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This article reflects long-term observations of a clinician in private practice. Significant changes have occurred in periodontology in the past 50 years, while basic principles of periodontics have remained firm. State of the art and predictions of the future of periodontal practice are based on experience gained in both a general practice and a practice limited to periodontics.
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Metacresylacetate with calcium hydroxide in a methylcellulose base produces clinically and radiographically successful pulpotomies, when performed on sound primary teeth. Under sterile conditions, with proper surgical and restorative technique, pulp tissue will heal with metacresylacetate with calcium hydroxide-methylcellulose. The dental pulp will form on osteodentin bridge and the pulp adjoining the bridge will remain histologically viable and free of inflammation. Methylcellulose with sterile distilled water does not produce as favorable a histological reaction as metacresylacetate with calcium hydroxide-methylcellulose. No dentinal bridging was in evidence and there were present in the radicular pulp varying degrees of inflammation.
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This article has described the treatment for a variety of restorative situations requiring urgent treatment. Successful management of these situations begins with a thorough knowledge of their possible causes and is reinforced by a careful history and a complete examination using all available diagnostic tools. By applying modern treatment modalities we have the ability to reduce the pain and discomfort associated with urgencies classified as restorative in nature.
An efficient systematic approach to proper diagnosis of pulpal and periradicular disease is presented. Then treatment planning considerations that determine if a tooth can be endodontically treated, if it has strategic value to be treated, and if the patient really wants the treatment are discussed. The long-term success rate of endodontic treatment is also discussed along with the predictability of emergency treatment for the patient being treated for urgent care.
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Data from several studies performed during the last 15 years indicate that bacteria and their products are the main etiological factor for dental pulp inflammation. The present series of investigations was conducted in order to determine the irritating effect from various oral bacterial components and restorative measures on dental pulpal tissue and to ascertain reaction patterns of inflamed pulp tissue. The different bacterial materials were tested in an experimental model where the test substance was applied and enclosed in buccal class V cavities prepared in human or monkey teeth. The pulp tissue response was evaluated from tooth specimens after both short (8 hours) and long time (150 days) challenge with the test substance. Intra and extra cellular components from pure bacterial species, cell wall material and a crude mixture of 8 bacterial species were used as representative test materials for oral bacteria associated with growth on or in dentin. Silicate cement restorations were also used as a pulp irritating restorative procedure. The degree of pulpal inflammation was classified according to a descriptive method. In order to obtain a better evaluation method for pulp tissue reactions, a stereo morphometric technique was developed. This method was used in the last study to evaluate the pulp tissue reactions to silicate cement restorations after dentin treatment with calcium hydroxide. The chemotactic effect of the different bacterial materials were also tested in wound chambers implanted in the back of rats. Results from these studies showed that components from different bacterial species had varying capacity to induce pulpal inflammation over cut dentin. The severity of the early inflammatory response was not altered after decomplementation. The tested bacterial products had a similar chemotactic effect on the pulp tissue as on ordinary connective tissue. If the pulp was challenged with bacterial products for a long time period, healing and repair were frequently found, although if the pulp tissue was primary severely inflamed. The inflammatory reactions and repair patterns in human teeth were similar to those of monkey teeth. Treatment of exposed dentin with calcium hydroxide reduced the pulp irritating effect of silicate cement restorations, but induced only limited volumes of irregular secondary dentin formation.
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