1. What are the indications for a vital pulp therapy?
Vital pulp therapy is indicated in teeth with incomplete apical development, primary teeth, teeth that would be difficult to be treated endodontically and teeth with pulpal inflammation confined to a small segment of the coronal pulp.
2. What is Apexogenesis?
A pulpotomy procedure that is indicated in a tooth with an open apex to allow completion of apical closure, with a vital pulp is called as Apexogenesis.
3. What is a Blunderbuss canal?
When trauma or decay causes a pulpal exposure or periapical involvement prior to the completion of root formation, an open apex results in which there is no conical taper to the canal. The canal is wider towards the apex than the cervical area. This is called a blunderbuss canal.
4. What are the materials used to fill the canal in apexification?
A thick paste that contains calcium hydroxide and CMCP is placed in the canal till it reaches the apical portion, to stimulate the tissues to form a calcific barrier.
5. What are the possible apical conditions in 6 months follow up radiograph of a patient treated by Apexification?
No radiographic change, but an inserted instrument encounters blockage
Radiographic evidence of calcified material at the apex.
Closure of the apex with no change in the canal space
Continuous apical development with canal space closure
No radiographic evidences, persistence of symptoms and an increase in the size of the periapical lesion.
6. Why is pulp testing not reliable in primary teeth and young permanent teeth?
The EPT or thermal tests are not reliable because of the incompletely formed apex, immature development of nerve bundle and the extent of inflammation within the pulp is not obtained. Also apprehension, fear, management problems give unreliable results.
7. What is indirect pulp therapy?
It is a technique done for vital teeth, to avoid pulp exposure while treating teeth with deep carious lesions with no clinical evidence of pulpal degeneration or periapical disease.
8. What is the objective of indirect pulp therapy?
The objective is to arrest the carious process by promoting dentinal sclerosis and stimulating the formation of reparative dentin with remineralisation of the carious dentin and also preserving the vitality of the pulp. The natural protective mechanisms of the pulp against caries are used by the teeth.
9. What are the layers in an active caries?
Necrotic soft dentin, not painful to stimulation and grossly infected with bacteria.
Firm but softened dentin, painful to stimulation, containing fewer bacteria.
Slightly discoloured, hard, sound dentin containing few bacteria and painful to stimulation.
10. How does indirect pulp capping aid in reparative dentin formation?
When indirect pulp capping is done, the outer layer of carious dentin are removed and most of the bacteria are eliminated from the lesion. When the lesion is sealed, the substrate for acid production is also removed. When the carious process is arrested, the reparative mechanism starts and dentin is laid down, avoiding pulpal exposure.
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