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  • 1. Pulp Therapy in Pediatric Dentistry Dr. Jeff Johnson Division of Pediatric Dentistry Department of Oral Health Science University of Kentucky
  • 2. Pulp Therapy in Pediatric Dentistry --Vital Pulp Therapy--
    • Permanent Tooth Pulpotomy
      • Objectives
        • Maintain vitality of radicular pulp
        • Achieve root-end closure (Apexogenesis)
        • Eliminate need for apicoectomy
        • Facilitate GP obturation with apical stop
  • 3. Pulp Therapy in Pediatric Dentistry --Vital Pulp Therapy--
    • Permanent Tooth Pulpotomy Agents
      • Formocresol
  • 4. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Objectives of Non-Vital Pulp Treatment (Primary Teeth)
      • Maintain tooth free of infection
      • Achieve biomechanical cleansing and canal obturation
      • Promote physiologic resorption
      • Maintain space and function
  • 5. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Non-Vital Pulp Treatment (Primary Teeth)
      • Choices
        • Pulpectomy (most are partial due to anatomy)
        • Extraction
  • 6. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Pulpectomy Indications/Considerations
        • Strategic importance of tooth (2 nd primary molar with unerupted 6-yr molar)
        • Sufficient remaining tooth structure
        • Poor chance of vital pulp treatment success
        • Adequate remaining root
        • Cooperative patient
  • 7. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Pulpectomy Contraindications
      • A non-restorable tooth
      • A tooth with a mechanical or carious perforation of the floor of the pulp chamber
      • Pathologic root resorption involving more than one-third of the root
      • Pathologic loss of bone support resulting in loss of the normal periodontal attachment
      • The presence of a dentigerous or follicular cyst
      • Radiographically visible internal root resorption
  • 8. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Pulpectomy Technique
      • Achieve adequate anesthesia and rubber dam isolation.
      • Remove all caries.
      • Remove the roof of the pulp chamber with a high-speed handpiece.
      • Amputate the coronal aspect of the pulp tissue with a large round bur in a slow-speed handpiece.
      • The remaining pulp tissue occupying the root canals is removed using endodontic files at a predetermined working length, approximately 1 to 2 mm short of the root apices.
      • The canals should be enlarged several sizes beyond the size of the first file that fits snugly into the canal to a minimum final size of 30 to 35.
      • Throughout root canal instrumentation, the canals should be irrigated with sodium hypochlorite to aid in debridement.
  • 9. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Pulpectomy Technique (continued)
      • 8. Dry the canals with sterile paper points.
      • 9. The canals are filled with a treatment paste (Zinc Oxide/Eugenol at UKCD) using a pressure syringe.
      • 10. The tooth is restored with a stainless steel crown.
  • 10. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
  • 11. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Criteria for an ideal pulpectomy obturant (treatment paste)
      • Antiseptic
      • Resorbable
      • Harmless to the adjacent tooth germ
      • Radiopaque
      • Non-impinging on erupting permanent tooth
      • Easily inserted
      • Easily removed
  • 12. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Apexification (Young Permanent Teeth)
      • Apical closure of an incompletely formed root
      • Implemented when apexogenesis has failed
      • Necrotic tissue removal short of the apexification site
      • Agent is placed in canals to achieve closure/apical stop
    • Apexification Recall Schedule
      • Calcium Hydroxide Rotation
        • 3-6 month intervals (Andreasen, 1994)
  • 13. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Action of Calcium Hydroxide in Apexification
      • Bactericidal
      • Low grade irritation inducing hard tissue barrier formation
      • Dissolves necrotic debris
    • Forms of Calcium Hydroxide
      • Caliscept
      • Self-mixed (CaOH + sterile water or local anesthetic)
  • 14. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • Evaluation of Success
      • Asymptomatic
      • Radiographic absence of pathology
      • Continued root development
      • Hard tissue barrier at apex
      • Responsive pulp
  • 15. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
    • In Review. . .
  • 16. FYI
    • Comparison between File Size and Needle for Pressure Syringe
      • Standard File Needle Gauge
        • 15-30 30
        • 40 27
        • 50 25
        • 70-80 22
        • 90-100 18
  • 17. References
    • Barr Elizabeth, Flaitz Catherine, Hicks John. “A retrospective radiographic evaluation of primary molar pulpectomies”. Pediatric Dentistry , Vol. 13, Number 1, 1991: 4-9.
    • Dummett, Cliff. “Pulp Therapy in Pediatric Dentistry”. Louisiana State University School of Dentistry, April 16, 2003.
    • Georig Albert C., Camp Joe H. “Root canal treatment in primary teeth: a review”. Pediatric Dentistry , Vol. 5, Number 1, 1983: 33-37.
    • Nash David A. “Pulpal Therapy, Module 6”. West Virginia University School of Dentistry.
    • Mink, John R. and Spedding, Robert. “Pediatric Pulp Treatment”. University of Kentucky College of Dentistry.
    • Pinkham, J. R., senior editor. Pediatric Dentistry, Infancy through Adolescence, Third Edition . W.B. Saunders Company, 1999.
    • Walton, Richard E. and Torabinejad, Mahmoud. Principles and Practice of Endodontics, Second Edition . W.B. Saunders Company, 1996.
    • The Handbook, Second Edition . American Academy of Pediatric Dentistry, 1999.