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EndoCaseScenarios

DIVISIONOFPEDIATRICDENTISTRY
COLUMBIAUNIVERSITYSCHOOLOFDENTALANDORALSURGERY
PULPTHERAPYFORPRIMARYANDYOUNGPERMANENTTEETH
CASESCENARIOS
INDIRECTPULPTREATMENT
1.Thebasethatshouldbeusedforindirectpulptreatmentfortheprimaryorpermanent
dentitionisGlassionomer.
2.Aftercompletinganindirectpulptreatmentprocedureinapermanentmolar,restorethe
toothandobserveit,reenteringonlyifsymptomsarise.
Restorethetoothwithaglassionomercement,thenreenteritafteragiventimeperiod(>48
days)toremoveanyresidualcaries,regardlessoftheabsenceofpathologyandsymptoms,
andplaceapermanentrestoration.
3.Thebasethatshouldbeusedforadirectpulpcapinapermanenttoothis:lightcured
calciumhydroxide.
PULPOTOMY
4.Themedicamentthatshouldbeusedforaprimarypulpotomyprocedureis:Buckley's
formocresol(1:5dilution)orBuckley'sformocresol(fullstrength)orFerrieSulfate15%.
5.Themedicatedpelletshouldbeleftinthepulpchamberfor5minbeforeremovingitfor
aninitialevaluation.
6.Thebasethatshouldbeusedinaprimarypulpotomyprocedureis:zincoxideeugenol,
glassionomercementoriodoformpaste.
PULPECTOMY
7.Themethodsthatshouldbeusedtomechanicallydebridetherootcanal(s)foraprimary
pulpectomyare:broaches,reamersorfiles.
8.Therootcanal(s)ofprimaryteethshouldNOTbeenlargedforapulpectomy.
9.Thesolutionthatshouldbeusedtoirrigatetherootcanal(s)inaprimarypulpectomy
couldbeanyoneofthefollowing:
sterilewater/saline
localanestheticsolution
sodiumhypochlorite,fullstrength
sodiumhypochlorite,diluted
10.Thematerialthatshouldbeusedfortheobturation(filling)ofprimaryrootcanal(s)is:
zincoxideeugenolpaste(notreinforcedIRM)oriodoformpaste.
11.Thetechniquethatshouldbeusedtoplacetherecommendedfillingmaterialintotheroot
canalofaprimarytoothcouldbe:alentulospiral,handcondenser,orsyringe.
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12.Thenumberofappointmentsrecommendedforappropriatecompletionofaprimary
pulpectomyprocedureiseitheroneortwoappointmentsONEifthepulpisvitaland
TWOifthepulpisnonvital.
13.Thefrequencyofexposurewithperiapicalradiographsrecommendedforfollowup
evaluationofaprimarypulpectomyprocedureis:immediatelyafterfillingand
periodicallythereafteruntilexfoliation.
CLINICALCASESCENARIOS
FORTHEFOLLOWINGSCENARIOS.THETOOTHINQUESTIONISAPRIMARY
MANDIBULARPRIMARYSECONDMOLARANDTHEPATIENTIS5YEARSOLD.
14.Afterdeepcariesremovalinaprimarymolar,ifthereisstillcariespresentinthe
preparation,which,ifremovedinitsentiretywouldresultinaminimalpulpexposure.You
should:
continuetoremoveallcariesand,ifthepulpisexposed,initiateapulpotomy
procedure.
15.DuringaClassIIcavitypreparationwithrubberdamisolationyouverifythatyouhave
removedallthecariesandafewmomentslaterthepatientbitesdownwhileyouare
completingfinaloutlineform.Uponevaluationyounotethatthereisasmallburholeinthe
pulpalfloorofthepreparationwiththepulpexposedbutnothemorrhagic.Youshould:
doadirectpulpcaporapulpotomy,dependinguponthesizeoftheexposureandisolation
ofthetooth.
16.Duringtheexcavationofcariesinaprimarymolaracariouspulpexposureoccurs.The
radiographrevealsnopathologicrootresorptionnorobviousfurcationorapical
radiolucenciesandtherearenosignsofadrainingfistulaormobility.Youshould:
doapulpotomy.
17.Threeyearsfollowingpulpotomytreatmentinaprimarysecondmolarofan8yearold
child,aperiapicalradiographrevealspathologicrootresorptionbuttherearenonegative
clinicalsignsorsymptoms.Yourtreatmentapproachshouldbe:
routinefollowupevaluationsforclinicalsignsorsymptoms.
18.Duringapulpotomyprocedure,theamputatedradicularpulptissueisveryhemorrhagic
evenaftermedicamentapplication,hemostasisisdifficulttoachieve.Uponcloseinspection
ofthetooth,youdeterminethatthepulpchamberisadequatelyunroofedandthereisno
evidenceofcoronalpulptissuetags.Theradicularpulpcontinuestoappearhyperemic.You
should:
doapulpectomyprocedure.
19.A5yearoldpatientpresentswithadrainingfistulaassociatedwithalargecariouslesion
inaprimarymandibularsecondmolarthatappearstoberestorablewithasteelcrown.A
periapicalradiographrevealsasmallfurcalradiolucency,butthereisnoevidenceof
pathologicrootresorptionormobility.Youshoulddoeither:
atwoappointmentpulpectomy(extirpate,observe,andfill,iffavorable,on
reappointmentaoneappointmentpulpectomyoranextractionfollowedbyspace
maintenance,dependinguponcircumstancesandprofessionaljudgement.

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FORTHEFOLLOWINGTHREESCENARIOS,THETOOTHINQUESTIONISANINTACT,
DISCOLORED(GRAY)PRIMARYMAXILLARYCENTRALINCISORANDTHEPATIENTIS
3YEARSOLD.THEREARENOOTHERCLINICALSIGNSORSYMPTOMS.MOTHER
REPORTSTHATTHEPATIENTBUMPEDTHETOOTHINANACCIDENT3MONTHSAGO.
20.A3yearoldpatientpresentswithadiscolored(gray)primarycentralincisortraumatized
inanaccidentabout3monthsago.Theperiapicalradiographshowsnosignsofpathology.
Youshould:
followupandobserveevery6monthsforthedevelopmentoffurthersignsor
symptoms.
21.Theabovepatientpresentsfor6monthfollowup.Therearestillnoclinicalsignsor
symptomsofpathology.Aperiapicalradiographrevealsa2mm,poorlydefinedapical
lucency.Youshoulddo:
apulpectomy.
22.Theabovepatientpresentsfor6monthfollowup.Theradiographrevealsa2mm,
poorlydefinedperiapicalradiolucency.Clinicalexaminationrevealsalabialparulis
associatedwiththetooth.Thepatientdoesnotreportanysymptomsyoushoulddoeither:
apulpectomyorextractiondependingupontheextentoftheabscess.
23.A3yearoldpatientpresentswithanEllisclassIIIfracture(exposureofthepulp)ofa
primarymaxillaryincisorthatoccurredlessthan1hourago.Softtissuesareintact,thetooth
initsnaturalpositionandisonlyslightlymobile.Aperiapicalradiographisnormalexcept
forthefracture.Youshoulddo:
apulpectomy
24.A7yearoldpatientpresentswithanEllisClassIIIfractureofapermanentmaxillary
centralincisorthatoccurredlessthan1hourago.Softtissuesareintact,thetoothinits
naturalpositionandisonlyslightlymobile.Aperiapicalradiographisnormalexceptforthe
fracture.Youshoulddoeither:
adirectpulpcapwithlightcuredcalciumhydroxidebase
or
partialpulpotomy(Cvektechnique)usingcalciumhydroxidepowder
dependinguponcircumstancesandprofessionaljudgement.
25.A9yearoldpresentswithdeepcariesinapermanentmandibularfirstmolar.Abitewing
radiographshowsamostlikelycariouspulpexposureifallcarieswereremoved.A
periapicalradiographshowsnoevidenceofabscess.Youshoulddo:
indirectpulptreatment.

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