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medicaments can be used in pulpotomy In primary teeth :
Calcium hydroxide.

Electrosurgery

Laser.

glutaraldehyde



Collagen.

Mineral trioxide aggregate (MTA).

Formocresol.

Diluted formocresol.

Ferric sulfate

calcium hydroxide

The greatest benefit of Ca(OH)2 is the stimulation of reparative dentin bridge, due to a high alkalinity, which leads to enzyme phosphatase being activated and thus releasing of inorganic phosphate from the blood (calcium phosphate) leading to formation or dentinal bridge. It also has an antibacterial action. When calcium hydroxide is applied directly to pulp tissue, there is necrosis of the adjacent pulp tissue and inflammation of the contiguous tissue. Compounds of similar alkalinity cause liquefaction necrosis when applied to pulp tissue. Internal resorption may occur after pulp exposure and capping with calcium hydroxide. Calcium from Dentin Bridge comes from the blood stream. The action of calcium hydroxide to form Dentin Bridge appears to be a result of low grade irritation in the underlying pulpal tissue after application.

Radiographic study,103 teeth

Success rate of 31%.

Among the unsuccessful teeth, 69% showed evidence of

internal resorption.

The high failure rate in calcium hydroxide pulpotomies can be attributed to:

Calcium hydroxide has no beneficial



effect on the inflamed pulp.

The creation of an extrapulpal blood cloth.


electrosurgery
Its mechanism of action is the cauterization of the superficial pulp tissue

A layer of coagulation necrosis that is caused by the electrosurgery application, provides a barrier between healthy radicular tissue and any base material placed in the pulp chamber. The odontoblasts are stimulated to form a dentin bridge and the tooth is

maintained in the arch with vital radicular tissue until it exfoliates

-

pharmaceutical technique.



It creates a superficial zone of

coagulation necrosis that

remains compatible with the

underlying tissue.

pulps retain their vitality and



capability of normal pulp
glutaraldehyde

Has been suggested as an alternative to formocresol as a pulpotomy agent , based on

its superior fixative properties, low antigenicity, and low toxicity.

high molecular weight that limits its tissue penetration.

has a self limiting penetration, hence, reduces the extent of inflammatory response.



superficial fixation with very little underlying inflammation.

• In a 2% solution destroys fungi, viruses, and bacteria.

•It is considered to be better than formocresol since:

GA does not diffuse trough the apical foramen.



GA does not penetrate the periapical tissues as formocresol.

However, the material/technique was not well accepted by the pediatric

dentists.

collagen

Biological non pharmacological material that may induce tissue healing.

Biological mineral formation initiates within collagen fibers

Collagen gels may provide an appropriate scaffolding for tissue formation.

Substantial tissue healing with an acid soluble autologous skin collagen solution.

However,

•Animal product (skin)

•May cause allergies (to tissue or to

antibiotics).

•A commercial preparation of collagen was associated with pulpal inflammation and

necrosis.

•Naturally sourced collagen is not a promising material for biological

approaches to vital pulp therapy.
mineral trioxide aggregate
Prevents microleakage

Biocompatible.

Promotes regeneration of original tissues when it is placed in contact with the dental pulp or periradicular tissues.
Rationale

Not been found to induce internal resorption, which has been observed in teeth treated with some other medicaments.


MTA is a fine hydrophilic powder Consists of tricalcium silicate, tricalicum

aluminate, tricalcium oxide, silicate oxide and bismuth oxide.

•Each pack of MTA comes with a pre measured unit dose of water for convenience in mixing.

Pulpotomy:

mineral trioxide aggregatePortland cement may serve as an effective and less expensive

MTA substitute in primary molars pulpotomies.



formocresol (full strength or diluted)

Excellent clinical success

•Releases formaldehyde which may diffuse trough the pulp fixating (mummify)

the tissue.

•Does not promote pulp The rationale of fixation is that we may create a tolerable irritation which replaces an intolerable infection caused by bacteria.

ferric sulfate

Is a nonaldehyde agent that produces haemostasis at pulp stumps by

chemically sealing blood vessels.The haemostasis takes place by

agglutination of blood protein, without the presence of a blood clot, which suggested that preventing clot formation .Induces favorable histological results in the form of secondary dentin and bridging.Retention of maximum vital

tissue and virtual conservation of the radicular pulp without induction of reparative dentin.

Comparisons

Laser(n=68):

97 % and 94.1 % clinical and radiographic success respectively, follow

up for 6 to 64 months.

Formocresol


(n=69): 85.5and 78.3% clinical and radiographic success respectively, follow up for 9 to 66 months.Currently available evidence suggests
MTAcompared to FC

,

FS and CHresulted in significantly higher clinical and radiographic success



.

MTA


induces less undesirable responses and may be FC’smost suitable

replacement.

MTAis superior to CHand equally effective as a pulpotomy dressing in primary mandibular molars . Internal resorption was the most common radiographic finding up to 24 months after pulpotomy.

Portland cement may become the material

of choice for pulpotomies in primary teeth.

Success %ElectrosurgeryClinical 96% Radiographic 84%

Formocresol

Clinical 100% Radiographic92%

In human carious primary molars with reversible coronal pulpitis, pulpotomies performed with either formocresol or ferric sulfate

are likely to have similar

clinical/radiographic success.

Ferric sulfate

clinical96.4%radiographic92.0%

Formocresol

clinical97.5%radiographic94.6%

References

http://jiads.net/Archives/2011/8.pdf

http://cutt.us/499Gb



http://cutt.us/m7U7D

http://cutt.us/jeI1V


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