pulpotomy procedures in primary dentitionPresentation Transcript
PULPOTOMY PROCEDURES IN PRIMARY DENTITION
Ca(OH) 2 pulpotomy
A pulpotomy is defined as the surgical removal of the entire coronal pulp pre-sumed to be partially or totally inflamed and quite possibly infected, leaving intact the vital radicular pulp within the canals .
The aim is to relieve pain due to pulpalgia and leave the vital pulp in roots for its completion , if incomplete (apexogenesis )
Partial pulpotomy complete pulpotomy
calcium hydroxide formocresol
Non vital pulpotomy Vital pulpotomy
Beechwood cresol Devitalization
Vital pulpotomy technique
Bone morphogenetic protein
Single sitting – Formocresol Electrosurgery Laser Two stage – Gysi triopaste Easlick’s formaldehyde Paraform devitalising pastePreservation
Formocresol was introduced in 1904 by Buckley, who contended that equal parts of formalin and tricresol would react chemically with the intermediate and end products of pulp inflammation to form a “ new, colorless, and non-infective compound of a harmless nature.”
formocresol, consists of tricresol, 19% aqueous formaldehyde, glycerine, and water.
Carious / mechanical exposure in vital asymptomatic tooth
Tooth free of radicular pulpitis
Presence of atleast 2/3 rd root length
Absence of abscess or fistula.
Absence of inter radicular bone loss
Absence of internal root resorption
Permanent posterior teeth for the expedient treatment of pulpalgia. (it relieves pain in emergency as formocresol fixes the contiguous pulp left in the root canal.)
Local : -
Spontaneous pain / pain at night
Swelling or fistula
Less than 2/3 rd root remaining
Periapical inter radicular radiolucency
Pus / serous exudate at exposure site
Uncontrolled haemorrhage from amputed pulp
Excesive pulp calcification
Medical : -
The formocresol pulpotomy technique was first advocated by SWEET 
He used a multiple sitting technique, which has been subsequently modified to either a single or two stage technique.
FORMULA :- 19% Formaldehyde
15% Glycerin & Water
To prepare 1.5%concentration of this formula, first mix 3 parts of glycerin with 1 part of distilled water ,
then add 4 parts of this preparation to 1 part buckley’s formocresol , and throughly mix again.
Mechanism of action
Formocresol causes coagulation necrosis in tissues in immediate vicinity of the application with fixation of tissue cells and micro organism.
only on those restorable teeth in which it has been determined that inflammation is confined to the coronal portion of the pulp.
Teeth with a history of spontaneous pain
Pathologic or internal root resorption
Inter radicular bone loss
Presence of fistulas or pus in the chamber
PROCEDURE Anesthetize the tooth and tissue.
Isolate the tooth with rubber dam
Remove caries & determine site of pulp exposure Remove roof of pulp chamber
Remove coronal pulp with a large excavator or a large round bur
Apply formocresol on the pledge of cotton wool for 4 minute
Remove formocresol pledget after 4 min. & check that haemorrhage has stopped Fill pulp chamber with cement
Restore the tooth with stainless steel crown
Take a post operative photograph
(1) Evidence of sluggish or profuse bleeding at the
(2) Difficult-to-control bleeding
(3) Slight purulence in the chamber but none at
the amputation site
(4) Thickening of the periodontal ligament
(5) A history of spontaneous pain without other
(2) Soon To Be Exfoliated
1. The steps are the same as for the one-appointment procedure
2. A cotton pellet moistened with diluted formocresol is sealed into the chamber for 5 to 7 days with a durable temporary cement.
3. At the second visit, the temporary filling and cotton pellet are removed and the chamber is irrigated with hydrogen peroxide.
4. A ZOE cement base is placed.
5. The tooth is restored with a stainless steel
Partial pulpotomy (pulp curretage )
It is removal of coronal pulp tissue up to the level of healthy pulp. This process is also known as partial pulpotomy.
INDICATIONS : --
when zones of inflammation has extended more than 2 mm. in an apical direction but has not reached root pulp.
Eg. A traumatic exposure (a few days post injury in a large young pulp)
Area is anaesthetised and isolated
A 2 mm. deep cavity is prepared into pulp using sterile diamond bur and copius water coolent
Excess blood is removed by saline & small cotton pelletes
Calcium hydroxide is placed onto cavity
Sealed with ZOE reinforced IRM restoration.
IT IS RARELY SUCESSFUL AND HENCE HAS NO CLINICAL SIGNIFICANT.
REASONS FOR FAILURE
Pulp is highly vascular so, even with slightest infection in any corner of pulp , the whole of it gets infected very quickly.
Its practically impossible to remove one part of coronal pulp without disturbing the other parts of it in pulp chamber.
It is two stage procedure involving the use of paraformaldehyde to fix the entire coronal & radicular pulp tissue.
The medicament used have a devitalizing, mummifying, & bactericidal action.
First appointment :-
Same as formocresol pulpotomy but place the paraformaldehyde paste in cotton pellete over the exposure & seal the tooth for 1 to 2 weeks.
Formaldehyde gas liberates from the paraformaldehyde permeates through the coronal and radicular pulp, fixing the tissue.
Second appointment :-
pulpotomy is carried out with the help of local anaesthesia
Given by mack & dean (1933 )
It is a non chemical devitalizaton technique.
Electrocautery carbonizes and heat denatures the pulp & bacterial contamination
After amputation of coronal pulp,the pulp stumps are cauterized through this method
Jeng-fen liu et al in 1999 studied the effect on Nd:YAG laser for pulpotomy in primary teeth
by kopel (1979 )
Advantages over formocresol
Superior fixative property
Self limiting penetration
Elimination of cresol
2-5 % concentration
It forms a metal protein clot at the surface of the pulp stump and this act as a barrier to irritating components of the sub-base
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