单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Chapter 18Vital Pulp Therapy and Apexification,Chapter 18Vital Pulp Therapy,掌握：直接盖髓术、间接盖髓术、牙髓切断术的原理及适应证,根尖诱导成形术的修复机制和愈合类型,学习要点,熟悉：直接盖髓术、间接盖髓术、根尖诱导成形术操作步骤,了解：根尖屏障术的原理和操作步骤,掌握：直接盖髓术、间接盖髓术、牙髓切断术的原理及适,Vital Pulp Therapy,活髓保存治疗,Direct pulp capping,直接盖髓术,Indirect pulp capping,间接盖髓术,Pulpotomy,牙髓切断术,“,Principles and practice of endodontics,”,Vital Pulp Therapy活髓保存治疗Direc,1.Pulp capping,1.1 Direct pulp capping,Indications:,Accidental or mechanical pulp exposure,(normal pulp),Cavity preparation,Placement of pins,Trauma,Mainly for immature permanent teeth with recent(24 hr)traumatic pulp exposure or mechanical exposure during cavity preparation,1.Pulp capping1.1 Direct pul,Should mature teeth be pulp capped?,Size of exposure limited to o.5mm,Contraindicated for carious tooth with pulp involvement,Enamel-dentin fracture with pulpal involvement,Direct pulp capping,Should mature teeth be pulp ca,Hemostatic reagents,止血剂,Saline,盐水,Hydrogen peroxide,双氧水,Diluted sodium hypochlorite,次氯酸钠,Chlorhexidine,洗必泰,Hemostatic reagents止血剂Saline,Pulp capping materials,Calcium hydroxide,Mineral trioxide aggregates(MTA),矿化三氧化聚合物,Pulp capping materialsCalcium,MTA,Excellent biocompatibility and hydrophilicity,Induce hard tissue regeneartion,Indicated for apical barrier,perforation repair,retrofilling and vital pulpal therapy,Setting time:45 hrs,MTA,Procedures,Ca(OH),2,or MTA applied to the exposure to stimulate differentiation of new odontoblast-like cells and formation of secondary dentin,Temporary restoration placed over Ca(OH),2,or MTA,Follow-up,Permanent restoration,Pulpotomy or endodontic treatment for symptomatic tooth,ProceduresCa(OH)2 or MTA appl,1.2 Indirect pulp capping,Indications,Deep carious lesions,No history of pulpalgia,牙髓痛,No signs of irreversible pulpitis,No pulp exposure after excavation of carious dentine,1.2 Indirect pulp capping I,Pulp Capping Materials,Calcium hydroxide,氢氧化钙,The most commonly-used,(direct)pulp-capping material,Water-based calcium hydroxide,Resin-based calcium hydroxide,e.g.Dycal,Timeline,Pulp Capping MaterialsCalcium,Zinc oxide-eugenol cement(ZOE),Only for indirect pulp capping,Bactericidal effect and hermetic marginal seal,Cytotoxicity:use of ZOE as a liner in deep carious,lesions is still controversial,Zinc oxide-eugenol cement(ZOE,Procedures,1.Remove all softened,mushy or leathery dentine,2.Either ZOE or Ca(OH),2,placed on the remaining dentin to kill or suppress bacteria,3.Base,4.Temporary or permanent restoration,Procedures1.Remove all soften,2.Pulpotomy,Indicated for immature permanent teeth,Traumatic pulp exposure,Mechanical pulp exposure,Carious pulp exposure,2.PulpotomyIndicated for imma,Procedures,Removal of all carious dentin and pulp tissue to the level of the radicular pulp,Vital pulp stump capped with Ca(OH),2,Temporary restoration,Follow-up,Asymptomatic:permanent restoration,Symptomatic:endodontic treatment,Procedures Removal of all cari,Potential problems with pulpotomy as a permanent treatment,Impossible to determine whether all disease tissue has been removed,The remaining radicular pulp tissue may undergo mineralization,Making further endodontic treatment difficult or impossible,Internal resorption,Potential problems with pulpot,Conclusions,The vital pulp therapies are predictable in teeth with traumatic or mechanical pulp exposure,Direct pulp capping is contraindicated for teeth with carious pulp exposure,-Pulpotomy might be the choice but is considered unproven,When for financial or other reasons extraction is the only alternative,pulpotomy certainly should be considered for the benefit of the patient,ConclusionsThe vital pulp ther,4.Apical barrier technique,4.Apical barrier technique,4.1 Principle,Apical barrier technique,Use Mineral trioxide aggregate(MTA)to form a calcified barrier at the root terminus that helps obturating the root canal system,4.1 PrincipleApical barrier te,MTA,Exhibits outstanding biocompatibility,antibacterial properties,hydrophilicity,sealing ability and long-term success,Stimulates hard tissue formation,Provides a seal against microleakage,Establishes a hard apical barrier in order to obturate the root canal system,MTAExhibits outstanding biocom,MTA,MTA placement can be done in fewer clinical treatment visits,Calcium hydroxide typically includes multiple appointments over months and also requires potential tissue for continued tooth development,MTA used to,Induce an artificial barrier in open-apex cases,Repair perforation,Seal the retro-preparation in surgical endodontics,Protect the pulp in direct pulp capping,MTAMTA placement can be done i,4,.2 Indication,Pulpal necrosis teeth with apical periodontitis,Immature teeth with open apices,Fail to close the root end with long-term traditional apexification,4.2 IndicationPulpal necrosis,4.3 Procedure,(1)Cleaning and shaping of the root canals,Coronal-radicular access to the defect,to remove all necrotic pulp tissue and microbial infection,Not to heavily instrument the