Читать книгу Endodontic Materials in Clinical Practice - Группа авторов - Страница 30

If there is a suspicion that the pulp is exposed, the tooth should be immediately isolated with a rubber dam to ensure an aseptic environment and prevent any of the consequences that would result if the pulp were to become infected [12]. Magnification should ideally be used throughout the procedure to ensure removal of all softened dentine and to allow visual inspection of the pulp tissue in order to determine the degree of inflammation. The dentine should be carefully manipulated using sterile burs and sharp instruments. A high‐speed bur and water coolant should be used for pulp tissue removal [81], followed by disinfection and control of pulpal bleeding. Haemostasis and disinfection should be achieved using cotton pellets soaked ideally with sodium hypochlorite (0.5–5%) or chlorhexidine (0.2–2%) [64, 82, 83]. If haemostasis cannot be controlled after five minutes, further pulp tissue should be removed (partial or full pulpotomy). In cases with signs and symptoms indicative of irreversible pulpitis (i.e. partial irreversible pulpitis confined to the coronal pulp tissue), a full coronal pulpotomy can be carried out to the level of the root canal orifices, with bleeding arrested as detailed previously [84]. This procedure may be easier for general dental practitioners without access to magnification than either partial pulpotomy or even direct pulp capping. Ideally, an HCSC should be placed directly on to the pulp tissue and the tooth immediately definitively restored to prevent further microleakage [61, 83, 85]. If bleeding cannot be controlled after full pulpotomy, a pulpectomy and RCT should be carried out, provided the tooth is restorable. Four different VPTs can be carried out: direct pulp capping, partial pulpotomy, full pulpotomy, and pulpectomy.

Figure 2.3 Intraoral photographs of an indirect pulp‐capping procedure. (a) Preoperative image of a grossly broken‐down upper right first premolar, showing a deep lesion with unexposed pulp. (b) Indirect pulp cap with a thin layer of Biodentine interfacing with dentine overlying the pulp, leaving the maximum amount of bonding tooth tissue available for a direct composite resin restoration. (c) Direct composite resin build‐up. (d) Occlusal view of completed restoration. (e) Buccal view of composite resin restoration.

Source: Phillip L. Tomson.