Dear Dr. Nasseh Thank you for sharing. I always learn something new whenever I watch your videos even if I've already watched them. I was wondering, when you have an asymptomatic tooth with caries close to the pulp, is there a way to determine from the outset whether we can treat this tooth with an indirect pulp cap or if it is irreversibly inflamed (asymptomatic irreversible pulpitis) and will essentially require root canal treatment once all the caries are removed? Many thanks
A factor often not mentioned is clinical access to decay and whether you can remove it all with great visibility and video formation or if it’s too far in the back of the mouth in a difficult to access in a patient with opening issues, etc. In an asymptomatic tooth that has been tested and is vital (could be a fast reaction but without lingering beyond 30 sec and/or spontaneous pain) these kinds of teeth should theoretically work. The clinical challenges such as access which affects both on the removal of decay as well as placement of a well sealing restoration you end up having this unpredictability issue. So, one thing is theory and another clinical implementation of the theory which is not as ideal in the mouth as it is benchtop . 😅
Thank you very much dr.Nasseh for sharing your knowledge. There is a question, why the final restoration should be done after 2 months? not 1 or 3 months.
personally I have found that the material used for the cap is slightly less important than the pre-operative diagnosis. In teeth with normal pulp or reversible pulpitis and good isolation, my success rate for indirect pulp caps is very high. I have even had a decent direct pulp caps on teeth with normal pulp or reversible pulpitis end up working out. Not every tooth with deep caries needs non-surgical RCT
Can you do pulp capping and preserve the tooth when a large silver filing just fell out? Can be close to the nerve. I have no pain. Currently, there is a temporary filing right now. -- upper right in the back
@@AANasseh Thank You, I have never been informed of this procedure from any dentist. She only says implant and root canal. Will you test me for pulp capping please?
@@jeannezaks4117 You can get a second opinion at a dental school. Not everyone is a candidate for this. I'm in Boston. If you live here it's fine but it's nto worth a long trip. Just see a local dental school for this testing. Good luck.
Sorry for delay. Yes, you can use the same technique for that. The challenge is less the type of cavity for VPT but the difficulty in maintaining a seal with the final restorative material, which is the limiting factor if you can't seal adequately and allow leakage after VPT. This is one of the major causes of failure after VPT (the ability to maintain a microbe free environment).
I've read a study where Fuji VII and silver diamine produced tertiary dentine faster than CaOH. How do you compare bioceramic and those 2 for indirect pulp capping material?
I didn't fully understand. Once you've sent the patient to the restorative dentist, do they remove all the materials (RRM+Fufi 9) first, and THEN place Fuji as the base and restore the rest with composite?
No, they use the original Fuji IX as base by drilling only 2mm into it and bond an ideal composite to seal the surface. THat's all. The second visit is super quick. Cheers!
i have two doubts 1. while removing caries how far should we remove 2. radiographically will we know RDT or tertiary dentin wen we do our final filling
Could you use the bioceramic liner followed with Fuji II or Fuji IX, and then place composite on top? Like the Fuji sandwich technique, to eliminate the need to revisit the restoration
Great question. Yes you can. However, we've developed a new product called BC-Liner that's optimized to use with the Putty and will be released at the Chicago Mid-Winter meeting. The purpose of it is exactly the same thing you mentioned. A dual cure material that goes over the Putty and allows a sandwich technique to be applied to the Putty. Meanwhile, you can use a regular Glass Ionomer too. Not as good but acceptable. Cheers! :)
Can u pls tell me what are the chief complains of patient in which we have to do indirect pulp capping?? Indications of indirect pulp capping? And if patient complain of pain during cavity removal should we continue to remove carious lesion or we only place caoh and gic in it?
1/4 of my tooth is broken and the nerve is exposed (the dentist touched it and it hurt). Would a nerve that is exposed be a candidate for this procedure or is this only for tooth loss 'close to' the pulp? I'd prefer to keep my tooth alive if possible. I have cavit in my tooth for the time being and due to the pandemic dentists are only using a 'drill to kill' not to save. Thanks
It all depends how much of the tooth is remaining and how the tooth is testing; but every day that goes by your chances of a vital pulp therapy dimities rapidly.
TheraCal is a resin modified bioceramic, which translates into more toxicity and less bioceramic availability (bioceramic is bound in the resin matrix and has less bioavailability.) The resin helps with setting of the material but introduces unnecessary toxicity (like all resins!) Where you need the most biocompatibility, against the pulp, you should use a pure bioceramic and not one that's altered by resin. Combining the resin with bioceramic is not the ideal option.
MTA is not a final restorative material like Fuji IX. I think you've misunderstood something in this presentation. In this video, we demonstrate the use of EndoSequence BC RRM Paste as liner, then Fuxi IX on top. If you have no access to the RRM Paste then you can instead use MTA. RRM Paste is simply easier to apply than MTA and what's shown in this video.
I'm sorry as we are unable to give electronic consultations. However, if the pulp is necrotic, a pulp cap is not possible. Pulp capping is only feasible for teeth with reversible pulpitis. It appears that you should follow your dentist's advice and have an RCT or remove the tooth. Once the pulp is necrotic, these are the only two options. Regenerative endo has an unpredictable prognosis in multirooted molars, where the root anatomy is complex. Good luck!
