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PULPEC T  OMYin p r im a r y t e e t h
D E F IN IT IO NH IS T O R IC A L P E R S P E C T IV EIN D IC A T IO N S F O RP U L P E C TO M YC O N T R A -IN D IC A T I...
Definition It is the technique to gain an access to the root canals, remove as much dead & infected material as possible &...
Complete/Total Pulpectomy:It is the extirpation of normal ordiseased pulp to or near theapical foramen .Partial Pulpectomy...
Historical Perspective: Sweet      has described a 4-5 step technique using formocresol for the treatment of pulpless teet...
Indications: Irreversible inflammation extending to the radicular pulp Primary teeth with necrotic pulp Pulpless primary t...
Pulpless primary 2nd molars before eruption ofpermanent 1st molarPulpless primary teeth inhemophiliacsPresence ofan absces...
Contra-indications : Teeth with non-restorable crowns Pathologic resorption of at least 1/3r d of the root with a fistulou...
Excessive internal resorptionPrimary teeth with underlying dentigerousor follicular cysts
M e d ic a l c o n t r ain d ic a t io n s                   Heart disease               Immuno-compromised children
Treatment Objectives:  To maintain the tooth free of  infection  To bio-mechanically clean &  obturate the root canals  To...
Treatment Considerations:  GENERALThe O N S should R A T I & co-operative.  C patient I D E be healthy  ONSInformed consen...
Root canal obturating materials for primary teeth   Camphorated parachlorophenol mixed with calcium   hydroxide [CPC + Ca ...
Ideal root canal obturating material for  primary teeth……..uld not irritate the periapical tissuesnot coagulate any organi...
easily inserted into root canal & removed easily if nould not be soluble in waterbe radioopaque & not discolour the toothd...
Z O E P A S TE    Most commonly used root canal filling material for    primary teeth    Has bactericidal effect & decreas...
EX       { C a ( O H ) 2 + Io d o f o r m }     Nearly ideal material for filling primary root canals     Mixture is easil...
D O F O R M ( K R I) P A S T E    Resorbs rapidly & has no undesirable effects on    succedaneous teeth    Material extrud...
ALKHOFF           P A S TE     Is a mixture of parachlorophenol, camphor &    mentholM A IS T O     P A S TE     Contains ...
COMPARISON OF MATERIALS USEDFOR OBTURATION IN PRIMARY TEETH   PROPE                    ZOE                              KR...
The pulpectomy procedure                     Partial           Complet   (Single -           e         visit)           (T...
P A R T IA L ( S IN G L E -V IS IT ) P U L P E C T O M Y :    Indicatio    ns   Asymptomatic primary tooth with   necrotic...
C O M P L E TE ( TWO -V IS IT ) P U L P E C T O M Y :   Indicati   ons     Presence of an acute abscess with or   without ...
Procedure      Achieve regional      local analgesia.Isolate tooth with rubber dam.
Remove caries&       identifyexposure site.Remove roof ofpulp chamberusing  fissurebur.
Remove coronal pulp withan excavator.Remove radicular pulptissue.Clean out rootcanals with H-files.
Irrigate canalswith saline.Dry root canalswith paper points&     place     apledget        offormocresol    inthe         ...
Fill canals with         slurry of zinc         oxide paste.O B T U R A T IO N T E C H N IQ U E SIncremental fill techniqu...
Fill     pulpchamber withthick mix ofZOE cement.Restore     thetooth      withstainless steelcrown.
References        Grossman LI, Oliet S, Del Rio CE. Endodontic   practice, 11th edn: Lea & Febiger, 1988: 182-187       Du...
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  1. 1. PULPEC T OMYin p r im a r y t e e t h
  2. 2. D E F IN IT IO NH IS T O R IC A L P E R S P E C T IV EIN D IC A T IO N S F O RP U L P E C TO M YC O N T R A -IN D IC A T IO N S F O RP U L P E C TO M YT R E A T M E N T O B J E C T IV E ST R E A T M E N T C O N S ID E R A T IO N SR O O T C A N A L O B T U R A T IN GM A T E R IA L S F O R P R IM A R YTE E TH
  3. 3. Definition It is the technique to gain an access to the root canals, remove as much dead & infected material as possible & fill the root canals with a suitable material to maintain the tooth in a non – Complet Partia infected state. e l
  4. 4. Complete/Total Pulpectomy:It is the extirpation of normal ordiseased pulp to or near theapical foramen .Partial Pulpectomy:It is the extirpation of normal ordiseased pulp of tooth with anincompletely formed root & anopen apex.
  5. 5. Historical Perspective: Sweet has described a 4-5 step technique using formocresol for the treatment of pulpless teeth with & without fistula. Hobson has described a pulpectomy technique for necrotic primary teeth in which the canals were not debrided.
  6. 6. Indications: Irreversible inflammation extending to the radicular pulp Primary teeth with necrotic pulp Pulpless primary teeth without permanent successors Pulpless primary teeth with sinus tracts Primary teeth with evidence of furcation pathology
  7. 7. Pulpless primary 2nd molars before eruption ofpermanent 1st molarPulpless primary teeth inhemophiliacsPresence ofan abscessPulpless primary teeth next to the line of palatal cleftPulpless primary molars supporting orthodontic appliancesPulpless primary teeth when space maintainers or continuedsupervision are not feasible
  8. 8. Contra-indications : Teeth with non-restorable crowns Pathologic resorption of at least 1/3r d of the root with a fistulous sinus tract Peri-radicular involvement extending to the permanent tooth bud Extensive pulp floor opening into the bifurcation
  9. 9. Excessive internal resorptionPrimary teeth with underlying dentigerousor follicular cysts
  10. 10. M e d ic a l c o n t r ain d ic a t io n s Heart disease Immuno-compromised children
  11. 11. Treatment Objectives: To maintain the tooth free of infection To bio-mechanically clean & obturate the root canals To promote physiological root
  12. 12. Treatment Considerations: GENERALThe O N S should R A T I & co-operative. C patient I D E be healthy ONSInformed consent, with a clear explanation of the procedure tothe parents, must be obtained. D E N TA LTheO N S I D beR A T I after the root canal treatment. C teeth must E restorable ONSChronologic & dental age must be evaluated to rule out teethwith eminent exfoliation.Psychological or cometic factors must be considered.The number of teeth to be treated & strategic importance tothe developing occlusion must be evaluated.Primary molar root anatomy along with proximity of underlyingsuccedaneous tooth must be evaluated.
  13. 13. Root canal obturating materials for primary teeth Camphorated parachlorophenol mixed with calcium hydroxide [CPC + Ca (OH)2] CPC mixed with zinc oxide Formocresol mixed with ZOE Chlorhexidine mixed with ZOE Kri TM paste Zinc oxide eugenol Zinc oxide mixed with sterile water Calcium hydroxide with sterile water Vitapex TM Frank’s paste Maisto’s
  14. 14. Ideal root canal obturating material for primary teeth……..uld not irritate the periapical tissuesnot coagulate any organic remnants in canald have a stable disinfecting powerrb at a similar rate as the primary root
  15. 15. easily inserted into root canal & removed easily if nould not be soluble in waterbe radioopaque & not discolour the toothdhere to the walls of the canal & should not shrink
  16. 16. Z O E P A S TE Most commonly used root canal filling material for primary teeth Has bactericidal effect & decreases tooth pain Overfilling causes a mild foreign body reactionof resorption is slower than that Rate of the primary tooth roota ( O H ) 2 P A S TE Generally not used in pulp treatment for primary teeth
  17. 17. EX { C a ( O H ) 2 + Io d o f o r m } Nearly ideal material for filling primary root canals Mixture is easily applied Resorbs at a slightly faster rate than the primary tooth root Has no toxic effect on permanent successors Is radioopaque’ S P A S TE { C a(OH)2 + C PC } Is well tolerated by the adjacent periapical tissue without any inflammation & with deposition of osteodentin
  18. 18. D O F O R M ( K R I) P A S T E Resorbs rapidly & has no undesirable effects on succedaneous teeth Material extruded into periapical tissue is rapidly replaced by normal tissue Has superior antimicrobial action Does not set into hard mass & can be removed if re- treatment is requiredG U TTA P E R C H A Contains Iodoform 80.8%, Camphor 4.86%, Parachlorophenol 2.025%, Menthol 1.215% Is not resorbable & so, is generally not used in pulp therapy for primary teeth May be used only when succedaneous tooth bud is absent
  19. 19. ALKHOFF P A S TE Is a mixture of parachlorophenol, camphor & mentholM A IS T O P A S TE Contains zinc oxide 14 gms, iodoform 42 gms, thymol 2 gms, chlorophenol, camphor 3cc, lanolin 0.50 gms
  20. 20. COMPARISON OF MATERIALS USEDFOR OBTURATION IN PRIMARY TEETH PROPE ZOE KRI Rate ofE S R TI S lo w e r S TA y V lIi g h t lP E F aA t e r E P sS T resorption tha n tha t fa s te r tha n tha t o f t ooon e th X a n tha t th of to o th Toxicity N root of to o th root Overfill Occurs Nooonte r None resorption O c c urs O c c urs Antiseptic action P re s e nt P re s e nt P re s e nt Application Eas y Adherence to canal wall Good Good Good Removal Radioopacity Eas y Eas y Discoloration of R a d io o p R a d io o p a q R a d io o p a tooth aque ue ne No que None None
  21. 21. The pulpectomy procedure Partial Complet (Single - e visit) (Two - visit)
  22. 22. P A R T IA L ( S IN G L E -V IS IT ) P U L P E C T O M Y : Indicatio ns Asymptomatic primary tooth with necrotic pulp tissue. Presence of inflamed but vital radicular pulp. Presence of an abscess.
  23. 23. C O M P L E TE ( TWO -V IS IT ) P U L P E C T O M Y : Indicati ons Presence of an acute abscess with or without cellulitis. Presence of active & persistent discharge from root canals. Stages Stage-1 / Visit-1 Emergency management of the acute abscess. Stage-2 / Visit-2 Final root canal obturation.
  24. 24. Procedure Achieve regional local analgesia.Isolate tooth with rubber dam.
  25. 25. Remove caries& identifyexposure site.Remove roof ofpulp chamberusing fissurebur.
  26. 26. Remove coronal pulp withan excavator.Remove radicular pulptissue.Clean out rootcanals with H-files.
  27. 27. Irrigate canalswith saline.Dry root canalswith paper points& place apledget offormocresol inthe pulp
  28. 28. Fill canals with slurry of zinc oxide paste.O B T U R A T IO N T E C H N IQ U E SIncremental fill techniqueLentulo spiral techniqueEndodontic pressure syringetechnique
  29. 29. Fill pulpchamber withthick mix ofZOE cement.Restore thetooth withstainless steelcrown.
  30. 30. References Grossman LI, Oliet S, Del Rio CE. Endodontic practice, 11th edn: Lea & Febiger, 1988: 182-187 Duggal MS, Curzon MEJ, Fayle SA, Toumba KJ, Robertson AJ. Restorative techniques in paediatric dentistry- An illustrated guide to the restoration of carious primary teeth, 2nd edn: Martin Dunitz Ltd, 2002: 51, 59-74 Ingel JI, Bakland LK. Endodontics, 5th edn: B.C. Decker Inc.2002: 554-8, 889-95 McDonald RE, Avery DR, Dean JA. Dentistry for the child & adolescent, 8th edn: Mosby, 2004 : 400-3 Curzon M E J, Roberts J F, Kennedy D B. Kennedy’s

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