Contemporary Endodontics for Children and Adolescents

Preface
Contents
1: Introduction: Pulp Therapy for Children and Adolescents – Historical Approach, Present Perspective, and Future Directions
1.1 Introduction
1.2 Historical Perspective: Personal Approach
1.3 Present Perspectives
1.4 New Developments and Future Directions
References
2: Cellular and Molecular Mechanisms Guiding the Development and Repair of the Dentin–Pulp Complex
2.1 Introduction
2.2 Formation of the Dentin–Pulp Complex
2.3 Mesenchymal Condensation and Key Features of the Early Dental Papilla
2.4 Odontoblast Differentiation
2.5 Dentin Regeneration and Repair
2.6 The Role of Inflammation in Dentin Biology
2.7 Concluding Remarks
References
3: Dental Pain, Mechanism of Action
3.1 Dentinal Pain
3.2 Pulpal Pain
References
4: Assessment and Management of Pain in Pediatric Dentistry
4.1 Local Anesthesia in Pediatric Dentistry
4.2 Topical Anesthesia
4.3 Needle Selection
4.4 Injection Rate
4.5 Techniques of Local Anesthesia
4.6 Conventional Local Anesthesia
4.6.1 Supraperiosteal Technique: Local Infiltration
4.6.2 Palatal tissue’s Anesthesia: Papillary-Interdental Anesthesia
4.7 Inferior Alveolar Nerve Block (IANB)
4.8 Computer-Controlled Local Anesthetic Delivery
4.9 Behavior Management During Local Anesthesia
4.10 Materials and Solutions
4.11 Side Effects and Complications
4.12 Toxicity
4.13 Allergy
4.14 Trauma to Soft Tissue
References
5: Behavioral Approaches as an Adjunct for Pulp Therapy
5.1 Introduction
5.2 Patient Assessment
5.3 Informed Consent and Parental Guidance
5.4 Basic Behavior Guidance Techniques
5.4.1 Communication
5.4.2 Tell-Show-Do
5.4.3 Distraction
5.4.4 Relaxation Exercises
5.4.5 Nitrous Oxide
5.5 Pain Validation
5.6 Management of Challenging Situations
5.6.1 Inability or Refusal to Cooperate
5.6.2 Inadequate Pain Control
5.7 Recovery After a Difficult Appointment
5.8 Conclusions
5.8.1 Case 5.3
References
6: The Caries Lesion: Diagnosis, Decision-Making, and Recommendations for Lesion Management
6.1 Introduction
6.2 Caries Disease Development and Control Strategies
6.3 Caries Diagnosis
6.4 Strategies of Dental Caries Lesion Management
6.5 Treatment Options for Initial, Moderate, and Extensive Caries Lesions
6.6 Concluding Remarks
References
7: Pulp Response to Clinical Procedures and Dental Materials
7.1 Introduction
7.2 Concepts About In Vitro Animal and Usage/Clinical Tests
7.2.1 Resin Infiltration Systems for Treatment of Enamel White Spot-Like Lesions
7.2.2 Silver Diamine Fluoride (SDF)
7.2.3 Tooth Whitening Agents
7.2.4 Bonding Agents, Glass Ionomer, and Calcium Silicate Cements
References
8: SDF as an Adjunct Approach for the Management of Caries
8.1 Introduction
8.2 SDF’S Use for Caries Arrest
8.3 Appearance and Clinical Application
8.4 SDF’S Mechanism of Action in Enamel and Dentin
8.5 SDF on the Pulp Complex
8.6 SDF as an Indirect Pulp Therapy Agent
8.7 The Role of SDF in Caries Management
8.8 Conclusions
References
9: Guidance to Achieve Clinical Pulpal Diagnosis and Operative Decisions
9.1 Introduction
9.2 Clinical Examination
9.3 Diagnostic Tests
9.3.1 Electrical Pulp Test (EPT)
9.3.2 Cold Test
9.3.3 Heat Test
9.3.4 Laser Doppler Flowmetry (LDF)
9.3.5 Pulse Oximetry
9.3.6 Periapical Tests (Percussion)
9.3.7 Probing
9.3.8 Periapical Image
9.3.8.1 Focal View CBCT
9.4 Depth of Caries and Presence of Symptoms
9.5 Bleeding and Pulpal Status
9.6 Pulpal Diagnosis Terminology
9.7 Conclusion
References
10: Management of Deep Dentin Carious Lesions: A Contemporary Approach for Primary and Young Permanent Teeth
10.1 Introduction
10.2 Dental Caries Lesion Development and Pulp Reactions
10.3 Different Stages of Dental Caries Lesions, Dental Tissue Bacterial Invasion, and Lesion Control
10.4 Treatment Options for Deep Dentin Carious Lesions
10.5 Clinical Evidence for Primary Teeth
10.6 Clinical Evidence for Permanent Teeth
10.7 Pulp Response to SCR-SD
10.8 The Role of Cavity Liners After SCR-SD
10.9 Future Perspectives for the Management of Deep Carious Lesions
10.10 Concluding Remarks
References
11: Bioactive Ceramics for Pediatric Dentistry
11.1 Bioceramics
11.2 Bioactive Ceramics and Biomineralization
11.3 Bioactive Ceramic Cements
11.4 Bioactive Cement Compounds
11.5 Cement Hydration Reactions
11.6 Pediatric Bioactive Ceramic Dental Cements
11.6.1 Indications
11.6.2 Composition
11.6.3 Radiopacity
11.6.4 Pastes and Resins
11.6.5 Format
11.6.6 Packaging Materials
11.7 Cement Product Characteristics
11.7.1 Handling
11.7.2 Setting Time
11.7.3 Solubility
11.7.4 Dimensional Stability
11.7.5 Bonding
11.7.6 Strength
11.7.7 Costs
11.7.8 Other “Bioactive” Materials
11.8 Summary
References
12: Primary and Permanent Teeth Treated with Direct Pulp Capping
12.1 Purpose
12.2 Goals
12.3 Definitions
12.4 Pulpal Diagnosis
12.5 Caries Removal Methods Affect Pulpal Treatment Methods
12.5.1 Complete Caries Removal
12.5.1.1 Complete Caries Removal and Rate of Pulp Exposure
12.5.2 Stepwise Caries Removal (SW)
12.5.3 Selective (Partial) Caries Excavation
12.5.4 No Caries Removal
12.6 Vital Pulp Therapy for Carious Pulp Exposure Having Normal Pulp or Reversible Pulpitis Diagnosis
12.6.1 Direct Pulp Capping Primary Teeth
12.6.2 Direct Pulp Capping Permanent Teeth
12.7 Vital Pulp Therapy for Carious Pulp Exposure Having Irreversible Pulpitis Diagnosis
12.8 Considerations Before DPC in Primary and Permanent Teeth
12.9 Conclusions
References
13: Pulpotomy for Primary Teeth: Techniques and Materials
13.1 Introduction
13.1.1 Formocresol
13.1.2 Glutaraldehyde
13.1.3 Calcium Hydroxide
13.1.4 Sodium Hypochlorite
13.1.5 Zinc Oxide/Eugenol (ZOE)
13.1.6 Ferric Sulfate
13.1.7 Lasers
13.1.8 MTA and Biodentine
13.2 MTA/Biodentine Pulpotomy Procedure and Practical Considerations
13.2.1 Pulpotomy of Single Tooth with MTA-Like Material
13.2.2 Pulpotomy of Multiple Teeth with Biodentine
13.2.3 Is There a New Gold Standard?
13.3 Partial Pulpotomy for Primary Teeth
13.4 Treatment Planning for a Pulpotomy
13.5 Conclusions
References
14: Non-Vital Pulp Therapies in Primary Teeth
14.1 Morphological Considerations
14.2 Primary Tooth Root Canal Physiology
14.3 Primary Tooth Root Canal Anomalies
14.4 Pulpal and Periapical Diagnostics
14.5 Indications for Pulpectomy
14.6 Contraindications for Pulpectomy
14.7 Pulpectomy Procedures
14.7.1 Access and Debridement
14.7.1.1 Instrumentation Technique
14.7.2 Root Canals Irrigation
14.7.3 Filling the Root Canal(s)
14.8 Supplementary Methods
14.8.1 Electronic Apex Locators
14.8.2 Ultrasonic Instrumentation
14.8.3 Lesion Sterilization Tissue Repair (LSTR)
14.9 Evaluation of Pulpectomy
14.10 Adverse Effects of Pulpectomy
14.11 Adjunctive Systemic Antibiotic Treatment
References
15: Sealing and Building Up the Pulp Chamber and Crown with Glass Ionomer and Other Materials After Pulp Therapy
15.1 Introduction
15.2 Premise and Conceptual Framework
15.3 Boundaries of This Chapter Conversation
15.4 Purpose of Fill/Goals
15.5 Sealing the Orifices
15.6 Material Choices for Pulp Chamber Fill
15.6.1 Zinc Oxide: Eugenol
15.6.2 GIC Materials
15.6.3 Composite
15.7 Assessment/Outcomes
References
16: Restorative Guidelines for Endodontically Treated Primary Teeth
16.1 Introduction
16.2 Beyond the Tooth… Patient Behavior, Clinical Skills, Modality of Care Delivered, and Special Healthcare Needs
16.3 Isolation
16.4 Mouth Props and Bite Blocks
16.5 Amalgam Restorations
16.6 Composite Resin and Compomer Restorations
16.7 Composite Strip Crowns
16.8 Glass Ionomer Restorations
16.9 Sandwich Restorations (Glass Ionomer and Composite)
16.10 Stainless-Steel Crowns (SSCs)
16.11 Pre-veneered Stainless Steel Crowns
16.12 Zirconia Crowns
16.13 Final Tips
16.14 Conclusion
References
17: Endodontic Treatment for Young Permanent Teeth
17.1 Factors Affecting the Treatment of Young Permanent Teeth
17.1.1 Pulp Characteristics of Immature Permanent Teeth
17.1.2 Nature of Pulp Damage
17.1.3 Stage of Root Development
17.1.4 Restorability
17.2 Pulpal and Apical Diagnosis
17.2.1 Clinical Examination
17.2.2 Pulp Sensibility Tests
17.2.2.1 Thermal Tests
Cold Test
Heat Test
17.2.2.2 Electric Pulp Test (EPT)
17.2.2.3 Laser Doppler Flowmetry (LDF)
17.2.2.4 Test Cavity (Drill Test)
17.2.3 Radiographic Examination
17.2.3.1 CBCT
17.2.4 Pulpal and Apical Tissue Diagnostic Terminology
17.3 Materials Used in Vital Pulp Therapy
17.3.1 Sodium Hypochlorite (NaOCl)
17.3.2 Ethylenediaminetetraacetic Acid (EDTA)
17.3.3 Calcium Hydroxide [Ca(OH)2]
17.3.3.1 Hard Tissue Formation
17.3.4 MTA- and Calcium Silicate-Based (CSB) Materials (Bioceramics)
17.3.4.1 Biodentine and EndoSequence Root Repair Material
17.4 Pulpotomy
17.4.1 Clinical Procedure: Partial and Cervical Pulpotomy
17.4.2 Bleeding Time
17.4.3 The Expected Outcome
17.4.4 Pulpotomy with Different Materials
17.4.5 Timing of Pulpotomy After Traumatic Injuries
17.4.6 Prognostic Factors
17.5 Regenerative Endodontics
17.5.1 Clinical Procedure
17.5.1.1 First Visit
17.5.1.2 Second Visit
17.5.2 Scaffold
17.5.3 Follow-Up
17.5.4 Expected Outcome
17.5.4.1 Healing of Periapical Lesions
17.5.4.2 Continued Root Maturation
17.5.4.3 Response to Sensibility Tests
17.5.5 Survival
17.5.6 Pulp Regeneration
17.5.7 Tissue Reactions
17.5.8 Influence of Apical Diameter on the Outcome of Revascularization
17.5.9 Comparison of Revascularization and Apexification
17.6 Root Canal Treatment in Young Permanent Teeth and Apexification
17.6.1 Clinical Procedure
17.6.1.1 Access Preparation
17.6.1.2 Mechanical and Chemical Preparation
17.6.1.3 Root Canal Obturation
Root Canal Apexification in Immature Roots: Apical Barrier Technique
Obturation of Mature Roots with Open Apices
17.6.1.4 Coronal Restoration
17.6.1.5 Follow-Up
References
18: Restoring the Endodontically Treated Young Permanent Tooth
18.1 Introduction
18.2 The Access Cavity
18.3 Intraorifice Barrier
18.4 Coronal Restoration of Endodontically Treated Young Permanent Teeth
18.4.1 Young Permanent Molars
18.4.1.1 Prefabricated Crowns
18.4.1.2 Indirect Restorations
18.4.2 Young Permanent Incisors
References
19: Elucidating Tooth Development and Pulp Biology by Single-Cell Sequencing Technology
19.1 Introduction
19.1.1 Clinical Relevance, Challenges, and Questions
19.1.2 Tooth and Pulp Development
19.1.3 Basic Principles of scRNA-Seq
19.1.3.1 A Methodological Comparison of the Reviewed Studies
19.2 Formation and Patterning of the Ectomesenchyme
19.3 Odontogenesis from Bud to Bell Stages
19.4 Post-Eruption and Adult Stages
19.5 Summary
References
20: Biological Basis for Repair and Regeneration in Modern Endodontics and New Treatment Considerations
20.1 Introduction
20.2 Mechanisms of Pulpal Physiology and Repair
20.2.1 Reaction of Dentin and Pulp to Mild Injury: Healing, Regeneration, and Repair
20.2.2 The Pulp-Dentin Complex and Conventional Root Canal Treatment
20.2.3 Regenerative Potential of the Dental Pulp and Periapical Tissues
20.3 Biological Basis of Regenerative Endodontic Procedures
20.3.1 Stem Cells in Repair and Regeneration
20.4 Stem Cell Homing for Dental Pulp Tissue Engineering
20.5 Stem Cell Transplantation for Dental Pulp Tissue Engineering
20.6 Conclusions
References