Pulp Treatments in Primary Teeth (Canal Treatments) PDF

Indirect pulp capping is applied to teeth with deep caries approaching the pulp, but without any symptoms of pulp degeneration. It is left to prevent the opening of the carious pulp around the pulp and is covered with a biocompatible material. A radiopaque material such as dentin bonding agent, resi...

Indirect pulp capping is applied to teeth with deep caries approaching the pulp, but without any symptoms of pulp degeneration. It is left to prevent the opening of the carious pulp around the pulp and is covered with a biocompatible material. A radiopaque material such as dentin bonding agent, resin modified glass ionomer, calcium hydroxide, zinc oxide eugenol, or glass ionomer cement is placed over the remaining carious dentin tissue to stimulate dentin repair. Because calcium hydroxide is high in solubility, low in bond strength, and unstable under pressures, glass ionomer or reinforced zinc oxide ogenol should be placed on top of calcium hydroxide to form a barrier against microleakage. Glass ionomer cements or reinforced zinc oxide eugenol restorative materials provide an extra advantage as they have a stopping effect on cariogenic bacteria. Then the tooth should be restored with a sealed material.  Indication: It is indicated in deciduous and adult teeth that are not diagnosed with pulpitis or in the stage of reversible pulpitis, when the caries closest to the pulp is not cleaned to prevent perforation. The pulp must be clinically and radiographically vital and in a resilient condition.  It is the process of closing the dentinal tubules by placing a thin barrier between the pulp surface and the restorative material or cement in deep cavity preparations. The choice of calcium hydroxide, dentin bonding agent or glass ionomer cement as a protective barrier is at the discretion of the clinician. Indication: When all caries is removed in teeth with a normal pulp, a protective barrier can be applied to minimize damage to the pulp, induce healing of pulp tissue, and/or reduce post-operative sensitivity. Purpose: To preserve the vitality of the tooth, to support the healing of the pulp tissue and the formation of tertiary dentin, and to minimize bacterial microleakage. To avoid clinical symptoms that may occur after treatment, such as tenderness, pain or swelling.  Contraindication: If there are signs of infection in the pulp(?) If there is prolonged and spontaneous pain If there is a soft tissue finding (edema, fistula, etc.) If percussion sensitivity If there is a pathological finding radiographically NOT APPLIED in cases of excessive mobility.  Purpose: The restorative material to be used should completely disconnect the tooth from the oral cavity. The tooth should be able to maintain its vitality. There should be no symptoms such as tenderness, pain or swelling after treatment. Radiographically, there should be no pathological changes such as external or internal root resorption.The permanent tooth that will come from below should not be damaged.  Technical: Local anesthesia is administered Isolation is provided with the help of cotton pad, rubber dam or saliva ejector. The entrance cavity is opened with a water- cooled high-speed tour. All caries on the cavity walls are cleaned Soft necrotic and infected dentin at the cavity floor is removed using a low-turn large steel round bur without perforating the pulp. Colored and hard dentin is left at the base of the cavity The cavity is washed and dried with cotton pellets. Discolored dentin is covered with a thin layer of tissue-friendly material (fast-setting CaOH, glass ionomer, ZOE). Permanent restoration (compomer/composite, SSC, amalgam)  If the size of perforation is like a pinhead during cavity preparation or after traumatic injuries biocompatible radiopaque such as MTA or calcium hydroxidea material should be placed on the opened pulp tissue. Then the tooth will prevent microleakage should be restored accordingly.  Contraindication: In pulp openings caused by caries in primary teethm If there is inflammation in the pulp If there is prolonged and spontaneous pain If there is a soft tissue finding (edema, fistula, etc. Percussion sensitivity If there are pathological findings radiographically Excessive mobility If the pulp is opened from the approximal wall If bleeding from the pulp cannot be controlled If the opened part of the pulp is larger than the needle tip If there is calcification in the pulp NOT APPLIED.  Indication: This application is performed in primary teeth with healthy pulp, which is surrounded by solid dentin.It is indicated for traumatic small pulp openings. None or very little bleeding in the pulp is the important factor too.  Aim: The vitality of the tooth should be preserved. Absence of symptoms such as tenderness, pain or swelling after treatment required. Pulp healing and repair dentin formation should occur. There should be no external/internal root resorption or furcation site/apical radiolucency. The permanent tooth that will come from below should not be damaged.  Technic: Isolation is provided with the help of cotton pad, rubber dam or saliva ejector. The entrance cavity is opened with a water- cooled high-speed tour. All the caries on the cavity walls are cleaned, the caries on the pulp is removed last. Bleeding on the surface opened when the pulp is opened, saline / sodium hypochlorite impregnatedIt is controlled and dried by pressing lightly with a sterile cotton pellet. The opened pulp surface is covered with CaOH2 (powder-liquid/commercial preparation/fast-curing/light-cured) CaOH2 should be in direct contact with the pulp tissue.Pressure should not be applied when placing the paste on the pulp so that the paste is not pushed into the pulp. CaOH2 may remain in the cavity as a base material in small teeth such as primary first molars,ZOE, CIS are used as base material on CaOH2 on other teeth Permanent restoration (compomer/composite, SSC, amalgam)  Pulpotomy in deep caries deciduous teeth without radicular pathology and cleaning the caries is applied in cases where the pulp is perforated mechanically or with caries during the procedure. CoronalThe pulp is amputated and the remaining pulp tissue is Buckley's, which provides long-term clinical success.The solution is treated with formocresol or ferric sulfate. Clinical studies of calcium hydroxideits success is short-lived. MTA, on the other hand, has been used in pulpotomy in recent years.is the material. Clinical studies suggest that MTA is a better alternative to formocresol or ferric sulfate.that it is material.Then, after the coronal pulp chamber is filled with zinc oxide ogenol, the tooth is sealed.must be restored. The most effective long-term restoration is stainless steel crowns. However, the remainingIf the crown has sufficient enamel thickness, adhesive resins can be used as restorative material.can be used.  Then, after the coronal pulp chamber is filled with zinc oxide ogenol, the tooth is sealed.must be restored. The most effective long-term restoration is stainless steel crowns. However, the remainingIf the crown has sufficient enamel thickness, adhesive resins can be used as restorative material.can be used.  Indication: Pulpotomy during caries removal in healthy or reversible pulpitis-diagnosed primary teeth is indicated for pulp openings greater than 0.5 mm or traumatically. Coronal pulpAfter amputation, the remaining radicular tissues should be vital, any pus flow, necrosisUncontrollable bleeding and infection in a few minutes with a cotton ball or cotton pellet or there should be no signs of pathological resorption. The tooth should be asymptomatic, dependent on the stimulusThere may be temporary pain relief.  Contraindication:If there is spontenious and throbbing pain, night pain, If there is a lesion in the furcha and/or parapical region radiologically If there is internal/external resorption Fistula and edema Severe Percussion sensitivitym If there is pathological mobility NOT APPLIED if bleeding from the pulp cannot be controlled.  Aim: The remaining pulp should be asymptomatic and clinical signs such as tenderness, pain and swelling occur.should not occur.. Pathological external root resorption as a postoperative radiographic findings hould not be seen. Internal root resorption should be stable and well-defined. Internal resorption If there is, the physician should follow this tooth,:İ if the perforation that occurs creates a loss in the supporting bone If infection and inflammation occur as clinical signs and/or clinical signs, the tooth should be removed.  Technic:Access cavity is opened using a water cooled/high speed tour, diamond rond and fissure bur. All caries on the cavity walls are cleaned with the help of a low-speed round and a steel round bur. Before opening the pulp, the cavity is rinsed with physiological saline to remove dentin residues. The ceiling of the pulp chamber is lifted by a water cooled/high speed round rond bur. Coronal pulp residues are removed with the help of a sterile excavator. Bleeding with a cotton pellet impregnated with saline/sodium hypochlorite for 3-5 min.controlled by gentle pressure. If the bleeding does not stop within 3-5 minutes, the root pulp is considered infected and the root canal.treatment is done.  Formocresol: In this treatment technique, formocresol on amputated root pulp is used with the cotton pellet which is soaked with formocreso.lAfter keeping the cotton pellet there about five minutes.The surface is covered with zinc oxide eugenol paste. Then the selected restoration is done. and restoration are done.Formocresol is a caustic material and it comes into contact with the skin and mucosa of the patient during use.care should be taken not to. Fixation occurs in the pulp tissue in contact with formocresol.income. When the cotton pellet is removed, the surface of the pulp tissue in contact with formocresol is bleeding-free andshould be in brown image. Investigators histologically 1/3 below the pulp fixation area.reported that vital pulp tissue remained in the apical region.o  Ferric Sulphate Ferric sulfate enters into a chemical reaction with blood and provides pulpal hemostasis. It is used as a pulpotomy agent due to its clot formation. Cotton impregnated with ferric sulfateThe pellet is left on the pulp for 10-15 seconds. Then zinc oxide eugenol is placed.  Mineral Trioxide Aggregate MTA has been used in endodontics since the early 1990s. In the content of MTA; tricalciumsilicate, dicalcium silicate, tricalcium aluminate, tetracalcium aluminoferrite, calcium sulfate and bismuthoxide. This material has excellent bioactive properties and inhibits cytokine release from pulpal fibroblasts.It stimulates the formation of hard tissue. It is mixed with sterile water and a sandy structure is formed.It is gently placed on the radicular pulp. Since this material is hydrophilic it takes 4 hours to fully harden.  Root canal treatments in primary teeth have been a subject of debate for many years for many reasons.The reasons PULPECTOMY are:- IN PRIMARY The short lifespan of primary teeth. TEETH (CANAL The presence of permanent tooth TREATMENTS) germs in the apical regions of primary teeth and the concern that possible injuries may occur.  The variability of primary tooth canal morphologies and the difficulties of adequate canal shaping and cleaning.-An infection that starts in the primary teeth can quickly move to the periodontal and interradicular areas.  The alternative to root canal treatment in primary teeth is extraction and space maintainer.-Although most children easily adapt to the use of space maintainers, the best space maintainer is always the baby tooth itself.-Space maintainers fall out from time to time and if the family does not bring them in time, space losses are still seen.-Space maintainers cause retention for food residues when oral hygiene is not sufficient and new cavities develop.  The success criteria for root canal treatments in primary teeth are almost the same as those in permanent teeth. The treated primary tooth should not show any signs of infection later on and should be able to provide adequate function. The radiological image should be normal and it should be able to remain in the mouth until it falls out.  While the preparation, canal shaping and irrigation procedures in primary teeth canal treatments are the same as in permanent teeth, it should be kept in mind that the root length is much shorter, around 14-16 mm (from the crown cusp apex), and root morphologies vary considerably.  The most important point to be considered when filling primary tooth root canals is that the material to be FILLING THE used is a resorbable material, and it should not damage the permanent tooth PRIMARY and prevent it from erupting. The most ROOT successful material with these properties is pure ZnOE (ZINCOOXIDE CHANNELS EGENOL). Fortified, catalyst added zinc oxide eugenol preparations (Kalzinol, IRM) should definitely not be used. Gutta-Percha is definitely not used.  Zinc oxide powder is mixed with eugenol until a homogeneous paste of medium hardness is obtained. Lentulo is poured into the canal with an amalgam gun or endodontic injectors. Special pluggers and moistened cotton pellets help. PULP What kind of pulp treatment TREATMENTS will be done in such teeth IN YOUNG depends on the root development and pulp vitality PERMANENT of the related tooth. TEETH VITALTOOTH, ROOT If the exposed small area is not left DEVELOPMENT open for a long time, direct pulp coating is performed with calcium hydroxide. It COMPLETED, is restored with glass ionomer cement. PULP EXPOSURE It is checked with periapical or bite- wing radiographs every 3 months, IS SMALL IN SIZE vitality test is performed. When AND DUE TO reperative dentin formation is observed, permanent restoration is started. EITHER CARIES OR TRAUMA TOOTH IS VITAL, ROOT Pulpotomy (amputation) is the treatment that should be preferred. The DEVELOPMENT material to be used is calcium NOT hydroxide. The patient is called for control every 3 months to check both COMPLETED, the apexification and the vitality of the tooth. After the apexification is PULP IS OPEN completed, root canal treatment and FOR A LONG permanent restoration are performed. TIME Extirpation, canal preparation, filling of canal with calcium hydroxide. The apexification is checked with X-ray every 3 months, then the apex is sealed with MTA. Root canal treatment and permanent restoration are performed. TOOTH NONVITAL,ROOT DEVELOPMENT NOT COMPLETED  It is a treatment method in young permanent teeth that have not completed their development. The tooth can be vital or nonvitall. In nonvital teeth, necrotic pulp APEXIFICATION tissue toxins damage the Hertwig epithelial cells responsible for root formation, root development stops. A normal apex cannot be formed, the chance of success decreases.  For more normal closure of the apex, all devital pulp tissue is removed. To create a calcified barrier in the apical region, pure calcium hydroxide mixed with sterile distilled water is placed into the canal using lentulo or endodontic syringes.  The length of the canal is determined by apex locator or x- ray. The canal is filled with calcium hydroxide, 1.5-2 mm shorter. Apexification is completed within 6 months to 3 years. X-rays are taken every 3 months for the first year, then every 6 months, and clinical checks are performed. When sufficient apexification occurs, the canal is reopened. Calcium hydroxide is removed with irrigation. Normal canal filling is performed.  This treatment is recommended for teeth in which the pulp is devitalized especially due to trauma. The chance of success is higher if the REVASCULERIZATION pulp is necrotic but not infected. This technique AND REGENERATION OF THE PULP is based on the idea that stem cells in the periapical region adhere to the nonvital but non- infected pulp tissue in the apex and provide regeneration.  Stem cells are cells that can change their identity for regeneration purposes when necessary. For this purpose, the pulp tissue is first disinfected without being extirpated. The canal is irrigated with 5.25% sodium hypochlorite solution. Then, Metranidazole, Minocyline, Ciprofloxacin are mixed and placed in the canal. The canal is closed for 15-20 days. Then the canal is opened, bleeding is created at the apex with a canal instrument, after the clot is formed, MTA is applied on top of it and placed in the apex and along the canal. The chance of success is high, especially in teeth with wide apex.