Documente Academic
Documente Profesional
Documente Cultură
OPERATIVE DENTISTRY
Paracelsius (1493-1541)
www.jorgeperdigao.com
PULP CAPPING
Composition
State-of-the art
(Vol %)
mineral
water
organic
After D. H. Pashley
Perdigao, 2005
Bacterial leakage
Toxic components of dental materials
Cavity desiccation
Threaded pins
Temperature increase (no water refrigeration)
Pressure and speed of handpiece
Lee SJ, Walton RE, Osborne JW. Pulp response to bases and cavity
depths. Am J Dent 1992; 5:64-68.
Bacterial Leakage
Toxicity of Dental Materials
...The result of the present study demonstrated that dental
materials such as silicate cement, zinc phosphate, amalgam,
and composites, when surface-sealed, are well accepted by
the dental pulp tissue and do not impair or negatively affect
pulpal wound healing on a short-term basis ...
ZOE
Skodegal & Eriksen, 1976
Bacterial Leakage
Toxicity of Dental Materials
...In the presence of bacterial colonization at the
restoration interface, severe inflammatory involvement and
pulp tissue breakdown were seen. This observation
indicates that chemical toxic factors such as acid and
components of the restorative materials per se are less
significant in causing pulpal injury than bacterial leakage
around the restoration margins...
Hatton JF, Holtzmann DJ, Ferrillo PJ Jr, Stewart GP. Effect of handpiece
pressure and speed on intrapulpal temperature rise. Am J Dent 1994; 7:108-110.
PULP CAPPING
PULP CAPPING
Two strategies
PULP CAPPING
Two strategies
PULP CAPPING
Deep dentin - RDT < 0.5 mm
At 7 days, with All Bond 2 capping, there was a large area of neutrophilic
infiltrate underlying the pulp capping material, and the death of adjacent
odontoblasts. With time, the neutrophilic reaction was replaced by
fibroblastic proliferation with macrophages and giant cells surrounding
globules of resin scattered in the coronal pulp.
Ersin NK, Eronat N. The comparison of a dentin adhesive with Ca(OH)2 as the pulp-capping
agent on the exposed pulps of human and sheep teeth. Quintessence Int 2005;36:271-280
The dentin adhesive did not allow any pulp repair and is not
indicated for direct pulp capping of human teeth.
In contrast, at 7 days, the pulp tissue capped with calcium
hydroxide exhibited odontoblast-like cells organized
underneath coagulation necrosis.
Pulp repair evolved into apparent complete dentin bridge
formation at 60 days.
Hebling et al. (1999). Biocompatibility of an adhesive system applied to
exposed human dental pulp. J Endod 25:676-82.
NO
Cavity preparation is in superficial or in middle
dentin (>0.5 mm from the pulp)
YES
A. Cavity preparation is deep dentin (0.5 mm
from the pulp)
B. There is a non-carious mechanical exposure
on a tooth without symptoms of irreversible
pulpitis
Lewis et al. (1992). Mechanical properties of dental base materials. Am J Dent 5:69-72.
Mechanical exposure
(with residual carious dentin)