODONTIC PULPOTOMY
SUCCESSFUL PULP CAPSSUCCESSFUL PULP CAPS
Healthy patient
Recoverable pulp
Flawless caries removal
Disinfection
Histological repair
Inflammationmanagement
Seal
SEALING THE PULP CAPSEALING THE PULP CAP
IMMEDIATE RESTORATION improves IMMEDIATE RESTORATION improves prognosis 30% (Mente et al)prognosis 30% (Mente et al)
PROTECT THE CAP from shrinkage PROTECT THE CAP from shrinkage FINAL RESTORATION with low FINAL RESTORATION with low
sensitivity techniquesensitivity technique CAREFUL OCCLUSIONCAREFUL OCCLUSION
CAREFUL AND ACCURATE CAREFUL AND ACCURATE OCCLUSION OCCLUSION
SUCCESSFUL PULP CAPSSUCCESSFUL PULP CAPS
Healthy patient
Recoverable pulp
Flawless caries removal
Disinfection
seal
Histological repair
Inflammationmanagement
INFLAMMATION INFLAMMATION MANAGEMNTMANAGEMNT
MEDICATIONMEDICATION Disciplined use ofDisciplined use of
Ibuprofen Ibuprofen 400 mg 400 mg for 24 hours q4h 6 for 24 hours q4h 6 tabstabs
Instruct to use Instruct to use regardless if painful regardless if painful or notor not
COMMUNICATIONCOMMUNICATION 1.1. Cautious prognosisCautious prognosis2.2. ““Call me I want to Call me I want to
know”know”3.3. Next day follow-up Next day follow-up
call 11 amcall 11 am4.4. Not that night!Not that night!5.5. Inform that success Inform that success
may be temporarymay be temporary
THE ENDTHE END