Challenges in pulpal treatment of young permanent teeth.pptx

Challenges in pulpal treatment of young permanent teeth

1. Challenges in pulpal treatment of young permanent teeth AHMED ALI YOUSSIF LECTURER OF ENDODONTIC – MINIA UNIVERSITY LECTURER OF ENDODONTIC – Deraya UNIVERSITY [email protected]

2. Pediatric patients have a greater risk of dental caries and a higher incidence of dental trauma.

3. Establish communication . Alleviate fear and anxiety. D eliver quality care . B uild trust . P romote a positive attitude towards oral health care. 

4. Behavioral Management

5. Young permanent teeth Recently erupted. Normal physiological apical root closure has not occurred. Root closure may take 2-3 years after eruption. In developmental stage in children from 6 years of age until mid-teens(15). Human tooth with immature apex is a developing organ. Essential for development and growth of alveolar process and periodontal ligament.

6. Young permanent teeth Average eruption age Maxilla Mandible Central incisor 7-8 6 Lateral incisor 8 7-8 Canine 10-12 9-10 1 st Premolar 10-12 10-12 2 nd Premolar 10-12 12 1 st Molar 6 6 2 nd Molar 12 12

7. Damage Caries Trauma

8. < 1/2 root length 1/2 root length 2/3 root length Wide open apical foramen and nearly completed root length C losed apical foramen and completed root development NON –BLUNDERBUSS BLUNDERBUSS A . Constriction

9. APICAL FORAMEN THIN D. WALL SHOR ROOT APICAL LESION BLUNDERBUSS TUBLAR FRACTURE SHAPING C/R RATIO

10. SYPTOMS SIGNS VITALITY FUNCTION RADIOGRAPHIC HEALING

11. PULPAL ASSESSMENT 1- CLINICAL EXAMINATION.

12. PULPAL ASSESSMENT 2 - DIAGNOSTIC TESTS

13. Vitality test and young permanent teeth Modified pulse oximeter   Laser Doppler Pulse oximeter  

14. 3-Radiographic examination Conventional Radiographs CBCT

15. Treatment modalities AAPD guidelines 2020 VITAL PULP THERAPY NON-VITAL PULP TREATMENT Protective base. Apexogenesis . Pulpectomy . Apexification . Regenerative endodontics.

16. VITAL PULP THERAPY

17. 1- Protective liner A protective liner is a thinly-applied material placed on the pulpal surface of a deep cavity preparation. F ollowed by a well-sealed restoration . MTA & calcium hydroxide . Minimize pulp injury . Promote pulp tissue healing . M inimize postoperative sensitivity .

18. 2- Apexogenesis INDIRECT PULP TREATMENT DIRECT PULP CAPPING COMPLETE PULPOTOMY PARTIAL PULPOTOMY

19. Procedure performed in a tooth with a diagnosis of reversible pulpitis and deep caries that might otherwise need endodontic therapy if the decay was completely removed. INDIRECT PULP TREATMENT

20. INDICATION Mild pain associated with eating. Negative history of spontaneous , extreme pain. Normal lamina dura & PDL space No radiolucency in the bone around the apices of the roots or in the furcation .

21. FAGUNDES et al 2009 1 st visit

22. FAGUNDES et al 2009 2 nd visit (6o days)

23. DIRECT PULP capping When a small exposure of the pulp is encountered during cavity preparation and after hemorrhage control is obtained, the exposed pulp is capped with a material such as calcium hydroxide or MTA prior to placing a restoration that seals the tooth from micro-leakage .

24. DIRECT PULP capping Sensitive Technique Pain Radiograph Hemorrhage Isolation Material Sealing

25. Partial pulpotomy The partial pulpotomy is a procedure in which the inflamed pulp tissue beneath an exposure that is four millimeters or less in size is removed to a depth of one to three millimeters or more to reach the deeper healthy tissue. Indicated in a young permanent tooth for a pulp carious or traumatic exposure in which the pulp bleeding is controlled within several minutes. The tooth must be vital, with a diagnosis of normal pulp or reversible pulpitis .

26. Complete pulpotomy C omplete surgical removal of the coronal vital pulp tissue followed by placement of a biologically acceptable material in the pulp chamber and restoration of the tooth. A full pulpotomy is indicated in immature permanent teeth with cariously exposed pulp as an interim procedure to allow continued root development.

27. Sensitive Technique Pain Radiograph Hemorrhage Isolation Material Sealing

28. Non-VITAL PULP THERAPY

29. 1- Apexification

30. 1- Apexification Problems?????

31. 2- Regenerative endodontics

32. revascularization

33. 3-Pulpectomy ( conventional root canal treatment)