Adjunctive endodontic treatment

Adjunctive endodontic treatment

1. Materials

   • Calcium Hydroxide (CaOH2)
     • Stimulates secondary odontoblasts to repair with dentinal bridge formation
       • Tertiary dentin
     • High pH = 12,5
       • Cauterizes tissue and kills bacteria
     • Resorbable
   • Mineral Trioxide Aggregate (MTA)
     • Stimulates cementoblasts to produce hard tisssue
     • 3 minerals: calcium, silicon, aluminum
     • Bismuth oxide = opacifier
       • Pros: radiopaque in RX
       • Cons: can leak and stain the tooth (not good for anterior teeth)
     • Long setting time (3h)
     • Antimicrobial
     • great sealing agent
       • Sets in the presence of moisture
       • Nonresorbable

2. Indirect Pulp Cap (IPC)

   • CaOH or RMGI is placed on thin partition of remaining dentin that if removed, might expose the healthy pulp
     • RMGI = resin-modified glass ionomer
     • Protect CaOH with RMGI
   • Deep caries approximating pulp

3. Direct Pulp Cap (DPC)

   • CaOH /MTAis placed directly on otherwise healthy pulp exposure
   • Traumatic exposure <24h
   • Caries of mecahanical exposure <2mm
   • Hard tissue barrier will hopefully form within 6 weeks

4. Cvek Pulpotomy (partial or shallow pulpotomy)

   • Remobval of small portion of coronal diseased pulp
   • Traumatic exposure >/= 24h
   • Caries of mecahanical exposure >2mm
   • NOT INDICATED IN MATURE PERMANENT TEETH

5. Pulpotomy

   • Removal of coronal diseased pulp
   • Traumatic exposure >/= 72h
   • Primary teeth must be restorable, vital, with pulp exposure and asymptomatic
     • Formocresol to attain hemostasis
     • ZOE in crown build-up
   • NOT INDICATED IN MATURE PERMANENT TEETH
     • May induce undesired pulp calcification

6. Apexification

   • PULPECTOMY on an immature PERMANENT tooth
     • Disinfection of root canal followed by induction of an acceptable APICAL BARRIER
       • CaOH or MTA is placed at base of canal after dead or dying pulp is removed

7. Pulpectomy

   • Removal of coronal and radicular dead or dying pulp
   • Temporary pain relief with irreversible pulpitis before RCT can be done
   • Primary teeth must be NON vital, restorable, with pulp exposure and asymptomatic
     • ZOE in crown
     • CaOH in roots
       • reabsorbable for undelying permanent tooth

8. Extraction

   • Primary first molars that aren't restorable, is symptomatic and has root resorption
     • Challenging because of various accesory canals

9. Apexogenesis

   • ANY endodontic treatment (except pulpectomy) in an immature PERMANENT tooth
     • Mantain pulp vitaly in order to sitmulate root development
       • CaOH/MTA is placed on healthy or diseased pulp
   • Contraindicated on avulsed nonrestorable severe horizontal fracture and necrotic teeth

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