BASICS OF
ENDODONTICS IN
CHILDREN
CONTENTS
PLO- K1
Introduction CLO- 1.1
Pulpodentin complex
Functions of pulpodentin complex
Differences in primary and permanent pulpodentin complex
Reactions of the primary pulp to irritants
Primary pulp diseases
Management of primary pulp diseases
INTRODUCTION
ENDODONTICS:
"Endo" is the Greek word ="inside”
“Odont" in Greek ="tooth"
Morphology Physiology
.
Endodontics
is the branch of dentistry Diagnosis,
Pathology Prevention and
concerned with treatment
History
ANATOMY OF THE PULP
PULPODENTIN COMPLEX
FUNCTIONS OF THE PULPO-DENTIN COMPLEX
Dentin and the pulp are functionally coupled and hence
integrated as a tissue with many functions.
Formative
Nutritive
formation of primary, secondary,
provision of nutrients and
and tertiary dentin
minerals via vascular supply
Functions
Sensory Defensive
response to all types of noxious through various responses to
stimuli is interpreted as pain irritants forming dead tracts,
sclerotic dentin, tertiary dentin
(reactionary& reparative), and
dentin bridge formation
DIFFERENCES BETWEEN PRIMARY AND
PERMANENT PULPODENTIN COMPLEX
1. Thickness of dentin is much lesser in primary teeth, moreover the dentinal tubules are wider.
Permeability of dentin increased
Rapid progression of caries and early pulpal involvement.
2. Pulp cavity occupies a greater bulk of the tooth and the pulp horns are highly extended.
More likely for pulpal exposure, either carious or traumatic.
DIFFERENCES BETWEEN PRIMARY AND
PERMANENT PULPODENTIN COMPLEX
Radicular pulp space exhibits unpredictable various configurations that may range from
simple round canal to oval and ribbon-shaped anatomy with multiple isthmus, fins,
anastomoses and lateral branches.
DIFFERENCES BETWEEN PRIMARY AND
PERMANENT PULPODENTIN COMPLEX
3. Secondary dentin deposition and ongoing physiologic resorption can alter the shape and number
of the root canals
4. Root resorption leaves some areas on the root surface denuded of Cementum with open
dentinal tubules
Increase the permeability of root surface
Communication between the radicular space and the periradicular tissues.
DIFFERENCES BETWEEN PRIMARY AND
PERMANENT PULPODENTIN COMPLEX
Apical foramen is relatively oval in shape and wider and not usually coincident
with the anatomic apex especially after root resorption begins.
DIFFERENCES BETWEEN PRIMARY AND
PERMANENT PULPODENTIN COMPLEX
On the histologic and physiologic level the primary tooth pulp differs
from that of the permanent dentition
This will lead to different pulpal reactions to the same procedures
and materials used for permanent teeth
REACTION OF THE PRIMARY TOOTH PULP TO
IRRITANTS
Slowly progressing ‘chronic” inactive
carious lesion. Mild
Defensive mechanism in the irritant
form of reactionary dentin deposition,
sclerotic dentin
Irreversible damage in the
Reparative mechanism Moderate Severe form of irreversible pulpitis
e.g. dead tracts, reparative irritant irritant followed by pulp
dentin deposition, dentin degeneration
bridge.
CONDITIONS / DISEASES OF THE PRIMARY TOOTH
PULP AND PERIRADICULAR TISSUES
Normal pulp :
The pulp is clinically symptom free. (e.g. sound tooth)
Reversible pulpitis:
• Mild inflammation that completely resolves after removing the causative agent, with the
pulp returning to its normal healthy condition (e.g. mild carious lesion).
• Clinically it is associated with no or mild momentary pain only with stimulus (thermal or
chemical)
CONDITIONS / DISEASES OF THE PRIMARY TOOTH
PULP AND PERIRADICULAR TISSUES
Irreversible pulpitis:
Severe inflammation making the pulp incapable of healing and leading to irreversible
damage.(e.g. large or deep carious lesion)
“Symptomatic irreversible pulpitis” “ Asymptomatic irreversible pulpitis”
Clinically it is usually associated with Sometimes no subjective symptoms
severe lingering pain. can be detected
PREVENTION AND
MANAGEMENT OF
ENDODONTIC
DISEASES IN PRIMARY
TEETH
PULP THERAPY FOR PRIMARY TEETH
VITAL PULP THERAPY FOR PRIMARY TEETH
▪ Indirect pulp treatment
▪ Direct pulp treatment
▪ Pulpotomy
INDIRECT PULP TREATMENT
It is a procedure performed in a tooth with a deep carious lesion approximating the pulp but
without signs or symptoms of pulp degeneration
The caries (affected dentin) surrounding the pulp is left in place to avoid pulp exposure
and is covered with a biocompatible material
Calcium hydroxide, zinc oxide/eugenol, or glass ionomer cement is placed over the remaining
carious dentin to stimulate healing and repair.
INDIRECT PULP TREATMENT
Indications:
•Indicated in a primary tooth with no pulpitis or with reversible pulpitis when the deepest
carious dentin is not removed to avoid a pulp exposure.
• The pulp is judged to be vital clinically and radiographically
INDIRECT PULP TREATMENT
Objectives:
The restorative material should seal completely the involved dentin from the oral environment.
The tooth’s vitality should be preserved
No post-treatment signs or symptoms such as sensitivity, pain, or swelling should be evident
There should be no radiographic evidence of pathologic external or internal root resorption or
other pathologic changes
There should be no harm to the succedaneous tooth
DIRECT PULP TREATMENT
When a pinpoint mechanical exposure cavity preparation or following a
Traumatic injury, a biocompatible radiopaque base such as mineral trioxide aggregate (MTA)
or calcium hydroxide may be placed in contact with the exposed pulp tissue
The tooth is restored with a material that seals the tooth from microleakage.
DIRECT PULP TREATMENT
Indications:
•Primary tooth with a normal pulp following a small mechanical or traumatic exposure when
conditions for a favorable response are optimal. .
Direct pulp capping of a carious pulp exposure in a primary tooth is not recommended
Objectives:
•The tooth’s vitality should be maintained.
•No post-treatment signs or symptoms such as sensitivity, pain, or swelling should be evident.
•Pulp healing and reparative dentin formation should result.
•There should be no radio-graphic signs of pathologic.
•There should be no harm to the succedaneous tooth.
DIRECT PULP TREATMENT
PULPOTOMY
It is performed in a primary tooth with extensive caries but without evidence of radicular pathology
when caries removal results in a carious or mechanical pulp exposure
The coronal pulp is amputated, and the remaining vital radicular pulp tissue surface is treated with
a long-term clinically-successful medicament such as Buckley’s Solution of formo-cresol or ferric sulfate.
PULPOTOMY
Indications:
• Pulp exposure in a primary tooth with a normal pulp or reversible pulpitis.
•When the remaining radicular tissue is judged to be vital without suppuration, purulence,
necrosis, or excessive hemorrhage.
•No radiographic signs of infection or pathologic resorption.
Objectives:
•The radicular pulp should remain asymptomatic without adverse clinical signs or symptoms
such as sensitivity, pain, or swelling.
•There should be no postoperative radiographic evidence of pathologic external root
resorption
PULPOTOMY
Materials used for pulpotomy
Formo-cresol or ferric sulfate
Electrosurgery also has demonstrated success.
Glutaraldehyde and calcium hydroxide have been used but with less long-term success.
MTA is a more recent material used for pulpotomies with a high rate of success.
The coronal pulp chamber is filled with zinc/oxide eugenol or other suit-able base, the tooth is
restored with a restoration that seals the tooth from microleakage.
NONVITAL PULP TREATMENT FOR PRIMARY
TEETH
Pulpectomy:
Is a root canal procedure for pulp tissue that is irreversibly infected or necrotic due to caries or trauma.
Indications:
•Irreversible pulpitis
•Pulp necrosis (eg, suppuration, purulence)
•A tooth planned for pulpotomy in which the radicular pulp exhibits clinical signs of irreversible pulpitis (eg,
excessive hemorrhage that is not controlled with a damp cotton pellet applied for several minutes)
•The roots should exhibit minimal or no resorption.
PULPECTOMY
Accesses opening
The root canals are debrided and shaped with hand or rotary files and optimally disinfected
Dry the canals
Obturation of the canals
PULPECTOMY
A resorbable material such as nonreinforced zinc/oxide-eugenol, iodoform-
based paste (KRI), or a combination paste of iodoform and calcium hydroxide (Vitapex)
The tooth then is restored with a restoration that seals the tooth from microleakage.
PULPECTOMY
Any questions ???????
REFERENCES:
Dentistry for the child and adolescence 9th edition ; Mc Donald.
Pediatric Dentistry : Welburry
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