Pedodontics

Endodontics and Pulp Therapy – NEET and INICET pearls from Dentest and Pulse

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  1. Pulp of all primary teeth is active for a period of = 8.3 years/9.6 years
  2. Infected dentin (TRUE STATEMENTS)
    1. Loss of organic network 
    2. Lacking sensation
    3. Irreversible demineralization 
    4. Excavated during cavity preparation 
  3. Affected dentin (TRUE STATEMENTS)
    1. Demineralised but can be mineralized
    2. No loss of organic network 
    3. Sensitive
    4. Should be left out for remineralisation during cavity preparation
  4. The dye used for the detection of dentin caries is = Acid red system
  5. The greatest problem in pulpal diagnosis is estimating the amount of = INFLAMMATION
  6. Radiographs of permanent molar 
    1. Acute apical abscess shows
      1. Early stages – no radiographic changes
      2. Later stages – little change from the normal structure
    2. Acute alveolar abscess = thickened periodontal membrane
    3. Chronic pulpal infection = rarefaction at bony furcation
    4. Carious involvement = Radiolucency in the furcation area 
  7. ACUTE ALVEOLAR ABSCESS (TRUE STATEMENTS)
    1. Primary tooth = more diffuse 
    2. A localized collection of pus at root apex in alveolar bone
    3. There is swelling, mobility and elevation of a tooth from its socket 
  8. Pulse oximetry 
    1. Measures the pulpal circulation directly 
    2. TRUE STATEMENTS
      1. Objective test
      2. Measures and compares amplitudes of ratios of transmitted infrared light with red light 
      3. Capable of evaluating the stature of blood vasculature
      4. Depends on pulsatile blood flow
      5.  
  9. Laser doppler flowmetry
    1. Based on the velocity of RBC cells in capillaries 
    2. A non-invasive method to measure blood flow
    3. GAZELIUS
  10. Indirect Pulp Therapy 
    1. Objective = Eliminate the removal of deep caries
    2. Indicated (imp)
      1. in primary molars when the carious lesion is suspected of producing an exposure of the pulp
      2. when there is no history of spontaneous pain  = Tooth must be asymptomatic 
    3. IPT = It is dependent on the remineralisation of affected dentin and reparative dentin formation  
    4. ​​
    5. The success of IPT = placement of temporary restoration with excellent sealing properties
    6. Most ideal material = Calcium hydroxide
      1. Introduced by FAUCHARD
      3. When applied to residual carious dentin = it remains for 6 – 8 weeks 
      4. Following amputation of the coronal portion of the pulp of an immature permanent first molar = the stump is capped with CaOH
      5. The success of CaOH pulpotomy is determined by = Continuation of root formation and apexogenesis
      6. Dentin bridge is formed = at a level slightly below the amputation
  11. Direct Pulp Therapy 
    2. Amount of repartive/3* dentin formed after 30 days = 1.5 microns/day and then slows down after 48 days 
    3. Contraindicates in primary teeth 
    4. Prognosis is best = mechanically exposed permanent tooth
    5. Indicated in cases of little (Pinpoint exposure = less than 1 mm) or no haemorrhage from the exposure site
    6. The pulp should be vital
    7. Done in traumatic or iatrogenic cases = Reported within 24 hours
    8. High rate of failure = high cellular content of pulp
  12. Pulpotomy
    2. The simplest form of pulp therapy 
    3. Contraindicated = If there is Inflammation of radicular pulp and pain
    4. Mechanical exposure of mesiobuccal pulpal horns in primary maxillary 1st molar with moderate caries lesion on the mesial-distal surface = formocresol PULPOTOMY + stainless steel CROWNS
    5. Pulp preservative material and best   = MTA
    6. The primary function of MTA = Apexification of immature traumatised pulpless tooth
    7. Important criteria of success = Root end completion 
  1. Formocresol Pulpotomy 
    1. SWEET
    2. Composition of Buckley Solution
      1. 1:2 parts F: C
      2. 19% formaldehyde 
      3. 13% cresol
      4. 15% glycerine 
    3. Successful treatment for vital primary second molar with a large carious and pulpal exposure 
    4. The success of the technique depends on vital root pulp 
    5. Cotton pellet applied to the pulpal stumps after formocresol pulpotomy should be = Dampened with formocresol and placed for 5 mins
    6. Amount of pulp to be removed in formocresol technique= entire coronal pulp down to the cervical constriction of each root canal
    7. FERRIC SULPHATE = material with haemostatic effect, used as a substitute for formocresol pulpotomy
    8. EFFECT = Surface fixation of pulpal tissue accompanied by degeneration of odontoblasts 
    9. The first sign of formocresol technique failure = Internal resorption
  2. Glutaraldehyde Pulpotomy 
    1. Superior fixative properties 
    2. Conc as pulpotomy agent = 2 to 5 % concentration 
    3. The cotton pellet is kept on pulp stumps = for 3-4 mins
    4. KOPEL
  3. Ferric Sulphate Pulpotomy 
    1. 2 – 5 seconds 
    2. 15.5% concentration
    3. 100% clinical success rate
  4. CaOH Pulpotomy
    1. contraindicated in primary teeth due to internal resorption – odontoclastic reaction
    2. Immediate reaction = Severe inflammatory reaction
    3. The calcified bridge is evident within = 1 month
    4. Increases in thickness – next 12 months 
    5. Failure of technique = 
  5. Cvek Pulpotomy
    1. Partial technique
    2. Important criteria of success = Root end completion 
  6. Pulpectomy
    1. The entire pulpal tissue is removed
    2. Complete Pulpectomy technique for primary molars is developed by = STARKEY
    3. Pulp extirpation in primary teeth is difficult because = Tortuous anatomy and branching of canals 
    4. The major problem with this technique = is limited knowledge of pulpal anatomy
    5. KRI paste used for obturation in case of pulpectomy is primarily a mixture of = Iodoform and CMCP
    6. MC filling material, traditionally = Zinc Oxide Eugenol 
    7. ROOT CANAL SPREADER = It is not used in the widening of root canals 
  7. Pulp Devitalization 
    1. PARAFORMALDEHYDE = common medicament in all types of devitalization pulpotomy 
    2. Laser = Nd: YAG
  8. Pulp mummification = Indicated in = traumatic exposure of a vital primary tooth 
  9. Apexification
    1. Rx of pulpless/nonvital immature young permanent tooth
    2. A condition that leads to apexification = Pulpectomy of the young permanent tooth with incomplete root formation
    3.  Any excess CaOH periapically = will be removed by multinucleated giant cells 
    4. Increase success rate = Increased blood supply through the wide apex
    5. Best obturated by = OBTURA – thermoplasticized gutta percha system
    6. FRANK technique 
      1. Uses CaOH and CMCP (Camphorated monochlorophenol) 
      2. To stimulate root closure/ apexification in incompletely developed young permanent tooth 
      3. CMCP = 6 months
  10. Rate of resorption in pulpless primary teeth compared to vital teeth = SIMILAR
  11. In the absence of second premolar roots of primary second molar will most likely = resorb more slowly than normal
  12. Ideal Root Canal filling = CaOH
  13. Rx choice in poor prognosis cases, alveolar abscess and necrotic pulp cases = extraction 
  14. Apexogenesis
    1. TRUE STATEMENTS
      1. More of a physiological process
      2. Root development continues
      3. Indicates in pulp tissue with mild inflammation 
    2. Done in the vital and infected tooth
  15. In regenerative endo therapy, Metronidazole is replaced by = Ornidazole 
  16. Reattachment of fractured tooth fragments using the resin bonding technique is called = Fragment Restoration 
  17. STAINLESS STEEL CROWN
    1. Rx of choice for Ankylosis of a primary molar with the absence of a permanent successor
    2. Rx of choice for amelogenesis imperfecta in primary dentition = SSC
    3. HUMPHREY
    4. SSC is a = Semi-permanent restoration 
    5. Contraindicated in Medically compromised patients – Heart problems – VSD, ASD
    6. INDICATIONS 
      1. Restoration of hypoplastic teeth 
      2. Following pulpotomy or pulpectomy 
      3. As an abutment for space maintainers
      4. NOT USED = teeth that are not restorable 
    7. Iron content in 3M SCC = 10%
    8. CHENG CROWNS = pre-veneered crown which is stain resistant and pre-crimped
    9. Countering of stainless steel crown is done at middle 1/3rd of the crown to produce = BELLING EFFECT
    10. MC complication while tooth prep = LEDGE Formation
    11. PREVENTION OF LEDGING = most important for using burs in opening proximal contacts to receive SSC
    12. SCC should extend
      1. intra gingivally or below the gingival crest = 0.5 – 1mm 
      2. Occlusal = 1.5-2mm 
      3. Buccal and lingual = 0.5mm 
      4. Proximal = 1-1.5mm 
    13. Basket Crown technique
      1. Temporary crowns 
      2. Placed in the anterior tooth 
      3. 3/4th crown
      4. The window is prepared on the LABIAL aspect for aesthetic

    14. Finish Line of SSC = FEATHER edge
    15. Difficulty in adopting an SSC to a primary mandibular first molar = Buccal cervical ridge showing constriction
    16. Surface requiring the least amount of reduction = BUCCAL and LINGUAL 
    17. Retention is achieved primarily by = PARALLEL distal and mesial walls
  18. In a con-compliant pulp chamber, average intrapulpal pressure = 10 mm HG and varies with each arterial pulse
  19. PREPOMETER = device to measure the thickness of the dentin layer above the pulp chamber
  20. PULPDENT = most capable of stimulating early dentinal bridge formation
  21. Obturation of deciduous teeth can be done with = Iodoform paste

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