PULP PROTECTIONPULP PROTECTION

By:By:

dr shabeel pndr shabeel pn

Pulp is a specialized connective tissue that occupies the Pulp is a specialized connective tissue that occupies the pulp chamber .It comprises of nerves ,vessels ,lymph pulp chamber .It comprises of nerves ,vessels ,lymph channels etc.channels etc.

Mainly 4 functionsMainly 4 functions- Formative/DevelopmentalFormative/Developmental- NutritiveNutritive- SensorySensory- Defensive/ReparativeDefensive/Reparative

Knowledge of the size and contour of the pulp Knowledge of the size and contour of the pulp cavity is essential during tooth preparation.cavity is essential during tooth preparation.

If leakage of chemical irritants from biomaterials or If leakage of chemical irritants from biomaterials or bacteria occurs , there causes irritation to pulp.bacteria occurs , there causes irritation to pulp.

VARIOUS TYPES OF IRRITANTSVARIOUS TYPES OF IRRITANTS-Microbial irritation-Microbial irritation-Mechanical irritation-Mechanical irritation-Thermal irritation-Thermal irritation-Chemical irritation-Chemical irritation-Radiant irritation-Radiant irritation

MICROBIAL IRRITATIONMICROBIAL IRRITATION

Bacteria that survive drying under the filling Bacteria that survive drying under the filling material remain viable for many years .Such material remain viable for many years .Such dormant bacteria can become active when dormant bacteria can become active when moisture is reintroduced as a result of marginal moisture is reintroduced as a result of marginal percolation of various filling materials , poor percolation of various filling materials , poor marginal seals improper condensation of fillings marginal seals improper condensation of fillings etc. etc.

MECHANICAL AND THERMAL MECHANICAL AND THERMAL IRRITATIONIRRITATION

It depends on It depends on

- Speed of rotation - Speed of rotation

- Size & Shape of bur - Size & Shape of bur

- Amount of moisture / water- Amount of moisture / water

- Coolant- Coolant

CHEMICAL IRRITANTS CHEMICAL IRRITANTS

They are They are

- Various filling materials - Various filling materials

- Various medicaments used for - Various medicaments used for desensitization or dehydration of dentindesensitization or dehydration of dentin

- Dentin sterilizing agents such as phenol, - Dentin sterilizing agents such as phenol, silver nitrate, eugenol etc.silver nitrate, eugenol etc.

RADIANT IRRITANTS RADIANT IRRITANTS

X ray radiation, laser beam, uptake of radium X ray radiation, laser beam, uptake of radium containing water cause radiant irritation.containing water cause radiant irritation.

INFLAMMATIONINFLAMMATION

Is the complex vascular and lymphatic reaction Is the complex vascular and lymphatic reaction as well as local tissue destruction. Involve as well as local tissue destruction. Involve macrophages , plasma cells & lymphocytes.macrophages , plasma cells & lymphocytes.

Pulpal irritation leads to pulp inflammation.Pulpal irritation leads to pulp inflammation.

INFECTIONINFECTION

Invasion of micro organisms in to the region of Invasion of micro organisms in to the region of injury is called infection.injury is called infection.

PULP PROTECTIONPULP PROTECTION To protect the pulp against those irritants we To protect the pulp against those irritants we

give give - chemical protection - chemical protection - electrical protection- electrical protection - thermal protection- thermal protection - mechanical protection- mechanical protection - pulp medication- pulp medication

In case of exposure of pulp we give In case of exposure of pulp we give

- Pulp capping- Pulp capping

- Pulpotomy- Pulpotomy

LINERSLINERS It is used to provide a barrier against the passage It is used to provide a barrier against the passage

of irritants from cements or other restorative of irritants from cements or other restorative material and to reduce the sensitivity of freshly material and to reduce the sensitivity of freshly cut dentin. They are usually suspensions of cut dentin. They are usually suspensions of calcium hydroxide in a volatile solvents.calcium hydroxide in a volatile solvents.

composition: suspension of CaOH in an organic composition: suspension of CaOH in an organic liquid such as methyl ethyl ketone or ethyl liquid such as methyl ethyl ketone or ethyl alcohol.alcohol.

CaOH in paste formCaOH in paste form

Base paste catalyst pasteBase paste catalyst paste- Glycol salicylate Ca(OH)Glycol salicylate Ca(OH)- CaSo4 ZnOCaSo4 ZnO- TiO2 Zn stearateTiO2 Zn stearate- Ca tungstate,BaSo4 Ethylene tolueneCa tungstate,BaSo4 Ethylene toluene

sulphonamidesulphonamide

OTHER LINERSOTHER LINERS

- Type III GIC- Type III GIC

- Type IV ZOE- Type IV ZOE

CAVITY VARNISHCAVITY VARNISH

Cavity varnish is a solution of one or more resins Cavity varnish is a solution of one or more resins which when applied onto the cavity walls , which when applied onto the cavity walls , evaporates leaving a thin resin film, that serves evaporates leaving a thin resin film, that serves as a barrier between the restoration and the as a barrier between the restoration and the dentinal tubules .dentinal tubules .

Composition:Natuaral gum such as copal, rosin, Composition:Natuaral gum such as copal, rosin, or synthetic resin dissolved in an organic solvent or synthetic resin dissolved in an organic solvent such as alcohol, acetone or ether .such as alcohol, acetone or ether .

Applied by using a brush ,wire loop, or a small Applied by using a brush ,wire loop, or a small pledget of cotton.pledget of cotton.

Indication: In silicate or silico phosphate Indication: In silicate or silico phosphate restoration – varnish confined to dentin.restoration – varnish confined to dentin.

Contra Indication: Contra Indication:

Composite resins Composite resins

Glass ionomerGlass ionomer

Therapeutic action from Therapeutic action from overlying cement. overlying cement.

BASESBASES

A Base is a layer of cement placed beneath the A Base is a layer of cement placed beneath the permanent restoration to encourage recovery of permanent restoration to encourage recovery of the injured pulp and to protect it against the injured pulp and to protect it against numerous types of insults to which it may be numerous types of insults to which it may be subjected.The insults may be thermal or subjected.The insults may be thermal or chemical or galvanic. chemical or galvanic.

TYPESTYPES

- High Strength Bases- High Strength Bases

Provide thermal protection for pulp & Provide thermal protection for pulp & mechanical support for the restoration. Eg:Zn mechanical support for the restoration. Eg:Zn phosphate,Zn poly carboxylate,Glass phosphate,Zn poly carboxylate,Glass ionomer,RMGIionomer,RMGI

Low Strength BasesLow Strength Bases

Have min strength & rigidityHave min strength & rigidity

Act as a barrier to irritating chemicals and to Act as a barrier to irritating chemicals and to provide therapeutic effect to pulp.provide therapeutic effect to pulp.

eg: Ca Hydroxide, ZnOEeg: Ca Hydroxide, ZnOE

In case of deep excavation its necessary to In case of deep excavation its necessary to overlay CaOH with RMGI or a srong base. overlay CaOH with RMGI or a srong base.

PULP MEDICATIONPULP MEDICATION

Liners are also formulated to provide pulpal Liners are also formulated to provide pulpal medication .Main aspects aremedication .Main aspects are

- Relief of pulpal inflammation- Relief of pulpal inflammation

-Facilitation of dentinal bridging for -Facilitation of dentinal bridging for physiologic protection.physiologic protection.

PULP CAPPINGPULP CAPPING

Pulp capping is a process of placing a specialised Pulp capping is a process of placing a specialised agent in contact with or in close proximity to the agent in contact with or in close proximity to the pulp with the intention of encouraging pulp with the intention of encouraging formation of new dentin & promote the healing formation of new dentin & promote the healing of the pulp .eg: Calcium Hydroxide Cement .of the pulp .eg: Calcium Hydroxide Cement .

CRITERIA: -Pulp should be healthy & uninfected.CRITERIA: -Pulp should be healthy & uninfected.

- Area of exposure should be not more than - Area of exposure should be not more than 0.5mm0.5mm

- After exposure isolate the tooth - After exposure isolate the tooth immediately to prevent contamination.immediately to prevent contamination.

TYPESTYPESDirect pulp capping : Placement of the agent Direct pulp capping : Placement of the agent

directly on the exposed pulp.directly on the exposed pulp. - accidental exposure of pulp when - accidental exposure of pulp when

excavating deep caries.excavating deep caries.

-Traumatic fracture of tooth.-Traumatic fracture of tooth.

- Iatrogenic exposure during cavity preparation.- Iatrogenic exposure during cavity preparation.

-Iatrogenic exposure during crown preparation. -Iatrogenic exposure during crown preparation.

Indirect pulp capping: Secondary dentin Indirect pulp capping: Secondary dentin formation can be induced even when the pulp is formation can be induced even when the pulp is not exposed but near exposure.not exposed but near exposure.

Indication: - Deep carious lesion close Indication: - Deep carious lesion close to pulp.to pulp.

- excessive crown preparation.- excessive crown preparation.

- Traumatic tooth fracture. - Traumatic tooth fracture.

PULPOTOMYPULPOTOMY

When pulp of young teeth have been exposed by When pulp of young teeth have been exposed by dentinal caries ,pulpotomy is indicated.Infected dentinal caries ,pulpotomy is indicated.Infected coronal pulp tissue is removed.coronal pulp tissue is removed.

- safe in patients with history of rheumatic fever.- safe in patients with history of rheumatic fever.

-preferable in decidous teeth with chronic -preferable in decidous teeth with chronic pulpitis. pulpitis.

DRUGS: DRUGS: CalciumHydroxide,dentin CalciumHydroxide,dentin shaving,gluteraldehyde,tetracyclin,penicilinshaving,gluteraldehyde,tetracyclin,penicilin

THANK YOUTHANK YOU