Human Resource Management - Its Impact on ... - Dental Asia

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CLINICALFEATUREby Dr P.R. Chockalingam • Dr K.U. NallasivamDoes the DiagnosticCriteria for a PulpotomyRequire a ThirdDimension?Pulpotomy is a therapeutic invasive procedure whichimplies amputation of the irreversibly inflamedportion of the pulp, giving a chance for the reversiblyinflamed/uninflamed portion of the pulp to survive.Because of the inadequacies of diagnosticparameters/armamentaria, often, the tissue which cansurvive is extirpated and the tissue which should beexcised is preserved. This article focuses on therationale of conservative endodontic procedures andattempts to conclude on the need of more precisearmamentaria for clinical diagnosis.Pulpotomy is defined as the amputation of the coronal portion of the pulpleaving behind the uninflamed radicular pulp. (1-6) This procedure is based onthe rationale that when inflammatory stimuli on the pulp [may it be due tocaries/trauma] is of low magnitude or low duration the inflammatory changesare restricted to a coronal pulp [predictably] leaving the radicular pulp uninflamed.Indicating a tooth for pulpotomy in today’s practice is based on a history ofsymptoms and clinical examination for signs. Does this diagnosis require a thirddimension? Should this third diagnostic dimension be a comprehensive histologicalone?The results reported on the success of pulpotomy procedure are variable. The poor/variable results obtained could be attributed to the medicament or due to thediagnostic criteria devoid of a histological assessment of pulp. This pilot study wascarried out to:• Comment on the need of a histological assessment for indicating a tooth forpulpotomy• To comment if the success rates of pulpotomy could be improved by aninclusion of the histological dimension of assessment of pulp’sinflammatory status• To discuss of how could this histological criteria be probably designedMaterials and MethodsTwo recently traumatized [which had symptoms of pulpal inflammation but no26 Dental Asia • March / April 2008
DENTALUPDATEclinical exposure] permanent maxillary lateralincisors with complete root formation were selected.Time of elapsed since trauma for specimens A andB were 70 and 30 hours respectively. The accesscavity preparation was done with high speeddiamond points and the pulp was extirpated with no.25 sized barbed broach .the pulp was extirpated intoto and sent for histopathological examinationbeing fixed with formalin.Each of the specimens were studied under highermagnification (40x)at the coronal, mid root andapical portionsResultsSpecimen A: Under higher magnification showedvery high number of inflammatory cells withnumerous dilated blood vessels in the coronal• However there is no sharp line of demarcation between the inflamed anduninflamed pulp.• There is no differentiation as coronal/radicular pulp on observation.If a conventional pulpotomy procedure be performed on these specimens,this procedure on specimen A could have left inflamed pulp tissue [thatcould be irreversibly inflammed] beyond the cervical region, if the sameprocedure be carried out on specimen B, this conservative endodonticprocedure would have really not been conservative as the inflamed tissuewas only restricted to the rim of the coronal pulp.In present day practice, where partial pulpotomies [cvek] is also practiced,the criteria to limit the level of pulpal amputation is only clinical. [That is alevel is reached, at which hemostasis on pulp could be established].This could be a possible reason for pulpotomies to yield unpredictableresults, more possibly, could be termed as ‘‘missed diagnosis of level ofinflamed pulp”.Diagnosis could be more accurate, and the treatment results could be morepredictable if a histological dimension is incorporated into the diagnosticcriteria. Probable armamentaria could be a sphygmomanometer sensor probeFigure 1 Coronal portion of specimen A under highermagnificationportion. (Figure 1) The mid root portion showedboth these sign but to a lesser magnitude. Theapical portion was absolutely non-inflammatoryand simulated a normal pulp. (Figures 2 & 3)Specimen B: Under higher magnification showedovert signs of inflammation restricted to the coronalrim of the pulp. (Figure 4) The mid root portionshowed these signs to a lesser magnitude (Figure5). The apical portion was non-inflammatory andsimulated a normal tissue. (Figure 6)DiscussionAnalyzing these results on an analyticalperspective, we can conclude that:• There are varying levels/degrees of inflammationin a single pulp stump.Dental Asia • March / April 200827
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Page 8 and 9: INDUSTRYBRIEFDr Jean Bausch Sets Up
Page 10: INDUSTRYBRIEFNobel Biocare Acquires
Page 14 and 15: INDUSTRYBRIEFIvoclar Vivadent Award
Page 16 and 17: DENTALFOCUSacademia • dentalExten
Page 18: DENTALFOCUSFigure 5 Implant support
Page 22 and 23: CLINICALFEATUREFigure 8 Gum colors
Page 24 and 25: CLINICALFEATUREFigure 12c Porcelain
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Page 31 and 32: DENTALUPDATEFigure 6 Apical portion
Page 33 and 34: DENTALMANAGEMENTpractices and busin
Page 35 and 36: DENTALMANAGEMENTthe extent of pract
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Page 42 and 43: USERREPORTThe TissuecareConceptImpo
Page 44: USERREPORTPlatform switching is an
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Page 49 and 50: USERREPORT1618layering consists of
Page 52 and 53: USERREPORTFigure 5 Preparation of a
Page 54: EXHIBITIONPREVIEWby Desmond TeoIDEM
Page 58 and 59: EXHIBITIONPREVIEWIDEM Products at a
Page 60 and 61: EXHIBITIONPREVIEWGebr. Brasseler (B
Page 62 and 63: EXHIBITIONPREVIEWRemedent (Booth #C
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