pulpotomy procedures in primary dentition


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pulpotomy procedures in primary dentition

  2. 2. index <ul><li>Definition </li></ul><ul><li>Classification </li></ul><ul><li>Technique </li></ul><ul><li>Formocresol pulpotomy </li></ul><ul><li>Ca(OH) 2 pulpotomy </li></ul><ul><li>Other procedures </li></ul><ul><li>Summary </li></ul><ul><li>References </li></ul>
  3. 3. <ul><li>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 . </li></ul><ul><li>The aim is to relieve pain due to pulpalgia and leave the vital pulp in roots for its completion , if incomplete (apexogenesis ) </li></ul>DEFINITION
  4. 4. classification <ul><li>Pulpotomy </li></ul><ul><li>Partial pulpotomy complete pulpotomy </li></ul><ul><li>calcium hydroxide formocresol </li></ul><ul><li>pulpotomy pulpotomy </li></ul>
  5. 5. CLASSIFICATION <ul><li>Non vital pulpotomy Vital pulpotomy </li></ul><ul><li>Beechwood cresol Devitalization </li></ul><ul><li>Formocresol Preservation </li></ul><ul><li>Regeneration </li></ul>
  6. 6. Vital pulpotomy technique <ul><li>Devitalization </li></ul><ul><li>Preservation </li></ul><ul><li>Glutaraldehyde </li></ul><ul><li>Ferric sulphate </li></ul><ul><li>Regeneration </li></ul><ul><li>Bone morphogenetic protein </li></ul><ul><li>Dentin chips </li></ul>Single sitting – Formocresol Electrosurgery Laser Two stage – Gysi triopaste Easlick’s formaldehyde Paraform devitalising pastePreservation
  7. 7. Formocresol pulpotomy <ul><li>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.” </li></ul><ul><li>Buckley’s formula </li></ul><ul><li>formocresol, consists of tricresol, 19% aqueous formaldehyde, glycerine, and water. </li></ul>
  8. 8. indications <ul><li>Carious / mechanical exposure in vital asymptomatic tooth </li></ul><ul><li>Tooth free of radicular pulpitis </li></ul><ul><li>Presence of atleast 2/3 rd root length </li></ul><ul><li>Absence of abscess or fistula. </li></ul><ul><li>Absence of inter radicular bone loss </li></ul><ul><li>Absence of internal root resorption </li></ul><ul><li>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.) </li></ul>
  9. 9. Contraindications <ul><li>Local : - </li></ul><ul><li>Spontaneous pain / pain at night </li></ul><ul><li>Pathologic mobility </li></ul><ul><li>Swelling or fistula </li></ul><ul><li>Internal resorption </li></ul><ul><li>Less than 2/3 rd root remaining </li></ul><ul><li>Periapical inter radicular radiolucency </li></ul><ul><li>Pus / serous exudate at exposure site </li></ul><ul><li>Uncontrolled haemorrhage from amputed pulp </li></ul><ul><li>Excesive pulp calcification </li></ul><ul><li>Medical : - </li></ul><ul><li>Cardiac condition </li></ul><ul><li>Immunocompromised children </li></ul>
  10. 10. TECHNIQUE <ul><li>The formocresol pulpotomy technique was first advocated by SWEET [1930] </li></ul><ul><li>He used a multiple sitting technique, which has been subsequently modified to either a single or two stage technique. </li></ul><ul><li>FORMULA :- 19% Formaldehyde </li></ul><ul><li>35% cresol </li></ul><ul><li>15% Glycerin & Water </li></ul><ul><li>To prepare 1.5%concentration of this formula, first mix 3 parts of glycerin with 1 part of distilled water , </li></ul><ul><li>then add 4 parts of this preparation to 1 part buckley’s formocresol , and throughly mix again. </li></ul>
  11. 11. Mechanism of action <ul><li>Formocresol causes coagulation necrosis in tissues in immediate vicinity of the application with fixation of tissue cells and micro organism. </li></ul>
  12. 12. One-Appointment Pulpotomy. <ul><li>Indications :- </li></ul><ul><li>only on those restorable teeth in which it has been determined that inflammation is confined to the coronal portion of the pulp. </li></ul><ul><li>Contraindications :- </li></ul><ul><li>Teeth with a history of spontaneous pain </li></ul><ul><li>Profuse haemorrhage </li></ul><ul><li>Pathologic or internal root resorption </li></ul><ul><li>Inter radicular bone loss </li></ul><ul><li>Presence of fistulas or pus in the chamber </li></ul>
  13. 13. PROCEDURE Anesthetize the tooth and tissue.
  14. 14. Isolate the tooth with rubber dam
  15. 15. Remove caries & determine site of pulp exposure Remove roof of pulp chamber
  16. 16. Remove coronal pulp with a large excavator or a large round bur
  17. 17. Apply formocresol on the pledge of cotton wool for 4 minute
  18. 18. Remove formocresol pledget after 4 min. & check that haemorrhage has stopped Fill pulp chamber with cement
  19. 19. Restore the tooth with stainless steel crown
  20. 20. Take a post operative photograph
  21. 21. Two-Appointment Pulpotomy. <ul><li>Indications </li></ul><ul><li>(1) Evidence of sluggish or profuse bleeding at the </li></ul><ul><li>amputation site </li></ul><ul><li>(2) Difficult-to-control bleeding </li></ul><ul><li>(3) Slight purulence in the chamber but none at </li></ul><ul><li>the amputation site </li></ul><ul><li>(4) Thickening of the periodontal ligament </li></ul><ul><li>(5) A history of spontaneous pain without other </li></ul><ul><li>contraindications. </li></ul><ul><li>Contraindications. </li></ul><ul><li>(1) Nonrestorable </li></ul><ul><li>(2) Soon To Be Exfoliated </li></ul><ul><li>(3) Necrotic. </li></ul>
  22. 22. Procedure <ul><li>1. The steps are the same as for the one-appointment procedure </li></ul><ul><li>2. A cotton pellet moistened with diluted formocresol is sealed into the chamber for 5 to 7 days with a durable temporary cement. </li></ul><ul><li>3. At the second visit, the temporary filling and cotton pellet are removed and the chamber is irrigated with hydrogen peroxide. </li></ul><ul><li>4. A ZOE cement base is placed. </li></ul><ul><li>5. The tooth is restored with a stainless steel </li></ul><ul><li>crown. </li></ul>
  23. 23. Partial pulpotomy (pulp curretage ) <ul><li>It is removal of coronal pulp tissue up to the level of healthy pulp. This process is also known as partial pulpotomy. </li></ul><ul><li>INDICATIONS : -- </li></ul><ul><li>when zones of inflammation has extended more than 2 mm. in an apical direction but has not reached root pulp. </li></ul><ul><li>Eg. A traumatic exposure (a few days post injury in a large young pulp) </li></ul>
  24. 24. TECHNIQUE <ul><li>Area is anaesthetised and isolated </li></ul><ul><li>A 2 mm. deep cavity is prepared into pulp using sterile diamond bur and copius water coolent </li></ul><ul><li>Excess blood is removed by saline & small cotton pelletes </li></ul><ul><li>Calcium hydroxide is placed onto cavity </li></ul><ul><li>Sealed with ZOE reinforced IRM restoration. </li></ul><ul><li>IT IS RARELY SUCESSFUL AND HENCE HAS NO CLINICAL SIGNIFICANT. </li></ul>
  25. 25. REASONS FOR FAILURE <ul><li>Pulp is highly vascular so, even with slightest infection in any corner of pulp , the whole of it gets infected very quickly. </li></ul><ul><li>Its practically impossible to remove one part of coronal pulp without disturbing the other parts of it in pulp chamber. </li></ul>
  26. 26. DEVITALIZATION PULPOTOMY <ul><li>It is two stage procedure involving the use of paraformaldehyde to fix the entire coronal & radicular pulp tissue. </li></ul><ul><li>The medicament used have a devitalizing, mummifying, & bactericidal action. </li></ul>
  27. 27. TECHNIQUE <ul><li>First appointment :- </li></ul><ul><li>Same as formocresol pulpotomy but place the paraformaldehyde paste in cotton pellete over the exposure & seal the tooth for 1 to 2 weeks. </li></ul><ul><li>Formaldehyde gas liberates from the paraformaldehyde permeates through the coronal and radicular pulp, fixing the tissue. </li></ul><ul><li>Second appointment :- </li></ul><ul><li>pulpotomy is carried out with the help of local anaesthesia </li></ul>
  28. 28. ELECROSURGICAL PULPOTOMY <ul><li>Given by mack & dean (1933 ) </li></ul><ul><li>It is a non chemical devitalizaton technique. </li></ul><ul><li>Electrocautery carbonizes and heat denatures the pulp & bacterial contamination </li></ul><ul><li>After amputation of coronal pulp,the pulp stumps are cauterized through this method </li></ul>
  29. 29. Laser pulpotomy <ul><li>Jeng-fen liu et al in 1999 studied the effect on Nd:YAG laser for pulpotomy in primary teeth </li></ul>
  30. 30. Glutaraldehyde <ul><li>by kopel (1979 ) </li></ul><ul><li>Advantages over formocresol </li></ul><ul><li>Superior fixative property </li></ul><ul><li>Self limiting penetration </li></ul><ul><li>Low antigenicity </li></ul><ul><li>Low toxicity </li></ul><ul><li>Elimination of cresol </li></ul><ul><li>2-5 % concentration </li></ul>
  31. 31. Ferric sulphate <ul><li>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 </li></ul>
  32. 32. references <ul><li>Restorative technique for paediatric dentistry - Ms DUGGAL, MEJ CURZON, SA FAYLE, KJ TOUMBA, AJ ROBERTSON </li></ul><ul><li>Endodontic – Fifth Edition - JOHN I. INGLE, LEIF K. BAKLAND </li></ul><ul><li>Text Book Of Pedodontics - SHOBHA TANDON </li></ul><ul><li>Clinical Pedodontics - FINN </li></ul><ul><li>INTERNET ( www.google.com) </li></ul>