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Adjunctive endodontic treatment

Materials
1. Calcium Hydroxide (CaOH2)
  1. Stimulates secondary odontoblasts to repair with dentinal bridge formation
    Annotations:
    - Tertiary dentin
  2. High pH = 12,5
    1. Cauterizes tissue and kills bacteria
  3. Resorbable
2. Mineral Trioxide Aggregate (MTA)
  1. Stimulates cementoblasts to produce hard tisssue
  2. 3 minerals: calcium, silicon, aluminum
  3. Bismuth oxide = opacifier
    1. Pros: radiopaque in RX
    2. Cons: can leak and stain the tooth (not good for anterior teeth)
  4. Long setting time (3h)
  5. Antimicrobial
  6. great sealing agent
    1. Sets in the presence of moisture
    2. Nonresorbable
Indirect Pulp Cap (IPC)
1. CaOH or RMGI is placed on thin partition of remaining dentin that if removed, might expose the healthy pulp
  Annotations:
  - RMGI = resin-modified glass ionomer
  1. Protect CaOH with RMGI
2. Deep caries approximating pulp
Direct Pulp Cap (DPC)
1. CaOH /MTAis placed directly on otherwise healthy pulp exposure
2. Traumatic exposure <24h
3. Caries of mecahanical exposure <2mm
4. Hard tissue barrier will hopefully form within 6 weeks
Cvek Pulpotomy (partial or shallow pulpotomy)
1. Remobval of small portion of coronal diseased pulp
2. Traumatic exposure >/= 24h
3. Caries of mecahanical exposure >2mm
4. NOT INDICATED IN MATURE PERMANENT TEETH
Pulpotomy
1. Removal of coronal diseased pulp
2. Traumatic exposure >/= 72h
3. Primary teeth must be restorable, vital, with pulp exposure and asymptomatic
  1. Formocresol to attain hemostasis
  2. ZOE in crown build-up
4. NOT INDICATED IN MATURE PERMANENT TEETH
  1. May induce undesired pulp calcification
Apexification
1. PULPECTOMY on an immature PERMANENT tooth
  1. Disinfection of root canal followed by induction of an acceptable APICAL BARRIER
    1. CaOH or MTA is placed at base of canal after dead or dying pulp is removed
Pulpectomy
1. Removal of coronal and radicular dead or dying pulp
2. Temporary pain relief with irreversible pulpitis before RCT can be done
3. Primary teeth must be NON vital, restorable, with pulp exposure and asymptomatic
  1. ZOE in crown
  2. CaOH in roots
    Annotations:
    - reabsorbable for undelying permanent tooth
Extraction
1. Primary first molars that aren't restorable, is symptomatic and has root resorption
  Annotations:
  - Challenging because of various accesory canals
Apexogenesis
1. ANY endodontic treatment (except pulpectomy) in an immature PERMANENT tooth
  1. Mantain pulp vitaly in order to sitmulate root development
    1. CaOH/MTA is placed on healthy or diseased pulp
2. Contraindicated on avulsed nonrestorable severe horizontal fracture and necrotic teeth

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Adjunctive endodontic treatment

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	Created by TR AS over 4 years ago