AO and Pulpotomy PDF

Chief Complaint – pain while eating; it subsides after a few minutes without taking analgesics...

Chief Complaint – pain while eating; it subsides after a few minutes without taking analgesics Examination Diagnosis Investigations – Periapical radiograph – Bitewing RG Diagnosis – reversible pulp inflammation 17/11/2024 Paedodontics and Preventive Dentistry 3 The clinical diagnosis The indications, objectives, and type of pulpal A comprehensive medical history. A objective extra-oral examination as well as therapy depend on whether the pulp is vital A review of past and present dental history examination of the intraoral soft and hard or nonvital, based on the clinical diagnosis of and treatment, including current symptoms tissues. normal pulp (symptom free and normally and chief complaint. If obtainable, radiograph(s) to diagnose responsive to vitality testing), reversible A subjective evaluation of the area associated pulpitis or necrosis showing the involved pulpitis (pulp is capable of healing), with the current symptoms/chief complaint by tooth, furcation, peri- apical area, and the questioning the child and parent on the surrounding bone symptomatic or asymptomatic irreversible pulpitis (vital inflamed pulp is incapable of location, intensity, duration, stimulus, relief, Clinical tests such as palpation, percussion, and spontaneity. and mobility. healing), or necrotic pulp. 17/11/2024 Paedodontics and Preventive Dentistry 4 Diagnosis and pulpal treatment Spontaneous, throbbing pain simulating an irreversible pulp History Clinical Ex Radiographic Ex planning condition can be observed when the inter dental gingiva is inflamed due to food impaction. Clinical history – History of pain – Symptoms of pain Extent of pulpal inflammation Operative diagnosis 17/11/2024 Paedodontics and Preventive Dentistry 7 17/11/2024 Paedodontics and Preventive Dentistry 8 17/11/2024 Paedodontics and Preventive Dentistry 9  Clinical assessment – Abscess, excessive mobility, swelling, or tenderness to percussion – Tooth restorable – Extent of marginal ridge breakdown – Site of caries occlusal or proximal – attention should be paid to missing or fractured restorations 17/11/2024 Paedodontics and Preventive Dentistry 11 17/11/2024 Paedodontics and Preventive Dentistry 12 Palpation – Fluctuation, felt by palpating a swollen mucobuccal fold, may be the expression of an acute dentoalveolar abscess prior to exteriorization. – Bone destruction following a chronic dentoalveolar abscess can be also detected by palpation. 17/11/2024 Paedodontics and Preventive Dentistry 13 17/11/2024 Paedodontics and Preventive Dentistry 14 17/11/2024 Paedodontics and Preventive Dentistry 15 Clinical assessment Mobility Percussion test Electrical - no – Comparing the mobility of a suspicious tooth with its – Sensitivity to percussion may reveal a painful tooth contralateral tooth is of particular importance. in which inflammation has progressed to involve Thermal – no – Significant difference is observed, pulpal disease the periodontal ligament (acute apical periodontitis). However, care should be taken in interpreting these – False positive results might be suspected – normal time of exfoliation tests. – apprehensive – Percussion should be done very gently with the tip of a finger and not with the end of a dental mirror to prevent exposing the child to unnecessary uncomfortable stimuli. 17/11/2024 Paedodontics and Preventive Dentistry 16 17/11/2024 Paedodontics and Preventive Dentistry 17 17/11/2024 Paedodontics and Preventive Dentistry 18  Radiographic assessment high-quality bitewing radiograph – Root length – Perifurcational pathology – Internal resorption seen in root canal 17/11/2024 Paedodontics and Preventive Dentistry 19 17/11/2024 Paedodontics and Preventive Dentistry 20 No caries Indirect Direct Pulpotomy Vital pulpotomy Non-vital Extraction removal pulpotomy No Hx of pain or symptoms Operative Diagnosis Yes Yes No Yes Yes NA NA Hx of reversible pulpitis No No No Yes Yes NA NA Hx of irreversible pulpitis No No No No Yes NA NA MR breakdown 2/3rd Yes No No Yes Yes Yes ? inflammation – Occlusal caries Yes Yes No Yes Yes Yes ? pain Proximal caries Yes ? No Yes Yes Yes If symptomatic or sepsis Pulp tissue is Unrestorable No No No No No No If symptomatic or sepsis exposed - in Sinus, swelling, TOP, mobility No No No No No No Yes pulpotomy, Root length >1/3rd Yes Yes No Yes NA NA NA Root length