Dr Judy McIntyre Vital Pulp Therapy

[@jackcosta]

Two great providers. Great lesson!

[@familyouting5]

Thank you Dear Dr. Ali Nasseh

[@sameeradilshan5515]

Great combination of conversation..hoping more videos future

[@vladimirsavenkov2424]

Thanks for video.

[@michaellupu2080]

Hey Dr. Al, here's a "grey area" question: say you perform vital pulp therapy on an 11 year old's first upper/lower molar, by shaving off layers of inflamed pulp, as Dr. Ricucci describes. Say I extend the "incision site" to the level of the orifice and the pulp looks perfect at all orifices apart from the Palatal/Distal pulp, which is still bleeding, indicating the need for pulpectomy of that root. My question is: can I perform VPT in some canals and RCT in others? I understand that an insurance company might not accept this treatment modality, but biologically speaking, this is conservative of tooth structure, reduces risk of procedural mishaps, and success rate for both procedures is similar, plus, it can be more economically feasable for the patient.

[@WisamAlRawi]

Great content. Thank you for sharing such information. I'm also interested in the video recording itself. Can you share your video setup and color grading done?

[@tomass.6516]

I love your content! Do you happen to have any experienced endo colleagues in Sweden who are able to do VTP in adult patients? I'm a reversible pulpitis case. I've head some lingering discomfort when chewing or flossing since I got a deep cavity filled back in 2020. It's gotten progressively better, but progress is incredibly slow.

[@AANasseh]

Thank you. Please visit the university near you and discuss with the endodontic department or the operative dentistry department. Don't wait as all reversible pulpitis turns into irreversible and necrosis in due time.

[@michaellupu2080]

Thank you for the video. I follow the protocol outlined by Dr. Ricucci when doing VPT, which is similar to the one described here. In the past, however, I did use white MTA. I have a friend I treated 6 years ago and VPT was needed. Now, she has a dark gray band showing through her treated premolar; back then the staining that white MTA could cause was not widely discussed and it was the material of choice. Can you recommend a way to manage this staining? Management of such stains is, again, not discussed often. Thank you in advance dr. Ali!

[@ahmadnajwa5385]

Hello Dr Nasseh, as always wonderful content. I hope that you could answer my question Is root canal treatment necessary after apexogenesis? I have done a case, after 3 year recall Radiography shows signs of calcification but the tooth is asymptomatic and pulp is vital when tested. Why do some endodontists prefer to do RCT after apexogenesis?

[@AANasseh]

Great question. It's technically not necessary. If there is decay left behind you can get further calcification. Otherwise, full calcification may not happen. The idea of doing it is to prevent the inability to do it later on. But this risk has to be assessed against doing it unnecessarily. It'll probably make a video about this since it's a very good question. 👍

[@ahmadnajwa5385]

@@AANasseh Dr Nasseh, can i share this particular case with you?

[@AANasseh]

@@ahmadnajwa5385 Sure.

[@ahmadnajwa5385]

@@AANasseh Thank you, i have sent it to your facebook messenger

[@AANasseh]

@@ahmadnajwa5385 Did not get it! You sure you sent to Facebook messenger?

[@khaledhamdan1622]

I love ur content

[@vikasdeep4428]

Good morning Sir, I just wanted to know that, which phase of root canal treatment we called disinfection ( complete BMP including final irrigation or final irrigation only).

[@AANasseh]

I refere to the removal of debris and dentin as Macro Debris Removal (MDR) and the application of a disinfectant to the remaining walls after all MDR is complete as disinfection. But that' just my definition. All biomechanical instrumentation involves removal of tissue (dentin/pulp) and killing and removal of bacterial (disinfection).

[@vikasdeep4428]

@@AANasseh Thanks Sir

[@hama4291]

What if I can't afford bioceramics? can we use dycal or use formocresol-zoe? Or remove most of the pulp with good irrigation and place caoh, even if it melts away later I think there will be no bacteria left,,

[@michaellupu2080]

I know you didn't ask me, but Dr. Ricucci demonstrated that using pure Calcium Hydroxide powder is a great alternative; it does wash away after a few months, and the tertiary dentine at the intervention site would be irregular in surface texture, but as long as sterility is maintained and all the infected dentine and diseased pulp is removed, the same outcomes will be achieved.

[@khaledhamdan1622]

I hope to see you doctor next weekend at Riyadh 😍

[@AANasseh]

Unfortunately, my presentation will be via Zoom. I was unable to make it in person. Hopefully we'll meet at the next meeting! Best wishes! :)

[@avinawprakash9390]

After applying hypo. And before applying bioceramic does the cavity needs to be cleaned with saline , dry then apply bio or directly

[@AANasseh]

Technically, it should be rinsed off. However, unless sterile saline is available I rather just dry the NaClO than rinse with regular water. I don't think there are studies clearly showing that a water rinse is mandatory. So, I rather go the simpler way and just dry the hypo and apply the bio. Cheers!

[@avinawprakash9390]

@@AANasseh ok but if we tap dry wouldn't hypo will interfere with chemical bonding later on just askin

[@AANasseh]

@@avinawprakash9390 Not with the Bioceramic but yes, it will affect the bonding agent and the composite. But keep in mind that hypo is only active for about 3minutes against dentin. Then it's buffered and hydrolyzed. Once the unset BC is covered with a RMGIC like BC Liner, then you can retreat the dentin with another solution (or water) prior to bonding your composite. That's one possible way to address your legitimate concern.

[@avinawprakash9390]

@@AANasseh 🙂🙂 great I got it thanks