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  1. 1. Pulpotomy Access Technique Cynthia Christensen, DDS, MS Department of Pediatric Dentistry
  2. 2. Pulp Therapy for Primary Teeth Michael Kanellis, DDS, MS Department of Pediatric Dentistry
  3. 3. Pulpotomy <ul><li>Pulpotomy is the extirpation of vital inflamed pulp from the coronal chamber followed by medicament placement over radicular pulp stumps to fix (mummification) or stimulate repair of the remaining vital radicular pulp. </li></ul>
  4. 4. Pulpotomy <ul><li>Rationale: The radicular pulp tissue is healthy, and can either heal after the surgical amputation of the coronal pulp, or be fixed/mummified. </li></ul><ul><li>Signs or symptoms of inflammation extending beyond the coronal pulp is a contraindication for a pulpotomy </li></ul>
  5. 5. Pulpotomy - Indications <ul><li>When the pulp is exposed (either through carious exposure or through trauma) </li></ul><ul><li>When it is desirable to maintain tooth (primarily for space, function, guidance of permanent teeth) </li></ul><ul><li>When there are no contraindications to pulpal therapy </li></ul>
  6. 6. Pulpotomy Procedure <ul><ul><li>Rubber Dam Isolation </li></ul></ul><ul><ul><li>Remove caries </li></ul></ul><ul><ul><li>Open pulp chamber and de-roof </li></ul></ul><ul><ul><li>Amputate pulp with round bur in slow speed running in reverse </li></ul></ul><ul><ul><li>Control hemorrhage with dry cotton pellet </li></ul></ul><ul><ul><li>Place Endo Bleach or FMC????? </li></ul></ul><ul><ul><li>Place Glass Ionomer over floor????? </li></ul></ul>
  7. 7. Although the Medicaments and Materials May Change… The Access Opening Technique Will Remain the Same
  8. 8. Pulpotomy Access Technique
  9. 9. <ul><li>Remove caries </li></ul><ul><li>Pulp exposed </li></ul>
  10. 10. <ul><li>Primary Pulp Chambers </li></ul><ul><li>Short vertical dimension </li></ul><ul><li>Thin floor </li></ul>
  11. 11. Therefore : Perforation of Floor is Much Greater Risk in Primary Molars
  12. 12. What happened here? Pre Post
  13. 13. Radiographic Appearance <ul><ul><ul><ul><li>Perforation </li></ul></ul></ul></ul><ul><li>Proper Appearance </li></ul>11/17/03
  14. 14. <ul><li>Access Opening Must Be LARGE </li></ul><ul><li>Root orafices splayed to accommodate succedaneous tooth. </li></ul>
  15. 15. <ul><li>Access Opening Must Be LARGE </li></ul><ul><li>Convenience Form to Amputate Radicular Orafice </li></ul>
  16. 16. Edontontic Department Will Teach You to Do A Conservative Access Opening
  17. 17. Edontontic Department Will Teach You to Do A Conservative Access Opening That is correct for Permanent Teeth!!
  19. 19. Why Not Do an Access That Conserves Tooth Structure? <ul><li>Has nothing to do with SSC Restoration Retention </li></ul><ul><ul><li>Cervical Bulge Intact </li></ul></ul><ul><li>Convenience Form Needed </li></ul><ul><ul><li>Not using flexible files </li></ul></ul>
  20. 20. <ul><li>Place cotton pellet and pressure to control initial hemhorrage </li></ul>
  21. 21. <ul><li>Remove cotton pellet </li></ul><ul><li>Irrigate with NaOH? </li></ul><ul><li>Place GI? </li></ul><ul><li>Place stainless steel crown </li></ul>
  22. 22. Rubber dam isolation
  23. 23. Remove caries Deep caries with pulp exposure
  24. 24. Open pulp chamber and “de-roof”
  25. 25. Amputate pulp with slow speed in reverse.
  26. 26. Control Hemorrhage with Cotton Pellet
  27. 27. Remove cotton pellet: Residual Bleeding Why???
  28. 28. Tissue Tags Remain : Not Amputated at Canal Orafices
  29. 29. Let’s Try A Larger Access Opening
  30. 30. Caries removal with pulp exposure
  31. 31. Outline of access opening
  32. 32. Access opening complete and pulp chamber tissue amputated
  33. 33. Placement of cotton pellet
  34. 34. Hemostasis Acheived
  35. 35. Place Medicaments and Liner
  36. 36. Restore with SSC
  37. 37. Mandibular First Primary Molar
  38. 38. Thank You!