Common forms of paediatric pulpal therapy
Protective liner: After the removal of all caries, a protective liner comprising a thinly applied liquid is placed on the pulpal surface of a deep cavity preparation, covering exposed dentin tubules and acting as a protective barrier between the restorative material or cement and the pulp. This preserves the tooth’s vitality, minimises injury to the pulp, promotes pulp tissue healing and tertiary dentin formation, and/or minimises postoperative sensitivity and bacterial microleakage.
Indirect pulp treatment: Indirect pulp treatment is a procedure performed in a tooth with a deep carious lesion approximating the pulp but without signs or symptoms of pulp degeneration. The caries surrounding the pulp is left in place to avoid pulp exposure and is covered with a biocompatible material. A radiopaque liner such as a dentin bonding agent, resin-modified glass ionomer, calcium hydroxide, zinc oxide/eugenol or glass ionomer cement is placed over the remaining carious dentin to stimulate healing and repair. The use of glass ionomer cements or reinforced zinc oxide/eugenol restorative materials helps in inhibiting cariogenic bacteria activity.
Pulpotomy: This is a dental procedure performed when tooth decay reaches into the pulp (nerve) tissue. This involves the removal of the infected part of the nerve tissue within the crown portion of the tooth to prevent further inflammation and spread of disease (caries). A sedative material is then placed within the tooth to prevent bacterial growth and calm the remaining nerve tissue. After pulpotomy, the child's tooth is restored with a stainless steel crown on the back molar teeth to re-establish normal chewing function and to continue to hold the space until the permanent tooth can take its place. On the upper front teeth, either a regular stainless steel crown or a white aesthetic stainless steel crown can be used.
Pulpectomy: This dental procedure is required when the entire pulp is involved. In this treatment, the diseased pulp tissue is completely removed from both the crown and the roots, and the root canals are cleansed, disinfected and, in the case of primary teeth, filled with a resorbable material. A final restoration is placed, which involves the same procedures as pulpotomy on a primary tooth. A permanent tooth would be filled with a nonresorbing material, then either a temporary stainless steel crown or an adult ceramic, porcelain, or gold permanent crown would be used.
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