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- 2. The main objectiveof pulp therapy in the primary dentition is to retain every primary tooth as a fully functional component in the dental arch to allow for proper mastication, phonation, swallowing, preservation of the space required for eruption of permanent teeth and prevention of detrimental psychological effects due to tooth loss.
- 5. Patient should bein good health with no systemic disease INDICATION
- 6. UNCONTROLLED PULPAL HEMORRHAGE Indicatedfor any tooth in absence of successor Any deciduous teeth with severe pulpal necrosis provided there is no radiographic contraindication Primary teeth with necrotic pulps and minimum of root resorption Primary teeth with an abscess or sinus opening Traumatized teeth with fracture or caries involving the pulp irreversibly INDICATION-CLINICAL
- 8. lnternal resorption withoutany obvious perforation INDICATION-RADIOGRAPHICAL
- 9. • Young patientwith systemic illness such as congenital ischemic heart disease, leukemia • Children on long term steriods therapy or those who are immunocompromised. CONTRA-INDICATION-GENERAL
- 10. • Excessive toothmobility and /or reduced bone support • A non- restorable tooth • Underlying dentigerous or follicular cyst • Communication between the roof of pulp chamber and the furcation Region • Insufficient tooth structure to allow isolation by rubber dam and extracoronal restoration CONTRA-INDICATION-CLINICAL
- 11. -A primary toothwith excessive root resorption invoving more than two thirds of the root -Internal root resorption in the apical 1/3 rd of the root - Radicular cyst, dentigerous cyst in association with primary teeth - Inter- radicular radiolucency that communicate with the gingival sulcus CONTRA-INDICATION-RADIOGRAPHICALLLY
- 12. Partial pulpectomy i procedure’ inwhich the coronal portion of the radicular pulp is amputated, leaving vital tissue in the canal that is assumed to be healthy • The decision to implement partial pulpectomy in primary molars is made after removing the coronal pulp and encountering difficulty with hemorrhage control from the radicular orifice. • The canals should not show evidence of necrosis or suppuration • It is widely used to refer to an:-
- 13. Indication -Large carious exposure with frankinvolvement of radicular pulp without any periapical changes -Primary teeth with inflammation extending beyond coronal pulp indicated by hemmorrhage from the amputed radicualar stumps that is dark red, a slowly oozing and uncontrollable. -Teeth that exhibit clinical symptoms to heat or cold and not to percussion
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- 17. • Studied byLawrence 1966 and later by starky 1973 Indication (Paterson and Curzon in 1992 ) • Indicated where infection , an abscess and chronic sinus exist • Nonvital primary teeth • Teeth with necrotic pulp and periapical invovlement MULTIPLE VISIT PULPECTOMY
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- 21. THIRD APPOINMENT (OBTURATION) Appointmentshould be 5-7 days apart Remove the temporary restoration Irrigate and dry the canaI Startobturating First coat the walls of canal with thin watery mix of cement with the help of Reamerand then then use thickmix andfilI the canals using lenturospirals Keep adding fresh mix till no further cement can be incorporated in canals Seal the pulp chamber with temporary restoration Recall after 1 week and if asymptomatic , do final restoration and give SSC.
- 22. Necrotic pulp Patent furcal communication s Tvieezers ;e) COttO n Slow setting zinc oxide eugenol Ic Temporary dressing Cotton wool Witha medicamen t such as ledermix Stainless steel crown Hard setting zinc oxide eugenol cement
- 23. That endodontic coronalpreparation which enables unobstructed access to the canal orifice , a straight line access to the apical foramen, complete authority over the enlarging instrument and to accommodate the filling technique ACCESS OPENING for pulpectomy in primary teeth
- 24. Rules 1. Obtaining astraight line access to the apical foramen or to the Initial Curvature of canal to aid in -improvised instrumentation control - Improved obturation -decreases the procedural error 2. Conservation of tooth structure: -to minimize weakening of remaining tooth structure 3. Unroofing the pulp chamber and removal of the pulp horns to aid in -locating the root canal orifice -maximum visibility -locate canals
- 30. Since instrumentation andirrigation with an inert solution ALONE CANNOT ADEQUATELY REDUCE THE MICROBIAL POPULATION IN AROOT CANAL SYSTEM:- Disinfection with irrigants such as one percent sodium hypochlorite and/or chlorhexidine is an important step in assuring optimal bacterial decontamination of the canals.
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- 33. • Non-inflammatory andnon-irritating to the underlying permanent tooth germ • Radio-opacity for visualization on radiographs • Ease of insertion • Ease of removal •Should not cause any discoloration of tooth Rifkin A . The root canal treatment of abscessed primary teeth: A three to four year follow-up. 1 Dent Child 1982; 49: 428-431.
- 35. Seala ex Calcicur ex Calcium H droxide ZincOxide Eu enol lodoform based Walcoff KRI aste Maisto aste Endoflas aste ex astes CLASSIFICATION OF OBTURATING MATERIALS IN PRIMARY TEETH
- 38. • Well toleratedperiapically, causing some degree of apical hard tissue deposition. • Mainly serves as an intracanal medicament. CALCIUM HYDROXIDE HERMAN(1930) • Antibacterial effect-hydroxyl ions and inactivation of enzymes in cytoplasmic membrane. • When in contact to vital pulp-inflammatory root resorption seen
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