Simple cover the pulp of a tooth caries and long (>24 hours) traumatic exposures cannot be recommended. In immature teeth, where the flesh is not yet finished its task of root formation, and where the root canal treatment
, it will be difficult, it was possible to take advantage of the pulp great healing ability. In these situations, amputation and pulp
defend, in which an attempt is made to delete all of the affected tissue and leave a sterile, healthy radicular pulp to finish the development of the teeth.
Work in aseptic conditions infected coronal 2-3 mm pulp is removed under sterile saline irrigation with high speed diamond drill. Specifying underlying pulp condition provided by the degree of bleeding from the wound. The bleeding should be light and easy to control in healthy tissue, and sodium hypochlorite can be washed over the wound for subsequent disinfection. In no event it is impossible to mask the condition of the pulp and to achieve hemostasis with tart. If hemostasis is not reached, then later tissue must be removed.
The same range of medical bandages again can be applied; traditionalists prefer calcium hydroxide cements, while others favor resins, MTA, or biological approaches. In any case, the tooth should be restored densely and continuously reviewed. This approach was initially adopted Cvek in 1978 for the management of traumatic pulp exposure, and its long-term success were above 80%. However, the usefulness of the approach is supported by recent studies show higher levels of success in the management of bacterial cellulose exposures in young permanent teeth (Nosrat and Nosrat 1998).
Advantages branch of infected tissue is well-known pediatric dentists who avoided simple cover the pulp of the tooth, as a dangerous procedure for preservation are of primary cellulose. Apical periodontitis in young bear the same danger pain and sepsis, but added, the Size in terms of damage to downstream permanent teeth, of the risks associated with accidental removal of the tooth and orthodontic the consequences of unplanned loss of teeth. Maintaining a healthy pulp tissue so it is very important, and coronal pulpotomy is common standard for deep caries primary molars. This is done under rubber dam with a sharp excavator or a drill, taking care to release coronal chamber of soft tissues and to cut healthy radicular pulp stumps. The dressing is then applied to the root pulp before restoring a tooth bacteria and liquid-tight. Clinical studies the main focus is on the selection of drugs and its impact on success.
In fact, the result again, probably more dependent on the state radicular pulp tissue and the ability to eliminate and exclude infection than on the exact composition of the chemicals applied. In carefully selected cases, it was shown that in about 80% cariously are primary molars will be saved without evidence apical periodontitis, whether the pulp stumps are formocresol or calcium hydroxide (Waterhouse et al. 2000). Attempts have begun to assess the status of the pulp more objectively by measuring mediators of inflammation in the blood from the cut surface, and therefore clinical outcome. The high level of pge2 and others were associated with higher levels of cellulose to break and apical periodontitis, regardless ligation (Waterhouse et al. 2002). Efforts for the application of binding materials, such as iron sulfate, to control bleeding may seem logical, but can not help clinical outcomes. Bleeding that is difficult to control could mean that the tissues in an irreversible condition of inflammation and destroy all that medical applications.
This is an interesting area for adult and pediatric dentistry, and one in which molecular biology will make a big breakthrough to support diagnosis and treatment in the coming decades...