PULP PULP PROTECTIONPROTECTION

By:By:

dr shabeel pndr shabeel pn

Pulp is a specialized connective tissue that occupies Pulp is a specialized connective tissue that occupies the pulp chamber .It comprises of the pulp chamber .It comprises of nerves ,vessels ,lymph channels etc.nerves ,vessels ,lymph 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 If leakage of chemical irritants from biomaterials or bacteria occurs , there biomaterials or bacteria occurs , there causes irritation to pulp.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 Bacteria that survive drying under the filling material remain viable for the filling material remain viable for many years .Such dormant bacteria many years .Such dormant bacteria can become active when moisture is can become active when moisture is reintroduced as a result of marginal reintroduced as a result of marginal percolation of various filling percolation of various filling materials , poor marginal seals materials , poor marginal seals improper condensation of fillings etc. improper condensation of fillings 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 / - Amount of moisture / waterwater

- 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 desensitization or dehydration of dentindentin

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

RADIANT IRRITANTS RADIANT IRRITANTS

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

INFLAMMATIONINFLAMMATION

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

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

INFECTIONINFECTION

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

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

irritants we give irritants we 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 It is used to provide a barrier against the

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

composition: suspension of CaOH in an composition: suspension of CaOH in an organic liquid such as methyl ethyl organic liquid such as methyl ethyl ketone or ethyl alcohol.ketone or ethyl 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 Ca tungstate,BaSo4 Ethylene

toluenetoluene

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

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

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

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

Contra Indication: Contra Indication:

Composite resins Composite resins

Glass ionomerGlass ionomer

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

BASESBASES

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

TYPESTYPES

- High Strength Bases- High Strength Bases

Provide thermal protection for Provide thermal protection for pulp & mechanical support for the pulp & mechanical support for the restoration. Eg:Zn phosphate,Zn restoration. Eg:Zn phosphate,Zn poly carboxylate,Glass 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 Act as a barrier to irritating chemicals and to provide therapeutic effect to and to provide therapeutic effect to pulp.pulp.

eg: Ca Hydroxide, ZnOEeg: Ca Hydroxide, ZnOE

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

PULP MEDICATIONPULP MEDICATION

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

- Relief of pulpal - Relief of pulpal inflammationinflammation

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

PULP CAPPINGPULP CAPPING

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

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

- Area of exposure should be not - Area of exposure should be not more than 0.5mmmore than 0.5mm

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

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

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

when excavating deep caries.when excavating deep caries.

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

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

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

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

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

- excessive crown preparation.- excessive crown preparation.

- Traumatic tooth fracture. - Traumatic tooth fracture.

PULPOTOMYPULPOTOMY

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

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

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

DRUGS: DRUGS: CalciumHydroxide,dentin CalciumHydroxide,dentin shaving,gluteraldehyde,tetracyclin,pshaving,gluteraldehyde,tetracyclin,penicilinenicilin

THANK YOUTHANK YOU