Conservation

Conservation

Caries management
1. Indirect pulp cap
  1. Hall technique (PFMC)
    1. No caries removal
    2. PFMC seals caries/tooth from substrate
  2. Stepwise excavation
    1. Deep carious cavity (5mm)
    2. Caries removal but some caries left at cavity base
      1. Setting CaOH liner placed
        GIC restoration
        6-9months later
        Remove GIC
        Remove soft dentine
        Place definitive restoration
        or GIC (CDH)
    3. CaOH liner kills bacteria (antimicrobial) & encourages tertiary dentine deposition (alkaline)
    4. Restoration seals cavity from substrate
  3. Atraumatic Restorative technique (ART)
    1. Soft caries removed with spoon excavator
      1. Restored with GIC
    2. Restoration seals cavity from substrate
  4. Partial caries removal
    1. Same as Stepwise excavation
    2. Difference
      1. Definitive restoration after some caries removal (1 visit)
2. When
  1. Asymptomatic dentine caries
  2. Reversible pulpitis
Pulpotomy
1. When
  1. Carious pulp exposure
  2. Traumatic pulp exposure
2. Isolate
  1. Use NaOCl to disinfect & control bleeding
    1. Remove pulp with high speed bur until bleeding stops / all coronal pulp removed
      1. MTA pulp cap
        Temporise
        Restore definitively if asymptomatic
        or ZOE cement liner (CDH)
        Restore with GIC + composite or PFMC
      2. Use Ferric Sulphate (CDH)
RCT (inc. pulpectomy)
1. When
  1. Irreversible pulpitis
  2. Pulp necrosis
  3. Periapical pathology
  4. Restoration requires use of pulp chamber/canals for retention
  5. Restoration would seriously endanger the pulp
2. Complete caries removal
  1. Access & unroof pulp chamber
    1. Isolate
      1. Remove pulpal tissue
        Irrigate with NaOCl (throughout)
        Shape & clean canals
        Obturate with GP & AH resin sealer
        Definitive restoration
Prevention
1. When
  1. Non-cavitated enamel caries
    1. e.g. white spot lesion
2. Fluoride varnish over lesion
  1. OHI
  2. Diet advice
Enamel Biopsy
1. When
  1. Stained fissures + sign suggesting caries
2. No caries or in enamel only
  1. Fissure sealant
Direct pulp cap
1. Isolate
  1. Use NaOCl to disinfect & control bleeding
    1. No pulp removed
      1. MTA pulp cap
        Temporise
        Restore definitively if asymptomatic
2. When
  1. Traumatic pulp exposure
    1. Open apex (complicated crown #)

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	Created by sanna pathy almost 5 years ago