This document discusses pulpotomy, including definitions, indications, contraindications, classifications, and types. Pulpotomy involves removing the coronal portion of the dental pulp and placing a medicament to promote healing and preserve vitality. Types discussed include formocresol pulpotomy, electrosurgical pulpotomy, laser pulpotomy, glutaraldehyde, ferric sulphate, calcium hydroxide, MTA, and Cvek's pulpotomy. Success is defined as asymptomatic pulp without pathology. Pulpotomy is indicated for carious exposure in a vital tooth with healthy supporting tissues and no signs of infection.

3.  DEFINITION
 INDICATIONS OF PULPOTOMY
 CONTRAINDICATIONS OF PULPOTOMY
 CLASSIFICATION
 TYPES OF PULPOTOMIES
 Formocresol pulpotomy.
 Electrosurgical pulpotomy.
 Laser pulpotomy.
 Glutaraldehyde.
 Ferric sulphate.
 Calcium hydroxide
 MTA
 Cvek’s Pulpotomy
 Biodentin Pulpotomy
 CONCLUSION
 REFERENCES

4.  Replacement agents or medicaments for formocresol in
primary teeth pulpotomy-10Marks(sept 2007)
 Mineral Trioxide Aggregate 10Marks(may 2009) and MAY
2019 (7 MARKS)
 Ferric sulphate as pulpotomy agent 7Marks (June 2018)
 Pulp therapy in children (75MARKS) Nov 2017
 Pulpotomy versus indirect pulp capping in deciduous
tooth(75Marks) July 2016
 Discuss the reaction of pulp to various pulp capping
materials. Add a note on Calcium Hydroxide
(20MARKS)May 2015

5.  Complete removal of the coronal portion of the
dental pulp, followed by placement of a suitable
dressing or medicament that will promote healing
and preserve the vitality of the tooth (Finn,1985).
 Pulpotomy is defined as the amputation of vital
pulp from the coronal pulp chamber followed by
placement of a medicament over the radicular pulp
stumps to stimulate repair, fixation or
mummification of the remaining vital radicular
pulp (Braham and Morris).

6.  Vital teeth
 Healthy periodontium
 Only coronal involvement
 Contraindicated extraction
 Absence of infection/abscess
 Absence of fistula
 Absence of spontaneous pain
 Absence of involvement of pulp floor
 Absence of inter-radicular bone loss

7. o Tooth fracture
o Tooth discoloration
o Persistent pain
o Anaesthesia complications
Pulpotomy vs. pulpectomy techniques, indications and complications Seraj Al Baik

8.  The radicular pulp should remain asymptomatic without adverse
clinical signs or symptoms such as sensitivity, pain, or swelling.
 There should be no postoperative radiographic evidence of
pathologic external root resorption.
 The clinician should monitor the internal resorption, removing the
affected tooth if perforation causes loss of supportive bone and/or
clinical signs of infection and inflammation.
 There should be no harm to the succedaneous tooth.
AAPD Guideline on Pulp Therapy for Primary and Immature Permanent Teeth 2009

9.  Carious pulp exposure
 Asymptomatic tooth or episodes of mild, transient
pain
 Pre operative radiograph confirms immature roots
with open apices
 Absence of radicular pathology
 Restorable tooth

10.  A correct diagnosis of pulp conditions in primary and
young permanent teeth is important for treatment
planning.
• Eidelman et al and Prophet and Miller have emphasized that
no single diagnostic means can be relied on for determining a
diagnosis of pulp conditions.

11. A SUGGESTED OUTLINE FOR DETERMINING
THE PULPAL STATUS OF CARIOUSLY INVOLVED
TEETH IN CHILDREN INVOLVES:
1.Visual and tactile examination of carious dentin and associated
periodontium
2. Radiographic examination of
a. periradicular and furcation areas
b. pulp canals
c. periodontal space
d. developing succedaneous teeth
3. History of spontaneous unprovoked pain
4. Pain from percussion
5. Pain from mastication
6. Degree of mobility
7. Palpation of surrounding soft tissues
8. Size, appearance, and amount of hemorrhage associated with
pulp exposures

12. Pulpotomy can be classified according to the treatment
objectives by Don Ranley.
 Devitalization pulpotomy (mummification)
a) Formocresol pulpotomy.
b) Electrosurgical pulpotomy.
c) Laser pulpotomy.
 Preservation (minimal devitalization, non inductive)
a) Glutaraldehyde.
b) Ferric sulphate.
 Regeneration (Inductive, Reparative)
a) Calcium hydroxide
b)MTA
A Systemic Review of the Materials Used in Primary Teeth Pulpotomy in Children Rajendran Ganesh.

13.  Formocresol was introduced in 1904 by BUCKLEY.
 He contended that equal parts of formalin and tricerion
would react chemically with the intermediate and end
products of pulpal inflammation to form a new colorless
and non-infective compound of a harmless nature.

14.  With formocresol as the pulptomy medicament, a zone
of fixation usually is evident where the pulp is in direct
contact with the medicament.
 Coagulation necrosis of the tissue occurs at the
amputation site and is supported by the fact that true
coagulation necrosis is produced by poisons such as
phenol, formaldehyde or mercuric chloride, which
denatures the protein of the cells.
 It has also been shown that formocresol inactivates the
oxidative enzymes in the pulp tissue adjacent to the
amputation site.
Formocresol, still a controversial material for pulpotomy: A critical literature review; Shashidhar
Chandrashekhar.

15.  It may also have some effect on hyaluronidase action.
Therefore, the protein-binding properties and the
inhibition of the enzymes that can break the pulp tissue
down together result in ‘fixation’ of the pulp tissue by
formocresol and render it inert and resistant to
enzymatic breakdown.
Formocresol, still a controversial material for pulpotomy: A critical literature review;
Shashidhar Chandrashekhar.

16.  The formocresol pulpotomy technique was first
advocated by SWEET [1930]
 He used a multiple sitting technique, which has
been subsequently modified to either a single or
two stage technique.
 BUCKLEY’S FORMALDEHYDE FORMULA :-
 19% Formaldehyde
 35% cresol
 15% Glycerin &
 31%Water
 To prepare 1.5% concentration of this formula,
first mix 3 parts of glycerin with 1 part of distilled
water , then add 4 parts of this preparation to 1 part
buckley's formocresol,and throughly mix again.

17. Anesthetize the tooth & isolation with rubber dam
Access cavity preparation done & all caries removed
The entire roof of the pulp chamber is removed using a high-
speed bur
All the coronal pulp is amputated with a slow-speed bur or
spoon excavator
Pulp chamber is thoroughly washed with saline to remove all
debris
Hemorrhage is controlled by slightly moistened cotton pellets
placed over pulp
Apply diluted formocresol to the pulp using a cotton pellet
Cavity filled with ZOE paste & permanent restoration
Stainless steel crown placed
Formocresol pulpotomy on (young) permanent teeth-Philip A et.al

18.  The restoration can be placed during the same
appointment, thus taking advantage of the already
anesthetized tissues; or a final restoration can be
placed at a later date pending the success of the
pulpotomy procedure (the tooth can be taken
slightly out of occlusion.)
 As with any Formocresol procedure, the patient
may experience some discomfort for the first 24
hours.

19.  Indications for two-visit pulpotomy procedure in
primary teeth are:
• Inability to arrest hemorrhage from the amputated pulp
stumps during a single visit formocresol pulpotomy.
• Non-vital coronal and/or radicular pulp without the
presence of an abscess.

20.  In two-stage procedure, this involves the use of
paraformaldehyde to fix the entire coronal and
radicular pulp tissue.
 The paraformaldehyde paste is most commonly used
(Hobson 1970).

21. The paste is placed over the pulpal exposure on a small pellet of
cotton wool.
The paraformaldehyde paste is sealed into the cavity with a thin mix
of zinc eugenol and left for 1-2 weeks.
Formaldehyde gas liberated from the paraformaldehyde permeates
through the coronal and radicular pulp, fixing the tissues.
On the second visit, the dressing is removed, there is no need to
administer a local anesthetic and the pulp contents should be nonvital
Pulpotomy is carried out and then covered with hard setting zinc
oxide cement or altenatively an antiseptic paste (equal parts of
eugenol and formocresol with zinc oxide) over the radicular pulp
before restoring the tooth.

22. ADVANTAGES
 Commonly available
medicament
 Stable at room temperature
 Long shelf life
 High clinical and
radiographic success of
formocresol pulpotomy
DISADVANTAGES
 It is a very caustic
medicament.
 In high doses it is toxic.
 Potential systemic
absorption and distribution
throughout the body.
 It has a mutagenic and
carcinogenic potential .

23.  It is a bifunctional reagent which allows it to form strong intra and
intermolecular protein bonds leading to superior fixation by cross
linkages.
 Glutaraldehyde has been suggested as an alternative to formocresol in
primary tooth pulpotomy.
 Histologic assessment of glutaraldehyde pulpotomy technique by
Kopel.,et al. revealed that a 2% solution results in maintenance of
pulp vitality beneath an initial zone of fixation.
 Clinical results on human primary teeth treated by 2% glutaraldehyde
pulpotomy demonstrated 96% of success over the first 2years.
A Systemic Review of the Materials Used in Primary Teeth Pulpotomy in Children Rajendran Ganesh.

24. Anesthetize the tooth and isolate with rubber dam
After complete removal of carious dentin, a high speed round bur is
used to enter the pulp chamber and the pulp amputation is
performed.
A sterile dry cotton pellet is used to pack the pulp stump.
A cotton pellet moistened with the designated glutaraldehyde
preparation is squeezed dry ,and pressed tightly against the pulp
stump for 5 minutes.
A thick mixed zinc oxide eugenol dressing with a drop of the
glutaraldehyde preparation is then placed in the pulp chamber.

25. IRM (Intermediate Restorative Material) or glass ionomer cement
can be used as the sealing material.
The stainless steel crown or resin restoration can be performed at the
same visit or within 2 weeks.
The clinical success requirements are:
Patients should be free of tooth mobility, pain, swelling, or sinus tract
condition.
Glutaraldehyde preparations and pulpotomy in primary molars by Tzong-Ping Tsai
et.al.

27.  Ferric sulphate (15.5%) causes coagulation of the tissues at the
entrances of the root canals.
 Agglutination of blood proteins results from the reaction of blood
with both ferric and sulfate ions.
 Ferric sulphate is proposed as a pulpotomy agent on the theory
that its mechanism of controlling hemorrhage might minimize the
chances of inflammation and internal resorption (Schroeder) to be
associated with physiologic clot formtaion.

28.  Fuks., et al.found similar results between formocresol and ferric
sulphate in inflammation response, periradicular or interradicular
abscess, root resorption, and dentin bridge formation.
 Fei., et al. found ferric sulphate to produce greater clinical and
radiographical success after 1 year than did formocresol.
 More recently Smith., et al. (2000) evaluated the long term
success rates of ferric sulphate pulpotomies in dental practice.

29. Anesthetize the tooth and isolate with rubber dam
Ferric sulphate 15.5% (Fe2(SO4)3) is applied for 15 seconds.
The pulp cavity is then to be washed with saline in order to remove
any pieces of blood clot formation.
Dry it with sterile cotton pellet and the pulp stumps can be now
covered with ZOE paste.
Permanent restorations can be given
Ferric sulphate and formocresol in pulpotomy of primary molars: long term follow-up study by H.
IBRICEVIC et.al

30.  Laser therapeutic pulpotomy offers a more biologically
acceptable and effective alternative to chemicals like
Formocresol.
 Not only does laser treatment offer a non-
pharmacologic hemostatic technique, it has a higher
success rate.

31. • Control of haemorrhage
• Sterilization
• it has Stimulation effects on the dental pulp
cells
• Improved healing
• Dentinogenesis stimulation
• Preservation of pulp vitality
• Non contact mode

32. Nd:YAG laser CO2 LASERS:
L.A & isolation
Excavation of caries
Complete hemostasis by exposure to Nd:YAG laser at 2W,
20 Hz (100 mJ)
IRM or composite
Stainless steel crown

33. MTA is composed of:
 Tricalcium silicate
 Tricalcium aluminate
 Tricalcium oxide
 Silicate oxide.
 MTA has demonstrated the ability to induce hard-
tissue formation in pulpal tissues.
 MTA has a greater ability to maintain the integrity
of pulp tissue.
A Systemic Review of the Materials Used in Primary Teeth Pulpotomy in Children Rajendran Ganesh.

34.  Histologic evaluation of pulpal tissue in animals and humans
demonstrated that MTA produces a thicker dentinal bridge, less
inflammation, less hyperaemia and less pulpal necrosis compared
with calcium hydroxide.
 MTA also appears to induce the formation of a dentin bridge at a
faster rate than does calcium hydroxide.
 Holland and colleagues theorized that the tricalcium oxide in MTA
reacts with tissue fluids ability of MTA to resist the penetration of
microorganisms.

36.  Deep carious lesion with restorable crown
 No obvious signs of pulpal degeneration
 Successful hemorrhage control within 5 min
 Color of hemorrhage: Bright red indicate inflamed
pulp where as red indicate extensive infection and
pulpal degeneration
 Carious or iatrogenic pulpal exposure.

37.  Calcium hydroxide is a white, crystalline, slightly
soluble basic salt that dissociates into calcium ions and
hydroxyl ions in solution and exhibits a high alkalinity
(pH 11).
 The high pH produces an environment that is not
conducive to bacterial growth.
A Systemic Review of the Materials Used in Primary Teeth Pulpotomy in Children Rajendran Ganesh.

38.  There are three mechanisms by which calcium
hydroxide induces bacterial lysis:
• The hydroxyl ions destroys phospholipids so the cellular
membrane is destroyed;
• The high alkalinity breaks down ionic bonds so that
bacterial proteins are denatured;
• The hydroxyl ions react with bacterial DNA, inhibiting
replication.
A Systemic Review of the Materials Used in Primary Teeth Pulpotomy in Children Rajendran Ganesh.

39.  Indications
• Young permanent tooth owing to its less cellular activity
than the primary
• Mechanical, Carious, Traumatic exposure with
incomplete apical closure
 Contraindications
• Not recommended for primary teeth
-Diffuse inflammation
-Internal resorption— Tronstad1988

40. Anesthesia, isolation
Caries removed
Deroofing the pulp chamber
Coronal pulp amputation
Control of haemorrhage
Ca(OH)2 placed over the orifice and dried with cotton pellet
Quick setting ZOE cement placed over it
Stainless steel crown (post. teeth) ; Restoration / composite
(ant. teeth)

41.  The rationale of this technique is the tissue of the coronal
pulp is removed during pulpal amputation, a layer of
coagulation necrosis carried by the electro surgery
application provides a barrier between healthy radicular
tissue and any base material placed in the pulp chamber.
 The odontoblasts are stimulated to form a dentin bridge
and the tooth is maintained in the arch with vital
radicular tissue until it exfoliates.

42. ADVANTAGES:
•Quick
•Self limiting
•Hemostasis
•Good visibility
•No systemic effects
DISADVANTAGES:
•Heat leads to tissue
destruction
•Persistent inflammation
•Root resorption

43. Local anesthesia and isolation with a rubber dam
Pulp chamber opened
Coronal pulp removed
Pulp hemostasis obtained
Electrosurgical current applied for 2 - 5sec to pulp stump
Calcium hydroxide paste placed
Light-cured glass ionomer cement seal obtained
Stainless steel crown

44.  Cvek described a pulpotomy technique where only
the superficial 2 to 3 mm of hyperplastic inflammed
tissue was removed with a water-cooled high-speed
diamond bur to place wound in a healthy site.
 Hemostasis is then secured before capping with an
appropriate material.
 If hemostasis could not be secured after several
minutes of saline-moistened cotton pellet application,
the preparation is checked carefully for residual
superficial tags of bleeding tissue which had not been
fully removed .

45.  Persistent bleeding from an inflamed pulp usually
indicates that the tissue should be resected at a deeper
level to preserve a vital apical pulp stump and then it
should be followed by hemostasis with saline and a
pulp capping agent.
 However, Histopathologically better results have been
shown more recently with MTA as an pulp capping
agent.
 MTA is thus recommended as a pulp-capping agent of
choice in cases that do not extend deeply into the roots.
Cohen’s Pathway of Pulp

46.  A small and recent pulpal exposure upto approximately 14 days in a
non carious Primary incisors.
 A sufficient tooth structure is present to allow proper restoration and
full coverage of the crown with a bonded resin- composite/strip crown.
 Partial pulpotomy is highly indicated in a very young tooth with a
wide- open apex and very thin root dentin walls.
 The decisive factor for selection of the partial pulpotomy and its
success is a healthy, non inflammed and asymptomatic vital pulp.
 During the procedure, an operative diagnosis should be made by
assessing the pulp with regard to the bleeding from the amputation site,
including the color, viscosity, and ability of the tissue to achieve
hemostasis.

47.  Exposure is very large or when more than 2 weeks and
gone beyond the injury and treatment time allowing
oral contaminants to cause extensive infection or
inflammation beyond 2 to 3 mm of the exposure
 Purulent drainage
 History of prolonged pain
 Necrotic debris in canal
 Periapical radiolucency

48.  Biodentin is a new tricalcium silicate (Ca3Si05) based inorganic
restorative commercial cement and advertised as “Bioactive dentin
substitute’.
 This material is claimed to possess better physical and biological
properties comapred to other tricalcium silicate cement such as
mineral trioxide aggregate(MTA) and Bioaggregate.

49.  Powder: packaged in capsule (0.7 g).
 Tricalcium Silicate: it’s the main component
 Diclacium Silicate: it's the second main component.
 Calcium Carbonate: as filler.
 Zirconium Oxide: responsible for radiopacity.
 Iron Oxide: responsible for shade.
 Liquid: packaged in pipette (0.18 nil).
 Calcium Chloride: as accelerator.
 Hydrosoluble polymer: (water reducing agent) maintain the balance
between low water content and consistency of mixture.
 Water

50. Anesthetized and isolated the tooth with a rubber dam.
The exposed pulp and surrounding dentin are flushed clean with
isotonic saline solution.
The superficial layer of the exposed pulp and the surrounding tissue
excised to a depth of 2 mm using a high-speed diamond bur.
The surface of the remaining pulp is irrigated with isotonic saline
along with gentle application of small sterile cotton pellets for 5
minutes until the bleeding is arrested.
Freshly mixed Biodentine is immediately placed over the exposed
pulp, following which it is allowed to set for 20 minutes. The exposed
dentin and Biodentine then restored.
Biodentine pulpotomy several days after pulp exposure: Four case reports Swati A

51.  It has the ability to induce cell proliferation and
biomineralization
 Induce pulp repair
 Dentin synthesis through an increase of transforming
growth factor-31
 Replaces natural dentin with the same mechanical
properties
 Better handling
 Reduced setting time

52. Clinical evaluation of diluted formocresol
pulpotomies in primary teeth of school
children Anna B. Fuks et.al
Children treated with pulpotomies using a
1:5 dilution of formocresol had a clinical
success of 94.3% and concluded that 1:5
dilution of formocresol was an effective
alternative medicament for primary
procedures in children
A 3-year clinical follow-up study of
pulpotomized primary molars treated with the
formocresol technique ROLLING et.al
The survival rate at the 3-month follow-up was
91 %, whereas the rate was 83 %, 78 % and 70
% - 12, 24 and 36 months respectively after the
treatment.
Success rate of formocresol pulpotomy in
primary molars restored with stainless steel
crown vs amalgam Gideon Holan et.al
Pulpotomized primary molars can be
successfully restored with one surface
amalgam if their natural exfoliation is expected
within not more than two years.
RELATED STUDIES

53. Ferric sulfate pulpotomy in primary molars:
A retrospective study Nikki L. Smith et.al
It was found out that the clinical success
rate is 99% but the radiographic success
rate was 74% in Ferric sulphate
pulpotomies
Ferric sulphate and formocresol in pulpotomy
of primary molars: long term follow-up study
H. IBRICEVIC et.al
Ferric sulphate showed similar clinical and
radiographic success rate as a pulpotomy agent
for primary molar teeth after long term
evaluation period, compared with formocresol.
Ferric sulphate, because of its lower toxicity,
may become a replacement for formocresol in
primary molar teeth.

54. Comparison of Mineral Trioxide Aggregate
and Formocresol as Pulp-capping Agents in
Pulpotomized Primary Teeth Hadeer A.
Agamy et.al
MTA appears to be superior to formocresol
as a pulp dressing for pulpotomized primary
teeth.
100% clinical and radigraphic success with
MTA and 90% success rate in formocresol.
Mineral trioxide aggregate as a pulpotomy
agent in primary molars: An in vivo study
NAIK S et.al.
Mineral trioxide aggregate showed clinical and
radiographic success as a dressing materials
following pulpotomy in primary teeth and has a
promising potential replacement for
formocresol in primary teeth.
Mineral trioxide aggregate versus formocresol
pulpotomy: a systematic review and meta-
analysis of randomized clinical trials
Armin Shirvani et.al.
MTA can produce a higher success rate in
comparison with formocresol.

55. STUDIES CONCLUSION
Evaluation of Biodentine Pulpotomies in
Deciduous Molars with Physiological Root
Resorption
Nasseh et al
Pulpotomies performed with Biodentine were
entirely successful. This dressing material
appears to be a serious pulpotomy agent in
primary molars.
An In Vivo Evaluation of Biodentine™ as a
Pulpotomy Agent
in Primary Teeth
Prasad K Musale et al
• Biodentine™ showed clinical and
radiographic success comparable to FC and
WMTA.
• Biodentine™ can be suggested as a
pulpotomy agent for primary teeth
Sirohi et.al in 2017 compared FS with bIodentin
as a pulpotomy medicament for 9 months.
There was 96% Clinical success in FS group
100% in Biodentin Group
Radiographic success in FS-84%
Biodentin -92%

56. STUDIES CONCLUSION
Comparative evaluation of formocresol and
electrosurgical pulpotomy in human primary
teeth- An in vivo study
Kritika Gupta et al 2018
The overall clinical success of FC was 100%,
whereas that of electrocautery was 96% at 3-, 6-
, and 9-month follow-up. The overall
radiographic success of FC was 100%, 93%,
and 93% and that of electrocautery was 97%,
87%, and 77% at 3, 6, and 9 months,
respectively.
Comparative evaluation of Ferric Sulfate,
Electrosurgical and Diode Laser on human
primary molars pulpotomy: an “in-vivo” study
P Yadav et al 2014
Clinically, 86.6% success rate was found in
ferric sulfate group whereas 100% success rate
was found in electrosurgical and diode laser
groups. Radiographically, 80% success rate was
found in all the three groups (FS,ES,DIODE)at
the end of 9 months with internal resorption
being the most common cause of failure after
pulpotomy.
Clinical and radiographic comparison of
primary molars after formocresol and
electrosurgical pulpotomy: A randomized
clinical trial
Zahra Bahrololoomi et al
The failure rates for electrosurgical pulpotomy
to be equal to those for formocresol pulpotomy.
Although electrosurgical pulpotomy is a
nonpharmacological technique giving favorable
results, it is still a preservative technique

57. STUDIES CONCLUSION
Laser Pulpotomy—An Effective Alternative to
Conventional Techniques: A 12 Months
Clinicoradiographic Study 1 Garima Gupta
Laser pulpotomy showed better clinical as well
as radiographical results than ES and FS
pulpotomy. Laser pulpotomy was also found
superior in terms of operating time, patient
cooperation, ease of use and pain.
In 1985, Ebihara reported the effects of
Nd:YAG laser on the wound healing of
amputated pulps.
Reported better wound healing in pulps exposed
to the laser than in controls during the first
week and facilitation of dentinal bridge
formation in the fourth and twelfth
postoperative weeks .
Outcome comparison between diode laser
pulpotomy and formocresol pulpotomy on
human primary molars Shan-li Pei,2020
No significant difference of clinical and
radiographic success rate between diode laser
and FC pulpotomy in human primary molars
followed for 12 months.

58.  A successful pulpotomy outcome should be based on
freedom from pathologic root resorption; maintenance
of the primary teeth in an infection free state to hold
space for the eruption of its permanent successor.
 The material, MTA may be useful as a substitute for
other materials in pulpotomy procedures.

59.  McDonald and Avery- Dentistry for the Child and Adolescent.
 Cohen’s Pathway of Pulp
 Pulpotomy vs. pulpectomy techniques, indications and
complications Seraj Al Baik
 A Systemic Review of the Materials Used in Primary Teeth
Pulpotomy in Children Rajendran Ganesh.
 Formocresol, still a controversial material for pulpotomy: A critical
literature review; Shashidhar Chandrashekhar.
 Formocresol pulpotomy on (young) permanent teeth-Philip A et.al
 Glutaraldehyde preparations and pulpotomy in primary molars by
Tzong-Ping Tsai et.al.
 Ferric sulphate and formocresol in pulpotomy of primary molars:
long term follow-up study by H. IBRICEVIC et.al
 AAPD Guideline on Pulp Therapy for Primary and Immature
Permanent Teeth 2009