Conservative Treatment of Pulp Tissue: Indications, Materials and Techniques

Description

"Dental pulp is a loose, vascularized connective tissue located within the walls of dentin. This tissue plays an important role in tooth longevity, whose functions are formative, sensitive, nourishing and defensive. Pulp exposure can be caused by severalfactors, such as a carious lesion or tooth fracture, leading to inflammation of the pulp tissue, which can result in necrosis if intervention is not performed quickly. Conservative treatments may be indicated when removal of the carious lesion results inpulp exposure in a young primary or permanent tooth, with normal pulp or reversible pulpitis, or after accidental pulp exposure. This book addresses the physiology and pathology of pulp tissue in order to communicate the importance, indications, and techniques of conservative treatments to be performed, especially in young patients, as well as the most suitable biomaterials"-- Contents Preface Acknowledgments Chapter 1 Pulp Biology – Structure and Function Abstract 1. Introduction 2. Morphology 2.1. Pulp Cells 2.1.1. Odontoblasts 2.1.2. Fibroblasts 2.1.3. Dental Pulp Stem Cells 2.1.4. Inflammatory and Immunocompetent Pulp Cells 2.2. Extracellular Components 2.3. The Pulp Vascular System 2.3.1. Blood Vessels 2.3.2. Lymphatic Vessels 2.3.3. Pulp Blood Flow 2.4. Pulp Innervation 2.4.1. Sensory Innervation 2.4.2. Sympathetic Innervation 3. Pulp Physiology and Functions 3.1. Inductive Function 3.2. Formative and Reparative Function 3.3. Sensorial and Defensive Function 3.4. Age-Related Changes Conclusion References Chapter 2 Etiology of Pulp Alterations Abstract 1. Introduction 2. Microorganisms and Pulp Pathology 2.1. Pathways of Dental Pulp Infection 2.1.1. Pulp Exposure 2.1.2. Dentin Tubules 2.1.3. Periodontal Disease 2.2. Dental Caries 2.2.1. Acute Caries 2.2.2. Chronic Caries 2.3. Dental Trauma 3. Defense Mechanisms of the Dentin-Pulp Complex 3.1. Dentin Permeability Reduction 3.2. Tertiary Dentin Formation 3.3. Immune Response and Initial Inflammation 4. Pulp Diseases 4.1. Reversible Pulpitis 4.2. Irreversible Pulpitis 4.3. Pulp Necrosis Conclusion References Chapter 3 Conservative Treatment of Pulp Tissue: What Is Its Importance? Abstract 1. Introduction 2. Conservative Endodontics and Clinical Considerations 3. Promissor Outcomes in Conservative Pulp Therapy Conclusion References Chapter 4 Behaviour Guidance of Young Patients in Dental Treatment Abstract 1. Introduction 2. Predictors of Child Behaviour 2.1. Dental Fear and Dental Anxiety 2.2. Cognitive Development of the Young Patient 2.3. Influence of Parents/Caregivers on Child Behaviour 2.4. Previous Negative Experiences 2.5. Complexity of Dental Treatment 2.6. Child Temperament 3. Guidelines for Parents/Caregivers Prior to the Appointment 4. Behaviour Assessment 5. Informed Consent 6. Pain Assessment in Young Patients 7. Basic Non-Pharmacological Behaviour Guidance Techniques 7.1. Desensitization 7.2. Distraction 7.3. Talk-Show-Do 7.4. Direct Observation 7.5. Memory Restructuring with Positive Reinforcement 7.6. Voice Control and Non-Verbal Communication 7.7. Absence/Presence of Parents 7.8. Relaxation Technique: Music, Essential Oils, Breathing Technique 8. Pharmacological Techniques 8.1. Protective Stabilization 8.2. Sedation 8.3. Nitrous Oxide 8.4. Midazolam 8.5. General Anesthesia 9. Particularities of Endodontic Treatment 9.1. Rubber Dam 9.2. Radiographs 9.3. Gag Reflex Conclusion References Chapter 5 Management of Deep Carious Lesion in Dentin Abstract 1. Introduction 2. Aggressions to the Dentin-Pulp Complex 3. Caries and Atraumatic Management of the Dentin- Pulp Complex 4. Management of Deep Caries Lesion 4.1. Concepts of Deep and Very Deep Caries Lesion 4.2. Clinical Presentations of Dentin Affected by Carious Lesions 5. Strategies for the Management of Deep Caries Lesions in Dentin 5.1 Gradual Carious Tissue Removal (GCTR) 5.1.1. Description of the Gradual Carious Tissue Removal Technique 5.1.2. Limitations of Gradual Caries Excavation 5.2. Selective Carious Tissue Removal (SCTR) in a Single Session 5.2.1. Scientific Evidence on Selective Carious Tissue Removal (SCTR) 5.3. Indirect Pulp Capping (IPC) 6. Materials used to Protect Dentin after SCTR 7. Clinical Protocol for Selective Carious Tissue Removal in a Single Session Conclusion and Recommendations for Future Research References Chapter 6 Treatment of Pulpal Exposures in Vital Teeth Abstract 1. Introduction 2. Etiology of Dental Caries 3. Response of the Pulp-Dentin Complex to External Aggressions 3.1. Pulp Immunoinflammatory Response 3.2. Pulp Repair 3.3. Influence of Capping Materials on Pulp Repair 4. Management of Exposed Vital Pulp 4.1. Direct Pulp Capping (DPC) 4.1.1. Direct Pulp Capping Classification 4.1.1.1. Class I Direct Pulp Capping 4.1.1.2 Class II Direct Pulp Capping 4.1.1.3. Scientific Evidence on Direct Pulp Capping 4.1.1.4 Direct Pulp Capping in Accidental or Traumatic Exposures 4.1.1.5. Direct Pulp Capping in Carious Exposures 4.1.1.6. Treatment Protocol for Class II DPC 4.2. Partial Pulpotomy (PP) 4.2.1. Scientific Evidence on the Partial Pulpotomy Technique 4.2.1.1. Partial Pulpotomy in Accidental Pulp Exposure 4.2.1.2. Partial Pulpotomy in Carious Pulp Exposure 4.2.1.3. Treatment Protocol - Partial Pulpotomy 4.3. Total Pulpotomy (TP) 4.3.1. Scientific Evidence on the Total Pulpotomy Technique 4.3.1.1. Total Pulpotomy in Teeth with Accidental Pulp Exposure 4.3.1.2. Total Pulpotomy in Teeth with Carious Pulp Exposure 4.3.1.3. Total Pulpotomy in Mature Teeth and Clinical Diagnosis of Irreversible Pulpitis 4.3.1.4. Treatment Protocol for Total Pulpotomy Conclusion References Chapter 7 Regenerative Endodontics Abstract 1. Introduction 2. Growth Factors 3. Stem Cells 4. Scaffolds 5. Bacteria-Free Environment 5.1. First Appointment 5.2. Second Appointment 6. Clinical Indications 7. Histological and Clinical Findings 8. New Pathways of Regenerative Endodontics 8.1. New Trends for Root Canal Disinfection 8.2. Low-Intensity Laser Phototherapy 8.3. Single-Visit versus Double-Visit Modalities 8.4. Regenerative Endodontics in Mature Necrotic Teeth Conclusion References Chapter 8 Biomaterials Used in the Conservative Treatment of Pulp Tissue Abstract 1. Introduction 2. Conservative Approaches of Pulp Tissue 2.1. Vital Pulp Status and Diagnosis 2.2. Indirect Pulp Capping 2.3. Direct Pulp Capping 2.4. Pulpotomy 3. Dental Materials and Techniques Used in Conservative Treatment of Pulp Tissue: A Brief Historic Overview 3.1. Formocresol 3.2. Glutaraldehyde 3.3. Electrosurgery 3.4. Zinc Oxide Eugenol (ZOE) 3.5. Ferric Sulfate 3.6. Glass Ionomer 3.7. Calcium Hydroxide 4. Biomaterials 4.1. Biomaterials in Dentistry 4.2. Biomaterials Used in the Conservative Treatment of Pulp Tissue 4.2.1. Mineral Trioxide Aggregate (MTA) 4.2.2. Biodentine 4.2.3. MTA-Like Cements (Calcium Silicate Cements) 4.2.4. Bioactive Molecules Conclusion References About the Editor List of Contributors Index Blank Page