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     pulpotomy procedures in primary dentition pulpotomy procedures in primary dentition Presentation Transcript

    • PULPOTOMY PROCEDURES IN PRIMARY DENTITION
    • index
      • Definition
      • Classification
      • Technique
      • Formocresol pulpotomy
      • Ca(OH) 2 pulpotomy
      • Other procedures
      • Summary
      • References
      • 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 )
      DEFINITION
    • classification
      • Pulpotomy
      • Partial pulpotomy complete pulpotomy
      • calcium hydroxide formocresol
      • pulpotomy pulpotomy
    • CLASSIFICATION
      • Non vital pulpotomy Vital pulpotomy
      • Beechwood cresol Devitalization
      • Formocresol Preservation
      • Regeneration
    • Vital pulpotomy technique
      • Devitalization
      • Preservation
      • Glutaraldehyde
      • Ferric sulphate
      • Regeneration
      • Bone morphogenetic protein
      • Dentin chips
      Single sitting – Formocresol Electrosurgery Laser Two stage – Gysi triopaste Easlick’s formaldehyde Paraform devitalising pastePreservation
    • Formocresol pulpotomy
      • 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.”
      • Buckley’s formula
      • formocresol, consists of tricresol, 19% aqueous formaldehyde, glycerine, and water.
    • indications
      • 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.)
    • Contraindications
      • Local : -
      • Spontaneous pain / pain at night
      • Pathologic mobility
      • Swelling or fistula
      • Internal resorption
      • 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 : -
      • Cardiac condition
      • Immunocompromised children
    • TECHNIQUE
      • The formocresol pulpotomy technique was first advocated by SWEET [1930]
      • He used a multiple sitting technique, which has been subsequently modified to either a single or two stage technique.
      • FORMULA :- 19% Formaldehyde
      • 35% cresol
      • 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.
    • One-Appointment Pulpotomy.
      • Indications :-
      • only on those restorable teeth in which it has been determined that inflammation is confined to the coronal portion of the pulp.
      • Contraindications :-
      • Teeth with a history of spontaneous pain
      • Profuse haemorrhage
      • 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
    • Two-Appointment Pulpotomy.
      • Indications
      • (1) Evidence of sluggish or profuse bleeding at the
      • amputation site
      • (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
      • contraindications.
      • Contraindications.
      • (1) Nonrestorable
      • (2) Soon To Be Exfoliated
      • (3) Necrotic.
    • Procedure
      • 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
      • crown.
    • 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)
    • TECHNIQUE
      • 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.
    • DEVITALIZATION PULPOTOMY
      • 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.
    • TECHNIQUE
      • 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
    • ELECROSURGICAL PULPOTOMY
      • 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
    • Laser pulpotomy
      • Jeng-fen liu et al in 1999 studied the effect on Nd:YAG laser for pulpotomy in primary teeth
    • Glutaraldehyde
      • by kopel (1979 )
      • Advantages over formocresol
      • Superior fixative property
      • Self limiting penetration
      • Low antigenicity
      • Low toxicity
      • Elimination of cresol
      • 2-5 % concentration
    • Ferric sulphate
      • 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
    • references
      • Restorative technique for paediatric dentistry - Ms DUGGAL, MEJ CURZON, SA FAYLE, KJ TOUMBA, AJ ROBERTSON
      • Endodontic – Fifth Edition - JOHN I. INGLE, LEIF K. BAKLAND
      • Text Book Of Pedodontics - SHOBHA TANDON
      • Clinical Pedodontics - FINN
      • INTERNET ( www.google.com)