FAQs – PULPOTOMY AND APEXIFICATION

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11. What is direct pulp capping?

It is the procedure in which a medicament or a dressing is applied to the exposed pulp, in an attempt to preserve the vitality.

12. Why is pulp capping not done in teeth with canal calcifications?

Teeth with calcifications in the canal or pulp chamber are indicative of previous inflammatory responses or trauma and make the pulp less responsive to vital pulp therapy. So pulp capping is not done in such teeth.

13. Exposed caries on primary teeth should not be pulp capped – WHY?

It is because, in carious pulp exposures, microorganisms and inflammation are associated which cannot be eliminated macroscopically. Also a larger area of carious exposure has more inflamed tissue and microorganisms. So pulp capping is indicated only for mechanical pulp exposures in primary teeth.

14. How does location of pulp exposure affect the prognosis of pulp capping?

If the pulp is mechanically exposed on the axial wall, the pulp tissue that is coronal to the exposure site is deprived of its blood supply and necrosis occurs. So in such cases, a pulpotomy or a pulpectomy is advised.

15. What is MTA?

MTA is Mineral Trioxide Aggregate which is a biocompatible pulp capping agent. It produces more dentinal bridge in a shorter period of time, with less inflammation when compared to calcium hydroxide.

16. What are the contra indications for pulp capping?

Primary teeth with carious exposures
Permanent teeth with H/o spontaneous tooth ache
Radiographic evidence of pulpal or periapical pathosis
Calcified canals
Excessive bleeding at the exposure site
Purulent or serous exudates at the exposure site

17. How is the pulpotomy procedure described for a primary tooth?

The pulpotomy procedure in a primary tooth is described as the amputation of the affected or infected coronal portion of the dental pulp, preserving the vitality and function of all or part of the remaining radicular pulp.

18. What are the evidences for the success for a pulpotomy in a primary tooth?

Vitality for major part of the radicular pulp
Absence of adverse signs and symptoms
No radiographic evidence of canal calcifications or internal resorption
No breakdown of periradicular tissue
No harm to the succeeding tooth

19. What are the zones present in a tooth that is exposed to formocresol pulpotomy?

A broad acidophilic zone of fixation
A broad pale staining zone with diminished cellular and fiber definition
A broad zone of inflammatory cells concentrated at the pale staining junction and diffusing apically into the normal pulp.

20. When is formocresol pulpotomy contraindicated in a primary tooth?

When the tooth is non restorable
Tooth nearing exfoliation
H/o spontaneous tooth ache
Presence of periapical pathology
No bleeding pulp
Uncontrolled bleeding after pulp amputation
Draining pulp
Presence of sinus