The decision for pulp therapy is based primarily on pain and pulpal status.
If the pain is -
- Spontaneous
- Nocturnal ------> Irreversible ------> Non Vital Pulp
- Constant
- Intermittent
- Thermal ------> Reversible -------> Vital Pulp
- Chemical
Outline of Pulp Therapy in Children
Vital Pulp Therapy
- Protective Base
- Indirect Pulp Capping
- Direct Pulp Capping
- Pulpotomy
Non Vital Pulp Therapy
- Pulpectomy
- Extraction
Vital Pulp Therapy
1] Protective Base
- Radiopaque base between restoration & dentin
- Acts as a protective barrier
- Seals dentinal tubules
- Minimizes pulp injury & allows pulpal healing
- Preserves health and vitality of restored tooth
2] Indirect Pulp Capping
Objectives IDP :
Objectives IDP :
- Halt the carious process .
- Allow pulp healing and reparative dentin formation.
Indications :
- symptom free tooth
- no X-ray evidence of Pulpal pathosis
- absence of furcal or periapical pathology
- negative percussion test
Procedure :
- Single appointment approach : (Most common approach used these days)
- Excavation of caries
- Permanent restoration is placed at the first appointment
itself.
- Periodic monitoring of the tooth.
- Two appointment approach :
- Excavation of all the superficial carious dentin.
- A layer of affected dentin is left behind to prevent potential
pulp exposure.
- Pulp dressing placed or the layer of affected dentin for
about 6- 12 months.
about 6- 12 months.
II. Second appointment : (after 6-12 months)
- Remaining soft carious dentin excavated
- Floor of the cavity examined for pulp exposure.
- No pulp exposure ----------> Place Permanent restoration.
- Pulp exposure present -------> Pulpotomy
Pulp Dressings used :
Pulp Dressings used :
- Calcium Hydroxide
- Hybrid Ionomer materials
- Glass Ionomer materials
Permanent Restoration :
- Glass Ionomer
- Hybrid Ionomer
- Composite
- Compomer
- Amalgam
- Stainless Steel Crown
For Permanent dentition- Composite, Amalgam, stainless steel crown or cast crown restorations are usually used.