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Permanent young

teeth

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Permanent young teeth
Definition- permanent teeth with incompletly formed
apices are called young permanent teeth.

Features-
1.pulpchamber anatomy approximates
surface shape of the crown more closely than in
permanent teeth.

2.Pulp are larger than permanent teeth

3.pulp protecting dentine thickness between the


pulp and DEJ is less than permament teeth.
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Comparison of root canals in primary
teeth with those of young permanent
teeth
1. Roots are more longer and slender in primary teeth

2. Primary roots canals are more ribbon like &have


multiple pulp filaments with more numerous accessory canals.

3. Roots of primary molar flare outward from the cervical part of tooth to greater degree than permanent teeth.

4. In anterior teeth mesiodistal width is narrower than permanent teeth

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Paediatric pulp therapy

• Indirect pulp capping


• Direct pulp capping
• Coronal pulpotomy
• pulpectomy

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INDIRECT PULP CAPPING

• Defined as the application of medicament over


a thin layer of remaning carious dentine,after
deep excavation with no pulp exposure.

• Objectives-
1. To avoid pulp exposure
2. Stimulate the pulp to generate reparative
dentin

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Advantages:
1. arrest of caries progression
2. preservation of vitality of non exposed pulp
3.One or two sitting procedures

Response to treatment:

1. Cellular fibrillar dentin at 2 months post treatment


2. Presence of globular dentin during 1st 3months
3. Tubular dentin is more uniformly mineralised
pattern
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Indications
History:
1. absence of spontaneous pain

Clinical examination:
1. large carious lesion
2. absence of lymphadenopathy
3. normal colour of tooth

Radiographs:
1. large carious lesion in close proximity to pulp
2. normal lamina dura
3. normal periodontal ligament space
4. no interradicular or periapical radiolucency

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contraindications
o History :
1. sharp penetrating pain that persists after withdrawing
stimulus
2. prolonged spontaneous pain

o Clinical examination:
1. excessive tooth mobility
2. tooth discolouration
3. non responsiveness to pulp testing technique

o Radiographic examination
1. large carious lesion with apparent pulp exposure
2. interupped or broken lamina dura
3. widened periodontal ligament space
4. radiolucency at the root apices or furcation areas
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Direct pulp capping
Definition:
It is a placement of a
biocompatible that has be
inadvertently exposed from
caries excavation or traumatic
injury.

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www.FourthMolar.com
objectives

• Seal the pulp against bacterial


leakage
• Initiate a dentin bridge
• Maintain the vitality of underlying
pulp
Indications:

pin point mechanical exposures that are surrounded with


sound dentin

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contraindications
• Spontaneous and nocturnal tooth aches
• Excessive tooth mobility
• Thickening of periodontal ligament
• Radiographic evidence of furcal and periradicular degeneration
• Uncontrollable hemorrhage at the time of exposure
• Purulent or serous exudate from the exposure
Note: Direct pulp capping tends to be more successful in young
permanent teeth

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Pulpotomy
Definition:
surgical removal of entire coronal pulp
leaving intact the vital radicular pulp.

Objectives:
1. to preserve the vitality of tooth
2. relief of pain in pts with acute pulpagia

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Indications

• Carious exposed teeth when retention is more


advantageous than extraction

• Clinical and radiographic signs of radicular pulp


vitality

• Absence of pathological changes


• restorability

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Contraindications

• Root resorption exceeds more than one third


of the root length
• Non restorable tooth crown
• Marked tenderness on percussion
• Mobility with locally aggravated gingivitis
• Radiolucency exist in the furcal or
periradicular areas

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Calcium hydroxide
pulpotomy

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Types of pulpotomy

• According to material used for dressing:

1. calcium hydroxide dressing- promotes


healing of pulp

2. formocresol pulpotomy- sensitizes and


fixes pulp tissues

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Formocresol pulpotomy

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Pulpectomy
• Definition:
Removal of necrotic pulp tissue followed by
filling the root canals with a resorbable cement

• Objectives:
1. maintains tooth free of infection
2. biomechanically cleanse and obturate the root
canals
3. promote physiologic root resorption
4. hold the space for erupting permanent teeth

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www.FourthMolar.com