OUTLINE                                                 A. The Pulpotomy Technique                                        ...
A1- Diagnosis                                                                               A1-1/5 dilution of            ...
A1- Diagnosis                                                  A1-                                                        ...
A3- Step-by-step                          A3- Step- by-                                A3- Step-by-step                   ...
A3- Step-by-step                              A3- Step- by-                                A3- Step-by-step               ...
A4- Mechanism of action of FC          A4-                                          A4- Mechanism of action of FC         ...
A5- Alternatives to FC                 A5-Other experimental methods  – Electrosurgery                                    ...
B3- Root canal filling material            B3-                                                  B3- Root canal filling mat...
B4- Single-visit of pulpectomy         B4-                                            B4- Single-visit of pulpectomy      ...
B4- Single-visit of pulpectomy            B4-                                             B4- Single-visit of pulpectomy  ...
B4- Single-visit of pulpectomy           B4- ingle-                                                                       ...
B4- Two-visit of pulpectomy   B4-                           B5- Success rates                                 B5-謝謝聆聽敬請指正
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Pulp Therapy

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Pulp Therapy

  1. 1. OUTLINE A. The Pulpotomy Technique 1- Diagnosis 2- Indications / Contraindications Pulp Therapy for Primary Teeth 3- Step-by-step pulpotomy technique Step- by- 4- Mechanism of action of formocresol 5- Alternatives to formocresol B. The Pulpectomy Technique 1- Rationale for pulpectomy Reporter: 許修銘 2- Indications / Contraindications 3- Root canal filling material 4- Types of pulpectomy techniques 2004/03/30 5- Success rates for primary tooth pulpectomies Introduction IntroductionPreservation of primary teeth in the arch Use of pulp therapy to conserve carious – Management of developing dentition primary teeth – Nurturing a positive attitude in – Preserve pulp involved primary molar children towards dental health when missing permanent successor – Prevent possible aberrant habits – Maintain masticatory function – Preserve aesthetics – Future dental attitudes A pulpotomy is the procedure of A. The Pulpotomy Technique removing coronal part of pulp tissue, inflamed or infected as a result of deep caries, & maintenance of vital radicular pulp tissue
  2. 2. A1- Diagnosis A1-1/5 dilution of Primary tooth with deep caries the original Buckley’s formocresol Buckley’ OD (with GIC) or Pulpotomy Cresol 40mL NISHIKA Formalin 40mLRoot canal disinfectant Ethanol 20mL A1- Diagnosis A1- A1- Diagnosis A1- The reason for this is that caries in primary teeth compromises pulp very early on, with pulp inflammation setting in even before pulp is exposed A1- Diagnosis A1- A1- Diagnosis A1-Hobson (1970) Duggal et al (1999) In over 50% of the primary molars –The need for pulp therapy for most primary molars where Loss of marginal ridge proximal caries has involved the irreversible pulp inflammation marginal ridge –The importance of early diagnosis of proximal caries with the use of bitewing radiographs
  3. 3. A1- Diagnosis A1- A1- Diagnosis A1- Proximal caries that involved less than half the intercuspal distance from buccal to lingual cusp A1- Diagnosis A1- A1- Diagnosis A1- By the time the caries exposes the pulp, the inflammation is irreversible irreversible Direct pulp capping is contraindicated A2- Indications A2- A2- Contraindications A2-Large caries with substantial loss (≧1/3 ) (≧ An unrestorable tooth of marginal ridge in restorable tooth Bi- or trifurcation involvement Bi-Tooth free of radicular pulpitis Less than 2/3 of root remainingAt least 2/3 of root remaining Presence of abscess or fistulaAbsence of abscess or fistula Permanent successor close to eruptionNo inter-radicular bone loss inter- Medical contraindicationsNo evidence of internal resorption – Heart diseaseInstances where extraction is C/I – Immuno-compromised children Immuno-
  4. 4. A3- Step-by-step A3- Step- by- A3- Step-by-step A3- Step- by-Step 1: Administer local analgesia with Step 2: Isolate tooth with rubber dam the use of a topical analgesic Nerve block Buccal infiltration A3- Step-by-step A3- Step- by- A3- Step-by-step A3- Step- by-Step 3: Remove caries & Step 4: Remove roof of pulp chamber determine site of pulp exposure A3- Step-by-step A3- Step- by- A3- Step-by-step A3- Step- by-Step 5: Remove coronal pulp with Step 6: Apply FC on a pledget of large excavator or large round bur cotton wool for 4 minutes
  5. 5. A3- Step-by-step A3- Step- by- A3- Step-by-step A3- Step- by-Step 7: Remove FC pledget after 4 mins Step 8: Fill pulp chamber with cement & check that haemorrhage has stopped A3- Step-by-step A3- Step- by- A3- Step-by-step A3- Step- by-Step 9: Restore tooth with SSC Step 10: Take a post-OP radiograph post- A3- Step-by-step A3- Step- by- A3- Step-by-step A3- Step- by-Follow-upFollow- –Regularly reviewed both clinically & radiographically 6-monthly 6- –Appearance of rarefaction of bone Pre-OP Pre- Post-OP Post- in furcation area or a worsening of bone condition in furcation usually signifies failure of the procedure 3M 12 M
  6. 6. A4- Mechanism of action of FC A4- A4- Mechanism of action of FC A4-FC acts through Reported formaldehyde, aldehyde group of formaldehyde, success rate forming bonds with side-groups side- of FC of amino acids of both bacterial pulpotomy proteins & remaining pulp tissueBoth bactericidal & devitalizing agent A5- Alternatives to FC A5- A5- Alternatives to FC A5-Concern about possible toxicity of Ferric sulphate [Fe2(SO4)3, 15.5%] FC, both locally & systemically – Excellent haemostatic agentAlternatives (ferric ion-protein complex) ion- – Ferric sulphate [Fe2(SO4)3] – As effective as FC – Glutaraldehyde – No “fixative” effect fixative” – Calcium hydroxide – Other experimental methods A5- Alternatives to FC A5- A5- Alternatives to FC A5-Glutaraldehyde Calcium hydroxide – Introduced by s’Gravenmade (1975) – Poor (around 60%) success rate – Better fixative agent – Extensive internal resorption – Toxic properties below amputation • Allergic reactions • Eye irritation
  7. 7. A5- Alternatives to FC A5-Other experimental methods – Electrosurgery B. The Pulpetomy Technique – CO2 lasers – Enriched collagen solution B1- Rationale for pulpectomy B1-It is true that some primary teeth Gain access to the root canals do have a complex root Remove as much dead & Remove morphology (with many fine infected material as possible accessory root cancals), cancals), Fill the root canals with a suitable but this does not contraindicate material pulpectomy Maintain primary tooth in a non- non- infected state B2- Indications B2- B2- Contraindications B2-Irreversible inflammation Unrestorable crown extending to radicular pulp Advanced pathological rootPrimary teeth with necrotic pulps resorptionEvidence of furcation pathology Medical contraindications – Heart diseasePresence of an abscess – Immuno-compromised Immuno- children
  8. 8. B3- Root canal filling material B3- B3- Root canal filling material B3-Being totally resorbed at the same rate as the roots – Pure zinc oxide & eugenal mixed as a slurry – Maisto’s paste Maisto’ – Iodoform paste 3 M later – Vitapex B3- Root canal filling material B3- B4- Types of pulpectomy B4-Ca(OH)2-Iodoform Mixture One-stage / single-visit - Vitapex, Endoflas pulpectomy - Machida (1983): Ca(OH)2-iodoform mixture to be a nearly ideal primary tooth filling material 1) easy to apply 2) resorbs at a slightly faster rate Two-stage / two-visit than that of the roots pulpedctomy 3) has no toxic effects on the permanent successor 4) radiopaque B4- Single-visit of pulpectomy B4- B4- Single-visit of pulpectomy B4-Indications Step 1: Give local analgesia & – Presence of inflamed but vital isolate tooth with rubber dam radicular pulp – An asymptomatic primary tooth with necrotic pulp tissue without any associated acute symptoms, such as cellulitis – Presence of a chronic buccal lesion without any active discharge or acute symptoms
  9. 9. B4- Single-visit of pulpectomy B4- B4- Single-visit of pulpectomy B4-Step 2: Remove caries & Step 3: Remove roof of pulp chamber, identify exposure site & identify opening of root canals B4- Single-visit of pulpectomy B4- B4- Single-visit of pulpectomy B4-Step 4: Take a diagnostic radiograph Step 5: Clean out root canals with H files with files in the root canals & remove remnants of pulp tissue & irrigate canals with saline Within 1-2 mm 1- File lightly Reaming is not advisable File to no more than size 30 B4- Single-visit of pulpectomy B4- B4- Single-visit of pulpectomy B4-Step 6: Dry root canals with paper points Step 7: Select a spiral root canal filler of & place a pledget of FC in pulp chamber appropriate size for 4 minutes
  10. 10. B4- Single-visit of pulpectomy B4- B4- Single-visit of pulpectomy B4-Step 8: Mix ZnO & eugenol as a slurry, Step 9: Fill pulp chamber with cement & spin it into root canals using spiral root canal filler B4- Single-visit of pulpectomy B4- B4- Single-visit of pulpectomy B4-Step 10: Restore the tooth with SSC Step 11: Take a post-op radiograph to post- check root filling B4- Single-visit of pulpectomy B4- ingle- B4- Single-visit of pulpectomy B4- ingle-Follow-upFollow- –Regularly reviewed both clinically & radiographically 6-monthly 6- Pre-OP Pre- 3 M later Pre-OP Pre- Post-OP Post- 6 M later Post-OP Post- 12 M later
  11. 11. B4- Single-visit of pulpectomy B4- ingle- 92/08/21 (F/U 9M) Pre-OP Pre- Pre-OP Pre- 91/11/12 (Root canal filling) 92/12/29 (F/U 13M) 6 M later Post-OP Post- B4- Single-visit of pulpectomy B4- ingle- B4- Two-visit of pulpectomy B4-Spiral root filler Indications – Presence of an acute abscess with or without associated cellulitis – Presence of active & persistent discharge from the root canals B4- Two-visit of pulpectomy B4- B4- Two-visit of pulpectomy B4-Visit 1: Emergency management of Visit 2: Final root canal filling the acute abscess – 7~10 days later – Gaining drainage through carious cavity – Rubber dam or puncturing fistula Access root canals – LA Filed to drain Pulpectomy procedure FC pledget IRM – Antibiotics: 2-dose regimen of amoxycillin 2-
  12. 12. B4- Two-visit of pulpectomy B4- B5- Success rates B5-謝謝聆聽敬請指正

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