METHODS OF

TREATING PULPITIS

Katherina Kolb
 Endodontic Therapy or
Root Canal Therapy
is a sequence of treating
infected pulp of a tooth which
results in the elimination of infection
and the protection of the
decontaminated tooth from
future microbial invasion
CHOICE OF PULP PATHOLOGY TREATMENT
THE STATE OF PULP

ALIVE DEAD
K04.1 Necrosis of pulp

NORMAL INFLAMMATION

REVERSIBLE PULPITIS IRREVERSIBLE PULPITIS

K04.00 Initial (hyperemia)
K04.01 Acute
K04.02 Suppurative [pulpal abscess]
K04.03 Chronic
K04.04 Chronic, ulcerative
K04.05 Chronic, hyperplastic [pulpal
polyp]
K04.08 Other specified pulpitis
K04.09 Pulpitis, unspecified
CHOICE OF PULP PATHOLOGY TREATMENT
METHODS OF PULP PATHOLOGY TREATMENT

Pulp capping Vital extirpation Mortal extirpation

removal of the removal of the
inflamed pulp inflamed pulp tissue
Direct Indirect under after its preliminary
anesthesia devitalization

Vital
amputation
(in primary teeth
or in immature
permanent teeth)
CHOICE OF PULP PATHOLOGY TREATMENT
PULP CAPPING

INDIRECT DIRECT

DEEP CARIES TREATMENT

Conservative treatment
Saves the tooth vitality
No need for root canal therapy
INDICATIONS FOR DIRECT PULP CAPPING

Immature Incomplete Root

permanent teeth Development
Thin Walls of
Dentin

Exposed
Pulp
 INDICATIONS FOR DIRECT PULP CAPPING

Recent traumatic (less than 24 h)

mechanical pulp exposure Little or no bleeding
at the exposure site
 CONTRAINDICATIONS FOR
DIRECT PULP CAPPING

No pulp vitality

Pulp
calcification
 CONTRAINDICATIONS FOR
DIRECT PULP CAPPING

Pre-operative tooth
sensitivity

Any inflammatory
sings

Primary teeth
CONTRAINDICATIONS FOR
DIRECT PULP CAPPING
 CONTRAINDICATIONS FOR
DIRECT PULP CAPPING

General diseases:
cancer, diabetes,
AIDS
PULP CAPPING MATERIALS
 Calcium Hydroxide Ca(OH)2
•It is the most
common direct pulp-
capping agent

•It has antibacterial

activity and disinfects
the superficial pulp

•It has high pH

(about 12.5)
 Calcium Hydroxide Ca(OH)2

Pure calcium hydroxide

is more caustic than
hard-setting calcium
hydroxide pastes
(Dycal, Life) but both
have been shown to
initiate the same type
of healing
 Calcium Hydroxide Ca(OH)2
Dentin bridges beneath
calcium hydroxide pulp
caps contain ‘tunnel
defects’, therefore an
additional base material is
necessary to seal the
exposed pulp from the
external environment
Calcium hydroxide materials tend to soften,
disintegrate, and dissolve over time
 MTA Composition

•Tricalcium silicate
•Tricalcium aluminate
•Tricalcium oxide
•Silicate oxide

Mixed with sterile water in a 3:1 powder-to-

liquid ratio, MTA sets in 5 minutes
MTA Properties:
•Low or no solubility
•PH value is 10.2 after mixing, and rises
to 12.5 in 3 hours
•Antibacterial effect
•Induces pulpal cell proliferation
•Stimulates mineralized tissue formation
ProROOT MTA INDICATIONS
pulp
capping

root
pulpotomy
resorption

perforation at
the bifurcation
area
apexification
root
perforation

retrograde
apexogenesis
filling
Bio-Aggregate

Bio-Aggregate is a root canal

repair material composed of
bio-ceramic nano-particles

Indicated as:
•Repair of Root Perforation
•Repair of Root Resorption
•Apexification
•Pulp Capping
MTA and Bio-Aggregate show similar
chemical composition with some
differences

Bismuth oxide Tantalum oxide

Biodentine™

Active Biosilicate
Technology™ /calcium
Silicate based cement

Dentin substitute from Septodont Saint Maur-des Fosses

France
Biodentine™
Indications:
•Endodontic indications (repair
of perforations or resorptions,
apexification, root-end filling)
•Permanent dentin substitute
and temporary enamel
substitute
•Restoration of deep or large
crown carious lesions
•Direct pulp capping in adults
presenting healthy pulp
Techniques of Direct Pulp Capping
Pulpotomy

Chamber pulp is removed

and replaced with
medicated filling

Canal pulp stays alive

(hopefully)
Calcium hydroxide pulpotomy, young permanent molar

A B

APulp of a first permanent molar exposed

c
by caries (white arrow)
BCalcified dentin bridges (arrows) over
vital pulp in canals. Note open apices
CPulp recession (arrows) and continued
root development indicative of continuing
pulp vitality
CHOICE OF PULP PATHOLOGY TREATMENT
VITAL EXTIRPATION – removal of
inflamed pulp under anesthesia

treatment of pulpitis in one visit

CHOICE OF PULP PATHOLOGY TREATMENT
Non-vital extirpation – removal of the
inflamed pulp tissue after its preliminary
devitalization (paste containing trioxymethylene and
paraformaldehyde)
treatment of pulpitis in two visits

Do not use paste with arsenic!!!

CHOICE OF PULP PATHOLOGY TREATMENT
Non-vital extirpation
first visit the imposition of the
mummifying paste
second visit endodontic treatment
temporary filling
cotton ball
mummifying paste
pulp horn
CHOICE OF PULP PATHOLOGY TREATMENT
Non-vital extirpation
Basic rules to impose non-vital paste :
•the imposition on the exposed pulp only
•the amount of paste is not larger than the
drill №3 size
•strict observance of imposing terms
(7-10 days)
•coating paste with a cotton swab (tight ball)
•hermetic, unpressurized isolation of the
cavity with temporary filling
 35
finish lines