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medicaments can be used in pulpotomy In primary teeth :
Calcium hydroxide.
Electrosurgery
Laser.
glutaraldehyde
Collagen.
Mineral trioxide aggregate (MTA).
Formocresol.
Diluted formocresol.
Ferric sulfate
calcium hydroxide
The greatest benefit of Ca(OH)2 is the stimulation of reparative
dentin bridge, due to a high alkalinity, which leads to enzyme
phosphatase being activated and thus releasing of inorganic
phosphate from the blood (calcium phosphate) leading to
formation or dentinal bridge. It also has an antibacterial action.
When calcium hydroxide is applied directly to pulp tissue, there
is necrosis of the adjacent pulp tissue and inflammation of the
contiguous tissue. Compounds of similar alkalinity cause
liquefaction necrosis when applied to pulp tissue. Internal
resorption may occur after pulp exposure and capping with
calcium hydroxide. Calcium from Dentin Bridge comes from
the blood stream. The action of calcium hydroxide to form
Dentin Bridge appears to be a result of low grade irritation in the
underlying pulpal tissue after application.
Radiographic study,103 teeth
Success rate of 31%.
Among the unsuccessful teeth, 69% showed evidence of
internal resorption.
The high failure rate in calcium hydroxide pulpotomies can be
attributed to:

Calcium hydroxide has no beneficial
effect on the inflamed pulp.

The creation of an extrapulpal blood cloth.
electrosurgery
Its mechanism of action is the cauterization of the superficial
pulp tissue
A layer of coagulation necrosis that is caused by the
electrosurgery application, provides a barrier between healthy
radicular tissue and any base material placed in the pulp
chamber. The odontoblasts are stimulated to form a dentin
bridge and the tooth is
maintained in the arch with vital radicular tissue until it
exfoliates
pharmaceutical technique.

It creates a superficial zone of
coagulation necrosis that
remains compatible with the
underlying tissue.

pulps retain their vitality and
capability of normal pulp
glutaraldehyde
Has been suggested as an alternative to formocresol as a
pulpotomy agent , based on
its superior fixative properties, low antigenicity, and low
toxicity.
high molecular weight that limits its tissue penetration.

has a self limiting penetration, hence, reduces the extent of
inflammatory response.

superficial fixation with very little underlying inflammation.
• In a 2% solution destroys fungi, viruses, and bacteria.
•It is considered to be better than formocresol since:

GA does not diffuse trough the apical foramen.

GA does not penetrate the periapical tissues as formocresol.
However, the material/technique was not well accepted by the
pediatric
dentists.
collagen
Biological non pharmacological material that may induce
tissue healing.
Biological mineral formation initiates within collagen fibers
Collagen gels may provide an appropriate scaffolding for tissue
formation.
Substantial tissue healing with an acid soluble autologous skin
collagen solution.
However,
•Animal product (skin)
•May cause allergies (to tissue or to
antibiotics).
•A commercial preparation of collagen was associated with
pulpal inflammation and
necrosis.
•Naturally sourced collagen is not a promising material for
biological
approaches to vital pulp therapy.
mineral trioxide aggregate
Prevents microleakage
Biocompatible.
Promotes regeneration of original tissues when it is placed in
contact with the dental pulp or periradicular tissues.
Rationale
Not been found to induce internal resorption, which has been
observed in teeth treated with some other medicaments.
MTA is a fine hydrophilic powder Consists of tricalcium
silicate, tricalicum
aluminate, tricalcium oxide, silicate oxide and bismuth oxide.
•Each pack of MTA comes with a pre measured unit dose of
water for convenience in mixing.
Pulpotomy:
mineral trioxide aggregatePortland cement may serve as an
effective and less expensive
MTA substitute in primary molars pulpotomies.
formocresol (full strength or diluted)
Excellent clinical success
•Releases formaldehyde which may diffuse trough the pulp
fixating (mummify)
the tissue.
•Does not promote pulp The rationale of fixation is that we may
create a tolerable irritation which replaces an intolerable
infection caused by bacteria.
ferric sulfate
Is a nonaldehyde agent that produces haemostasis at pulp
stumps by
chemically sealing blood vessels.The haemostasis takes place by
agglutination of blood protein, without the presence of a blood
clot, which suggested that preventing clot formation .Induces
favorable histological results in the form of secondary dentin
and bridging.Retention of maximum vital
tissue and virtual conservation of the radicular pulp without
induction of reparative dentin.
Comparisons
Laser(n=68):
97 % and 94.1 % clinical and radiographic success respectively,
follow
up for 6 to 64 months.
Formocresol
(n=69): 85.5and 78.3% clinical and radiographic success
respectively, follow up for 9 to 66 months.Currently available
evidence suggests
MTAcompared to FC
,
FS and CHresulted in significantly higher clinical and
radiographic success
.
MTA
induces less undesirable responses and may be FC’smost
suitable
replacement.
MTAis superior to CHand equally effective as a pulpotomy
dressing in primary mandibular molars . Internal resorption was
the most common radiographic finding up to 24 months after
pulpotomy.
Portland cement may become the material
of choice for pulpotomies in primary teeth.
Success %ElectrosurgeryClinical 96% Radiographic 84%
Formocresol
Clinical 100% Radiographic92%
In human carious primary molars with reversible coronal
pulpitis, pulpotomies performed with either formocresol or
ferric sulfate
are likely to have similar
clinical/radiographic success.
Ferric sulfate
clinical96.4%radiographic92.0%
Formocresol
clinical97.5%radiographic94.6%
References
http://jiads.net/Archives/2011/8.pdf
http://cutt.us/499Gb
http://cutt.us/m7U7D
http://cutt.us/jeI1V
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