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Lecture eight-- operative dentistry--Treatment of deep seated caries

الكلية كلية طب الاسنان     القسم ترميم ومعالجة الاسنان     المرحلة 4
أستاذ المادة احمد غانم مهدي الهلال       4/18/2011 7:44:23 AM
Treatment of deep seated caries

 In a shallow or moderately deep cavity, all carious dentine should be removed leaving a glossy hard dentin surfaces. In deep cavities, all carious dentine at the periphery of the cavity should be excavated to establish a clean healthy junction with the restorative material. In treatment of deep carious lesions, the dentist has several options listed below in order of severity, they are as follows:

A- Vital pulp therapy for teeth diagnosed with a normal pulp or reversible pulpitis:

 A protective base is a material placed on the pulpal surface of a cavity; it must cover the exposed dentinal tubules and act as protective barriers between the restorative material or cement and the pulp. The protective base is used to preserves the tooth vitality, promotes pulp tissue healing and tertiary dentin formation, and minimizes microleakage.

 I- Indirect pulp capping:

It is two or more appointment, preferred by many clinicians, more conservative and yields more favorable results than direct pulp capping. Procedure:
  •  The field must be isolated with rubber dam to minimize the bacterial contamination of the  treatment site.
  •  All peripheral carious dentin is removed with large round bur or sharp spoon excavator.
  •  Only soft carious dentin is removed in the area close to the pulp.
  •  CaOH2 and zinc oxide cement or temporary filling is placed.

 After 3-6 weeks:
  • The cement is removed.
  • Internal surface of the cavity is inspected for remineralization and secondary dentin formation.
  • Remove any residual soft dentin.
  • Place CaOH2 and lining material and permanent filling is placed.

Indication of indirect pulp capping:

1. Deep carious lesion.
2. No history of spontaneous pain.
3. Positive vitality test.
4. Very small exposure.
5. The bleeding should be bright red.

 II- Direct pulp capping:
  •  One or two appointment.
  •  Carious dentine is completely removed.
  • The pulp bleeds when touched.

Procedure:
  • The field must be isolated with rubber dam to minimize the bacterial contamination of the treatment site.
  •  Soft carious dentin is carefully removed.
  •  Extreme care not to force carious dentin into pulp chamber.
  •  Burs and air must not be used.
  •  Sterile water or normal saline must be used.
  •  If the bleeding at the exposure site is arrested and the area is dry, then we put CaOH2 covering all exposure site and 1-2 mm of the surrounding area.
  •  Then place cement (zinc oxide or glass ionomer or any other cement).
  •  Amalgam restoration.

 After 3-4 months:

Completely remove the filling and cement and inspect the exposure site for secondary dentin formation.

Signs of Clinical success:
  • No hemorrhage or blood coagulates on x-ray.
  • Secondary dentin formation.
  • No history of pain.

Indication:
 
1. Small mechanical exposure.
2. Adequate hemostasis is achieved.
3. Restorable tooth.

 III- Permanent tooth Pulpatomy:

 Is a conservative procedure to remove inflamed coronal pulp tissue and preserve the vitality of the remaining radicular pulp.

Indication:

• Permanent tooth with incomplete root formation.
• No abscess, fistula, no mobility, large carious lesion or mechanical pulp exposure.

Procedure:
 
  •  The field must be isolated with rubber dam to minimize the bacterial contamination of the treatment site.
  •  Cut the pulp and the surrounding dentin up to 2 mm beyond the exposure.
  •  Stop the bleeding, cover the pulp with CaOH2 and complete the restoration.

Criteria for success:

1. No clinical sign and symptoms.
2. No radiographical pathology.
3. Continued root development.
4. Formation of calcific barriers.

After the complete root formation the tooth should be reopened and removes any restorative material from the pulp chamber and root canal therapy is done.

 B-Non vital pulp treatment:

Either root canal treatment or extraction of the tooth.

 Healing process of pulp after injury:

Once the exposed pulp is capped with CaOH2, the healing process in the pulp begins. CaOH2 has high pH value ranging from (10-12) and its effect is of short duration. The repair process begins in the pulp at the 3rd day after capping by proliferation of fibroblast towards the side of injury from the deeper pulp tissue.

المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .