This document provides information on pulpectomy procedures for primary teeth. It defines pulpectomy and discusses guidelines for the procedure. It outlines the indications and contraindications for pulpectomy. Details are given on access opening and root canal anatomy in primary teeth. The document discusses techniques for pulpectomy, including one-stage and two-stage procedures. It also covers working length determination, instruments used, and cleaning and shaping of the root canals.

1. GOOD MORNING

2. PULPECTOMY
PULPECTOMY

3. AAPD guidelines 2016
Pulp therapy it is divided into:
Vital pulp therapy Non vital pulp therapy

4. INTRODUCTION
• Objective of pulp therapy - fully functional component - proper mastication,
phonation, swallowing, preservation of the space required for eruption of
permanent teeth and prevention of detrimental psychological effects due to
tooth loss.
• The first-report of endodontic procedures on primary teeth was published by
Rabinowitch in 1953.

5. DEFINITION
• AAPD 2015 - Pulpectomy is a root canal procedure for pulp tissue that is
irreversibly infected or necrotic due to caries or trauma. The root canals are
debrided, disinfected and filled with a resorbable material.
• MATHEWSON 1995- Defined it as the complete removal of the nectrotic pulp
from the root canals of primary teeth and filling them with an inert resorbable
material so as to maintain the tooth in the dental arch.
• Finn (1973) Defined pulpectomy as removal of all pulpal tissue from the
coronal and radicular portions of the tooth

6. INDICATIONS
a) Primary teeth with pulpal inflammation extending beyond
the coronal pulp.
b) Teeth with necrotic pulps.
c) Teeth with abscess.
d) Evidence of furcation involvement

7. CONTRAINDICATIONS
a) A non-restorable tooth.
b) Radiographicaily visible internal resorption in the roots.
c) Teeth with mechanical or carious perforations of the floor of the pulp chamber.
d) Excessive pathologic root resorption involving more than one third of the root.
e) Excessive pathologic loss of bone support with loss of the normal periodontal
attachment.

8. Differences Between Root Canal Instrumentation
in Primary and Permanent Teeth
• Distance from the occlusal surface to the floor of the pulp chamber is
much shorter than in the permanent tooth.
• Primary molar roots are widely divergent and curved to allow for the
development of the succedaneous tooth.

9. • Flaring of the canal should be kept to a minimum because of the thin
dentin walls of the roots.
• Signs of resorption are visible radiographically at the apex, it is
advisable to establish the working length of the endodontic
instruments 2-3 mm short of the radiographic apex

10. PRIMARY ROOT CANAL ANATOMY
PRIMARY ANTERIORS
MAXILLARY INCISORS
• The root canals are almost round
• Normally 1 canal without a bifurcation.
• Accessory canals are rare.

11. • Access cavity – maxillary central and lateral incisors are
triangular with the base of the triangle towards the incisal
edge and the apex towards the cingulum.

12. Step -1
• Entrance is gained through the middle of the
middle third of the palatal surface.

13. Step-2
• Initial entrance Is prepared with a round bur at
a high speed operated at a right angle to the
long axis of the tooth. Only enamel is
penetrated.

14. Step-3
• The bur is positioned in a 45 degree to the long
axis of the tooth then advanced to penetrate the
pulp chamber.

15. Step-4
• Removal of the pulp chamber (deroofing)

16. Step-5
• Removal of lingual shoulder.

17. MANDIBULAR INCISORS
• Root canals are flattened on mesial and distal surfaces and sometimes
groove.
• 2 canals are seen in less than 10% of cases
• Lateral or accessory canals are rare.
• Access cavity preparation is similar as that of maxillary incisors.

18. PRIMARY CANINES
Root canals correspond to the exterior root shape.
A rounded triangular or oval.
Lumen of the canal is sometimes compressed in mesial-distal
direction.
Lateral and accessory canals are rare.

19. • Access cavity- oval

20. PRIMARY MOLARS
Normally have same number of roots and positions of the roots as the
corresponding permanent molars.
The roots of the primary molars are long and slender
They diverge to allow for a permanent tooth bud formation.

21. MAXILLARY 1ST MOLAR
3 roots. 2 facial,1 palatal
Palatal root is often round and
longer than 2 facial roots 2-4
canals
Bifurcation of mesio facial root into
2 canals - 75%
MAXILLARY 2ND MOLAR
3 roots. 2 facial,1 palatal
2 – 5 canals
Mesiofacial root usually
bifurcates or contains 2
canals – 85%-95%

22. MANDIBULAR 1ST MOLAR
2 roots . 1 Mesial, 1 distal
Usually have 3 canals but may
have 2-4 canals
Mesial root contains 2 canals-
75%
Distal root contain more than 1
canal- 25%
MANDIBULAR 2ND MOLAR
2 roots . 1Mesial,1 distal
Usually have 3 canals . but
may have 2-5 canals
Mesial root has 2 canals – 85%
Distal root contains more than
1 canals – 25%

23. According to study by Sarkar S, Roa AP. JISPPD. 2002;20(3):94-7.
First primary maxillary molar-
• Mesiobuccal canal- one canal in 50%, 2 canal in 50 %.
• Distobuccal – one canal in 100%.
• Palatal canal- one in 75%, 2 in 25%.

24. • Access cavity- triangular if 3 canals.
• Trapezoid- 4 canal
Distal
Buccal
Mesial
Palatal

25. According to study by Sarkar S, Roa AP. JISPPD. 2002;20(3):94-7.
Second maxillary molar;
• Mesiobuccal- one canal in 22.2%, 2 canal in 77.7%.
• Distobuccal- one canal in 77.7% and 2 in 22.2%
• Palatal canal- one in 88.8%

26. According to study by Sarkar S, Roa AP. JISPPD. 2002;20(3):94-7.
Mandibular first molar-
• Mesial- one in 30%, 2 in 70%.
• Distal- one in 80%, 2 in 20%.
Second mandibular molar-
• Mesial-one in 14.3%, two in 85.7%
• Distal-one in 78.6%, 2 in 21.4%

27. Types of pulpectomy techniques
• Pulpectomy can be accomplished in either one or multiple visits, depending upon
the clinical signs and symptoms present.
One-stage-single-visit pulpectomy;
Two-stage-multi-visit pulpectomy.

28. One-stage-single-visit pulpectomy
• INDICATIONS
Presence of inflamed but vital radicular pulp.
An asymptomatic primary tooth with necrotic pulp tissue without any associated
acute symptoms, such as cellulitis.

32. Two-stage-two-visit pulpectomy
The indications for a two-stage pulpectomy are:
• Presence of an acute abscess with or without associated cellulitis,
• Presence of active and persistent discharge from the root canals.

33. ACCESS OPENING
• Removal of the pulp roof to gain direct access to the pulp chamber and all root canals.
-Medical Dictionary for the Dental Professions © Farlex 2012
OBJRCTIVES
1) Direct straight line access to the apical foramen helps in:
• Improved instruments control because of minimal instrument deflection and ease of
introducing instruments in the canal.

34. 2) Complete deroofing of pulp chamber helps in:
• Complete debridement of pulp chamber
• Improving visibility
• Locating canal orifices
• Permitting straight line access
• Preventing discoloration of teeth because of remaining pulpal tissue
3) Conserve sound tooth structure as much as possible so as to avoid weakening of
remaining tooth structure.

35. • Removal of the pulp tissue begins with
an analysis of the anatomy of the tooth
being treated and the anatomy of the
surrounding tissues.
Pre-Access Analysis
Krasner and Rankow (2004)
The pulp chamber of every tooth
is in the centre of the tooth at the
level of the cementoenamel
junction; they described this as “
The Law of Centrality.”

36. • The visualization of the
ultimate outline of the pulp
chamber can be aided by
utilizing another law of pulp
chamber anatomy,
‘The Law of Concentricity’
“The walls of the pulp chamber are concentric to the
external outline of the tooth at the level of the CEJ.”

37. MB 1
MB 2
Palatal
Point of
entry
DB

38. Working Length determination
• Working length is defined as the distance from a coronal reference point to
the point at which canal preparation and obturation should terminate.
• It is important to establish working length to prevent overextension through
the apical foramen
• Palmer et al. (1971), Pinkham (1988) Working length should be kept 1-
2mm short
• Grossman (1970), Cohen (1987) Working length should be 2-3 mm short of
the radiographic root length, especially teeth showing signs of apical root
resorption.

39. Instruments used in Access
Preparation
• No. 2, 4 & 6 round burs
• Fissure / carbide burs for axial wall extension
• EndoAccess bur
Combination of round and tapered fissured bur
For preparation of pulp chamber & flaring of walls
56
Dr. Nithin Mathew - Root Canal Morphology & Access Preparation

40. • BURS
• Endo Z bur
• Long tapered
• Create funnel shape for easier access to chamber
• Round non cutting safe ended tip
• Gates Glidden Drills

41. • Endodontic Explorer
• DG-16
• To identify canal orifices
• To determine canal angulation
• CK-17
• To identify calcified canals
• Endodontic spoon excavator

42. ISO Classification of endodontic
instruments

46. • Barbed broach
Extirpation Instrument

47. Cleaning and shaping
Reamer

50. chemomechanical Preparation
Cleaning:
• Refers to the removal of all contents of the root canal system before
and during shaping.
• Removal of microflora, bacterial products, foods, caries etc.
Shaping
• Establishment of a specifically shaped cavity which performs the dual
role of a three dimensional progressive access into the canal and
creating an apical preparation which will permit the final obturation.

51. Techniques for preparing root canals
Apical coronal technique/ Step-back
• In which the WL is established and the full length of the canal is then
prepared.

52. Step back preparation:
• WL determined.
• Instrument that fills to correct WL is chosen.
• Enlarge 3 No’s larger at the apex.
• Reduce the WL length by 1mm and continue to enlarge canal / flaring.
• Recapitulate, irrigate for patency.
• Coronal preparation done using GGD.

53. Disadvantages
• Apical blockage
• Alteration of W.L.
• Tendency for canal deviations.

54. Coronal-apical technique/ crown down
• In which the coronal portion of the canal is prepared before
determining the WL
• E.g. : - Step-down.

55. Step down technique:
• Is a modification of the step-back technique.
• Prepare the coronal portion to 16-18 mm /beginning of the curve with anti-
curvature filling.
• GGD’s are used to refine the coronal part.
• Determine WL.
• Using step-back, complete the apical preparation

56. Disadvantages
• Ledge formation
• Apical blockage
• Perforation

57. Canals cleaning and shaping in primary teeth
Isolation :
• Use of rubber dam is essential
• Provides clean, dry and sterilized field
Debridment:
• Main objective of chemo-mechanical preparation of primary tooth is
debridment of canal.
• Pulp chamber is irrigated with normal saline or sodium hypochlorite to
remove dentinal debris and pulpal remnants.

58. • After removal of coronal pulp
• Pulp chamber is dried with cotton pellet to assess
the dentinal map located on pulp chamber floor
• Canal orifice are located by probing with
endodontic explorer (DG 16)

59. • Patency of the canal is explored using an size 8 or
size 10 instrument.
• Endodontic file (K-file) are selected and adjusted
1-2mm short of the radiographic apex of each
canal as determined by radiograph
• Care should be taken to prevent over
instrumentation apically causing periapical
damage.

60. • Kennedy (1997), Mc Donald (2004)
• Hedstrom files, No.s 15 or 20, are strongly recommended
since they remove hard tissue only on withdrawal, which
prevents pushing infected material through the apices
(maximum size used should be No. 30).

61. Irrigants used in primary teeth pulpectomy
• Saline
• Sodium hypochlorite (0.5%, 2.5%) potent
antimicrobial and removes necrotic pulp tissue
• Ethylene Diamine Tetra-Acetic Acid (EDTA)
(17%) smear layer removal
• Citric Acid (10%) smear layer removal
• Chlorhexidine (2%) potent antimicrobial
• MTAD  mixture of 3% doxycycline, 4.25%
citric acid and detergent Tween-80.

62. Ideal Requirements of Irrigants
• Broad antibacterial spectrum
• Completely dissolve necrotic pulp tissue
• Should be non toxic
• Should dissolve smear layer
• High efficiency against anaerobic and facultative microorganisms

63. HISTORY
Prior to 1940’s Water was the most commonly used irrigant as it was:
• Readily available
• Inexpensive.
• Provided a lubricating effect during instrumentation.
• During 1940’s proteolytic enzymes were used. They had tissue
dissolving property.

64. • Grossman (1943)
• Introduced the concept of using oxidizing agents as irrigants.
• He recommended that solution of 3% hydrogen peroxide be alternated
with a solution of 5.25% sodium hypochlorite. so that effervescence
action results in removal of debris from the canal system.

65. • Glyoxide-
• for narrow, curved canals.
• Composition: carbamide peroxide
(provides good lubrication)
• Little antibacterial activity & not a
tissue solvent.

66. Ethylenediamine Tetra-Acetic Acid
Chelating agent
Functions
• Lubrication
• Emulsification
• Holding debris in suspension
• Smear layer removal
Mode of action
• On direct exposure for extended time, EDTA extracts bacterial surface
proteins by combining with metal ions from the cell envelope, which
can eventually lead to bacterial death

67. Uses
• Dentin disolving properties
• Enlarge narrow canals
• Easy manipulation of instruments
• Reduces time needed for debridement
• Irrigation with 17% EDTA for one minute followed by a final rinse
with NaOCl is the most commonly recommended method to remove
the smear layer

68. Saline:
• From a biological stand point, sterile normal saline is the best irrigant
to use because it causes:
• Least apical tissue irritation or damage
• Biocompatible.
• Least amount of cell lysis.
Disadvantages:
• However saline solution does not remove the smear layer but merely
flushes out some of the superficial debris from the root canal system.
• Has poor antibacterial properties.

69. • SODIUM HYPOCHLORITE
• Most popular irrigating solutions used as an irrigant.
• It was first recommended by HENRY DAKIN in 1915 and was called as DAKIN’s
SOLUTION during the time of World War-II for treatment of infected wounds.
Manufactured:
• It is made by bubbling chlorine gas through NaOH to form equal amounts of sodium
hypochlorite and sodium chloride (NaOH  gas NaOCl + NaCl2)
• NaOCl has been used in various concentrations ranging from 0.5-5.25%.
• Most commonly used concentration – 2.5%

70. Mechanism of Action of Sodium Hypochlorite
Antibacterial:
• Direct contact with microorganisms.
• Vapor action.
• Penetration into the bacterial cell.
• Chemical combination with the protoplasm of the bacterial cell that
destroys it.

71. • Siqueira et al., (2013) in an in vitro study, evaluated the effect of
endodontic irrigants against four black-pigmented gram-negative
anaerobes and four facultative anaerobic bacteria by means of an agar
diffusion test.
• A 4% sodium hypochlorite solution- formed largest average zone of
bacterial inhibition and was significantly superior when compared
with the other solutions.
• The antibacterial effects from strongest to weakest as follows: 4%
sodium hypochlorite; 2.5% sodium hypochlorite; 2%
chlorhexidine,0.2% chlorhexidine, EDTA, and citric acid; and 0.5%
sodium hypochlorite.

72. HYDROGEN PEROXIDE
• For years 3% H2O2 was recommended as a canal irrigant
because its effervescent action in presence of blood products.
• Disinfecting properties.
• Actions:
Effervesent action:
• This action was specially indicated in mandibular teeth where
the bubbling of the peroxide was thought to lift debris from
the canal system almost defying gravity.
• However, H2O2 does not possess tissue dissolution properties
and is not effective as a lubricant.
• Hence, alternate use of H2O2 + NaOCl irrigating solutions was
recommended by Grossman.

73. Injection of hydrogen peroxide beyond the apex
• Bhat (1974)
• Hydrogen peroxide of unknown concentration was injected into the soft tissues.
• As treatment was performed under local anesthesia, the patient experienced no
pain but complained about a rapidly developing swelling on the upper lip and
some difficulty in breathing.
• The canal was left open, the patient was prescribed antibiotics and instructed to
apply cold packs.
• The swelling, caused by oxygen liberated from the hydrogen peroxide, subsided
in 1 week and root canal treatment was completed.

74. • MTAD
It is a mixture of a tetracycline isomer
(doxycycline), an acid citric acid, and a detergent
(Tween 80) .Studies have shown that MTAD as a
final rinse is capable of removing the smear layer
with minimal erosive changes on the surface of
dentin.

75. • Beltz et al.(2014)
• Investigated the amount of tissue loss after exposing bovine pulp and
dentin to various concentrations of NaOCl, EDTA, or MTAD.
• Their results showed that various concentrations of NaOCl removed
organic components of pulp and dentin effectively.

76. • The soluble effects of EDTA on pulp and dentin were somewhat similar to those of
MTAD.
• The major difference between the actions of these solutions is a high binding affinity of
doxycycline present in MTAD for the dentin.
• It is also found that MTAD maintains its bactericidal properties significantly more than
NaOCl or EDTA.
• Cytotoxicity is less when compared to sodium hypochlorite.
• There was no effect on flexural strength and modulus of elasticity of dentin when
MTAD was used.

77. • TETRACLEAN
• Mixture of an antibiotic, citric acid and
polypropylene glycol.
• Properties:
• low surface tension-enables better adaptation of
the mixtures to the dentinal walls.
• Removes the smear layer,
• Effective against strictly anaerobic and
facultative anaerobic bacteria like E. faecalis

78. CARISOLV
• 0.5% sodium hypochlorite along with amino acids.
• Effective in removal of smear layer in root canal when
used as an irrigant.
• The mode of action is to degrade the denatured collagen.
• John BM (2012)
• Compared carisolv with 17% EDTA and 5.25% sodium
hypochlorite in removing layer on radicular dentin.
• Carisolv was ineffective in removal of smear layer.
• The reason attributed was because it was in gel form
which made it difficult to wet and flush the canals

79. • Singhal P (2012)
• Compared the efficacy of Carisolv, 1% NaOCl gel, and 1% NaOCl
solution as root canal irrigants in primary teeth .
• Carisolv was better compared to NaOCl gel in cleaning the debris at
the apical third.
• And hence concluded that Carisolv can be used as an effective root
canal irrigant

80. • Ruddle solution
• This contains 5% NaOCl, hypaque and 17%
EDTA.
• Hypaque is an aqueous solution of 2 iodine
salts diatrizoate meglumine and sodium
iodine.
• It is water soluble with pH of 6.7-7.7.
• This composition simultaneously provides the
solvent action of full-strength NaOCl.

82. Filling of the Primary Root Canals
• The filling material for primary root canals must be absorbable.
Optimal requirements of a root-filling material for primary teeth
CASTANGNOLA stated:
• Not irritate the periapical tissues.
• Stable disinfecting power.
• Excess pressed beyond the apex should be resorbed easily.
• Inserted easily into the root canal and removed easily if necessary.
• Adhere to the walls of the canal and should not shrink.

83. • Not be soluble in water.
• Not discolor the tooth.
• Radiopaque.
• Induce vital periapical tissue to seal the canal with calcified or
connective tissue.
• Harmless to the adjacent tooth germ.
• Not set to a hard mass, which could deflect an erupting
succedaneous tooth.

84. Obturating materials
• Zinc oxide eugenol paste
• Calcium hydroxide paste
• Iodoform paste.

85. Zinc oxide eugenol (ZOE)
• Zinc oxide eugenol was discovered by Bonastre(1837) and
subsequently used in dentistry by Chisholm(1876).
• First root canal filling material - for primary teeth- Sweet in 1930.
• Composition:
Powder Liquid
• Zinc oxide-69% eugenol-85%
• White rosin-29.3% olive oil-15.0%
• Zinc stearate-1.0%
• Zinc acetate-0.7%

86. Related articles
Allen KR (1979) Endodontic treatment of primary teeth. Aust Dent J
24: 347-51.
• Speculated that the resorption rate of zinc oxide eugenol (ZOE) and the root
differed, resulting in small areas of ZOE paste possibly being retained.
Garcia-Godoy [1987] Reported deflection of developing permanent tooth bud
because of its hardness
Sadrian R, Coll JA (2013) A long-term followup on the retention rate of zinc oxide
eugenol filler after primary tooth pulpectomy. Pediatr Dent 15: 249-253.
• Demonstrated that none of the retained ZOE particles caused observable
pathology and were also not related to treatment failure(success rate of 80%).

87. Calcium hydroxide
• Calcium hydroxide was introduced by Herman(1920).
• Composition
Base Catalyst
• Glycol salicylate-40% Calcium hydroxide-50%
• Calcium sulphate-30% Zinc oxide-10%
• Titanium dioxide-14% Zinc stearate-0.5%
• Calcium tungstate-16% Sulfonamide-39.5%
• The main drawback - it has the tendency to get depleted from the canals earlier than the
physiologic root resorption.
• Hollow tube effect
• Soluable in water

88. Related articles
Estrela C et al (2010) Verified influence of antibacterial potential of Ca(OH)2
against Staphylococcus aureus, Enterococci faecalis, Bacillus subtilis, and
Candida albicans and showed significant effectiveness for Ca(OH)2 paste or
iodoform plus saline

89. • Chawla HS et al., (2001) A combination of zinc oxide powder and
calcium hydroxide paste for obturation of primary teeth. They found
that the obturated material remained up to the apex of root canals till
the beginning of physiologic root resorption. Also the material was
found to resorb at the same rate as teeth.
• Chawla HS et al., (2008) Combination of calcium hydroxide, zinc
oxide, and 10% sodium fluoride solution has been tested in a clinical
study. It was observed that the rate of resorption of this new root canal
obturating mixture was quite similar to the rate of physiologic root
resorption in primary teeth.

90. Iodoform
• Introduced by Walkhoff in 1928.
• Castagnola and Orlay - that iodoform pastes are bactericidal to
microorganisms in the root canal.
• Iodoform because of the presence of iodine causes yellowish
discoloration of the tooth that may compromise the esthetics .
• Studies - it is irritating to periapical tissues and can cause cemental
necrosis .
• Commercially available as maisto’s paste, metapex vitapex etc

91. MATERIALS CONTAINING IODOFORM
KRI paste: Maisto Endoflas Vitapex Metapex
Iodoform Iodoform Iodoform Iodoform (40.4% Iodoform
Camphor Zinc oxide Eugenol Zinc oxide Calcium hydroxide
(30.3%)
Calcium hydroxide
Menthol Camphor Calcium hydroxide Silicon oil (22.4%)
Parachlorophenol Menthol Barium sulfate
Parachlorophenol Eugenol
Lanolin Parachlorophenol
Thymol

92. PROPERTIES
ZINC OXIDE KRI PASTE VITAPEX
Resorption Slow as compared to
physiologic root
resorption
Resorbs at the same
rate as the root
Faster resorption than
physiologic root
resorption
Harmless Harmful Harmless Harmless
Overfill resorption Slow resorption and
inflammatory reaction
Resorbs in1-2 weeks Resorbs in 1-2 weeks
Antimicrobial
Weak antibacterial Best antibacterial Weak antibacterial
Easily removed Difficult to remove Easily removed Easily removed
Radiopaque Radiopaque on
radiograph
Radiopaque on
radiograph
Radiopaque on
radiograph
Discolouration No discolouration Causes discolouration No discolouration

93. RELATED STUDIES
• Castagnola and Orley (1952) stated that KRI paste loses only 20% of
its potency in 10 years.
• Garcia Godoy (1987) found that KRI paste resorbs from the apical
tissue in a week or two; it does not set to a hard mass and can be
inserted and removed easily.
• Eliyahu Mass (1989) found Maisto paste to be successful in infected
primary teeth and had positive healing effect on periradicular tissue

94. OBTURATION TECHNIQUE
• Endodontic pressure syringe
• Mechanical syringe
• Tuberculi syringe jiffy tubes
• Incremental filling technique
• Lentulospiral technique
• The Reamer Technique
• The Insulin Syringe Technique
• Disposable Injection Technique
• NaviTip
• Pastinject.
RajDalsania.et al.ObturatingTechniquesinPediatricDentistry:LiteratureReview. J cur
med res opinion.2020:03(08);589−96.

95. Endodontic pressure syringe:
• Was developed by Greenberg in 1963
• Technique was described by Spedding and Krakow in
1965
• This apparatus consist of a syringe barrel, threaded plunger,
wrench and threaded needle.
• Needle is placed 1mm short of apex
• With a slow withdrawing type of motion, the needle is
withdrawn 3mm with each quarter turn of the screw until
the canal is visibly filled at the orifice.1
• needles are very flexible
• Aylard SR, Johnson R. Assessment of filling techniques for primary teeth.
Pediatric Dentistry 1987;9(3):195-198.

96. • Difficulties in placing the rubber stop correctly
• Removing the needle may lead the clinician to remove and reinsert
the syringe repeatedly, which, in turn, may displace the paste, create
voids, and thus decrease filling quality
• Cleaning the syringe immediately after use makes this method more
complex and time consuming

97. Mechanical syringe:
• This method was proposed by
Greenberg in 1971
• Cement is loaded into the syringe with 30 guage needle
• Press using continuous pressure while withdrawing the needle.
• According to Aylard and Johnson 1987, mechanical syringe is poor
performer in both canal types i.e. curved and straight canals

98. Tuberculi syringe jiffy tubes:
• Was utilized by Aylord and Johnson in
1987
• Requires 26 guage, 3/8th inch needle.
• Material expressed into the canal by slow
finger pressure on plunger until canal visibly
filled at the orifice.
• This technique was popularized by Riffcin
1980.
Memarpour M. 2013 worst length of obturation

99. Incremental filling technique
• First used by Gould in 1972
• Endodontic plugger corresponding to the size of the canal with rubber stop
is used to place a thick mix of cement into the canal 2mm short of root
length
• O'Riordan and Coll 1993 described a method of placing the material in bulk
and pushing it into the canals with endodontic pluggers.
• Because the flexibility of endodontic pluggers is limited, the paste cannot be
placed in the full working length of narrow, curved canals.

100. Lentulospiral technique:
• Was advocated by Kopel in 1970
• Lentulospiral should be dipped into the
mixture and then introduce into the canal
to its predetermined length and rotate in
the canal
• Additional amount of paste is added into
the canal, till it is filled.

101. • Aylard and Johnson and Dandashi et al., (1987) concluded that the
lentulospiral mounted in a slow speed handpiece was superior in
filling straight and curved root canals of primary teeth.
• Deonízio et al., (2011) reported that the 15,000 rpm speed was more
effective in filling the apical third and 5,000 rpm speed was more
effective in filling the cervical and middle thirds

102. The Reamer Technique :
• A reamer coated with ZOE paste
was inserted into the canal with
clockwise rotation, accompanied by
a vibratory motion to allow the
material to reach the apex, and then
withdrawn from the canal, while
simultaneously continuing the
clockwise rotary motion.

103. • Process was repeated 5 to 7 times for each canal until the canal orifice
appeared filled with the paste.
• Priya Nagar et al., (2011) showed that the obturation quality of both
the reamer technique and insulin syringe technique was found to be
very closely related

104. The Insulin Syringe Technique
• Priya Nagar et al., 2011 discribed this
method homogeneous mixture of ZOE,
is loaded into the insulin syringe and a
stopper is used after assessing the
working length of the canal.
• The needle is inserted into the canal
and kept about 2mm short of apex.

105. • The material is then pressed into the canal and while doing so the
needle is retrieved from the canal outwards while continuing to press
the material inside.
• This helps avoid incorporation of voids into the canal.
• Optimum operator skills is required

106. Disposable Injection Technique:
• ZOE can be loaded in a 2-ml syringe with 24-gauge needle along with
stopper adjusted to measured .
• Material is gently pushed into the canal till the material is seen flowing out
of the canal orifice.
• The needle is gradually withdrawn while pushing the material till the
needle reaches the pulp chamber.
• Simple, Economical
Bhandari et al. minimum chances of failures.

107. NaviTip
• A thin and flexible metal tip was
introduced to deliver root canal
sealer (ultradent)
• This NaviTip comes in different
lengths and a rubber stop may be
adjusted to it.
Mahtab Memarpour et al., (2013) conducted comparative study of anesthetic syringe,
NaviTip syringe, pressure syringe, tuberculin syringe, lentulo spiral and packing with a
plugger .Lentulo produced the best results in terms of length of obturation, while NaviTip
syringe produced the best results in controlling paste extrusion from the apical foramen and
having the smallest void size and lowest number of voids.

108. • Pastinject:
• Pastinject (Micromega) is a specially
designed paste carrier with flattened
blades, which improves material placement
into the root canal.
• Special design of the Pastinject seems to
favor a better intracanal placement of
calcium hydroxide paste in single rooted
teeth.
Grover et al 2013 most effective yielding optimally filled canals and
minimum voids.

109. • Dr. Barry Musikant [1998]
• Developed a new obturation technique with bi-directional
spiral.
• This technique ensures that a minimal amount of obturating
material will pas the apex.
• This controlled coverage is achieved because the spirals at
the coronal end of the instrument spin the material down
the shaft towards the apex, while the spirals at the apical
end spin the material upward towards the coronal end
• Where they meet (about 3-4 mm from the apical end of the
shaft), the material is thrown out laterally.

110. • Muskant et al. [1998] observed that the bi-directional spiral
prevented the apical extrusion of the sealer from the root
canals of permanent teeth.
• Grover et al. ( 2013) The highest number of voids was seen in
canals filled with the lentulo spirals and bidirectional spiral
• Gibson et al. (2008) Ca(OH)2 injected into canal with
NaviTip consistently produced better results than the spirally
placed dressings

111. Steven R. Aylard et al., 1987
• Five techniques for delivering ZOE in to straight and curved simulated root
canals were investigated for their depth of- fill capabilities.
• The technique tested were those using the endodontic pressure syringe, the
mechanical syringe, the lentulo spiral, the Jiffy Tube, and the tuberculin
syringe.
• Statistical analysis revealed that the instrument of choice for filling straight
canals were the endodontic pressure syringe and the lentulo spiral Also, the
lentulo spiral was found be the instrument of choice when filling curved
canals .When considering the depth-of-fill properties, it was concluded that
the lentulo spiral was the best overall ZOE filling tool.

112. • Sigurdsson et al. (1992) and Kahn et al., (1997)
• A lentulospiral mounted on the air motor hand piece studied for use in
obturation of primary root canals.
• It was reported that the letulospiral mounted on a slow speed
handpiece was most effective in carrying calcium hydroxide paste to
working length and also produced the highest quality fill..

113. a) lentulospiral (LS); (b) insulin syringe (IS); (c) endodontic pressure syringe (EPS); and (d) the NaviTip system (NS)

114. Conclusion
• Pulpectomy - treatment options for primary molars having radicular canals
with partial/total irreversibly inflamed or necrotic pulp.
• Adequate knowledge on the root anatomical variations and absolute
awareness of the radiographic limitations, instrumentation procedures,
chemical interactions among different endodontic irrigants and root canal
filling techniques are essential prior to commencing pulpectomy procedures
in exfoliating or retained primary molars.