pulpotomy treatment for primary teeth
TRANSCRIPT
![Page 1: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/1.jpg)
Pulpotomy treatment for
primary teeth
2010 National Primary
Oral Health Conference
October 24-27
Gaylord Palm, Orlando, Florida
Enrique Bimstein
Professor of Pediatric Dentistry
University of Florida College of Dentistry.
![Page 2: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/2.jpg)
Pulpotomy treatment
for primary teeth Goal
The participants will become
familiar with the basic
knowledge and procedures
required for the performance of
the pulpotomy treatment in
primary teeth.
![Page 3: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/3.jpg)
Pulpotomy treatment
for primary teeth Topics
Introduction
Definition and rationale.
Indications and contraindications.
Materials and techniques.
Pulpotomy technique (clinical procedures).
Pulpotomy follow up.
Summary and conclusions.
![Page 4: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/4.jpg)
Pulpotomy treatment
for primary teeth Topics
Introduction
Definition and rationale.
Indications and contraindications.
Materials and techniques.
Pulpotomy technique (clinical procedures).
Pulpotomy follow up.
Summary and conclusions.
![Page 5: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/5.jpg)
Preservation of the primary teeth until
their time of exfoliation is required to:
a. Maintain arch length,
masticatory function and
esthetics.
![Page 6: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/6.jpg)
Preservation of the primary teeth until
their time of exfoliation is required to:
a. Maintain arch length,
masticatory function and
esthetics.
![Page 7: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/7.jpg)
Preservation of the primary teeth until
their time of exfoliation is required to:
a. Maintain arch length,
masticatory function and
esthetics.
b. Eliminate pain, inflammation
and infection.
![Page 8: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/8.jpg)
Preservation of the primary teeth until
their time of exfoliation is required to:
a. Maintain arch length,
masticatory function and
esthetics.
b. Eliminate pain, inflammation
and infection.
c. Prevent any additional pain or
damage to the oral tissues.
![Page 9: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/9.jpg)
Despite all the
prevention
strategies,
childhood caries
is still a fact that
we confront
every day in the
clinic.
![Page 10: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/10.jpg)
The retention of pulpally
involved primary teeth
until the time of normal
exfoliation remains to be
a challenge.
Primary teeth with
cariously exposed vital
pulps should be treated
with pulp therapies that
allow for the normal
exfoliation process.
![Page 11: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/11.jpg)
The retention of pulpally
involved primary teeth
until the time of normal
exfoliation remains to be
a challenge.
Primary teeth with
cariously exposed vital
pulps should be treated
with pulp therapies that
allow for the normal
exfoliation process.
![Page 12: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/12.jpg)
Pulpotomy treatment
for primary teeth Topics
Introduction
Definition and rationale.
Indications and contraindications.
Materials and techniques.
Pulpotomy technique (clinical procedures).
Pulpotomy follow up.
Summary and conclusions.
![Page 13: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/13.jpg)
Definition of pulpotomy
Surgical excision of a vital tooth
pulp.
Surgical removal of a portion of
the dental pulp (levels may vary).
Amputation of the coronal portion
of the pulp, and treatment of the
remaining radicular portion in
order to preserve the vitality of
the remaining pulp tissue.
![Page 14: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/14.jpg)
Rationale of pulpotomy
Pulps with a carious
exposure show a
very limited potential
for pulp recovery, as
the result of
bacterial infection of
the pulp.
Therefore, the infected pulp (coronal
or complete) needs to be removed.
![Page 15: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/15.jpg)
Rationale of pulpotomy
The pulpotomy
treatment is based
on the rationale that
the radicular pulp
tissue is healthy, or
capable of healing,
after amputation of
the infected coronal
pulp.
![Page 16: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/16.jpg)
Rationale of pulpotomy After the pulpotomy is
performed the remaining
radicular pulp may be:
![Page 17: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/17.jpg)
Rationale of pulpotomy After the pulpotomy is
performed the remaining
radicular pulp may be:
1. Rendered inert
by using
formocresol
that is
bactericidal and
“fixes” the pulp
tissue.
![Page 18: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/18.jpg)
Rationale of pulpotomy After the pulpotomy is
performed the remaining
radicular pulp may be:
2. Preserved trough
minimal
inflammatory
insult by using an
haemostatic
agent / laser /
elecrosurgery.
![Page 19: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/19.jpg)
Rationale of pulpotomy After the pulpotomy is
performed the remaining
radicular pulp may be:
3. “Encouraged” to
form a dentin
bridge using
calcium hydroxide
or mineral trioxide
aggregate (MTA).
![Page 20: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/20.jpg)
Rationale of pulpotomy Pulpectomies in
primary teeth are
possible but relatively
complicated and time
consuming.
Root canal filling
materials may interfere
with the normal
exfoliation process of
the primary teeth.
![Page 21: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/21.jpg)
Rationale of pulpotomy A concept that
pulpectomy or
extraction should be
used in cases of vital
primary teeth with
carious exposures
instead of a pulpotomy
has been mentioned in
the literature. Coll JA. Indirect pulp capping and primary teeth: is
the primary tooth pulpotomy out of date? Pediatr
Dent 2008; 30(3): 231-6.
![Page 22: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/22.jpg)
Pulpotomy treatment
for primary teeth Topics
Definition, goals and rationale.
Indications and contraindications.
Materials and techniques.
Pulpotomy technique (clinical procedures).
Pulpotomy follow up.
Summary and conclusions.
![Page 23: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/23.jpg)
Indications for pulpotomy
a. Pulp exposure
caused by
caries: “small”
pulp exposure.
b. Coronal pulp is
still vital.
c. Radicular pulp is
considered to be
“normal”.
![Page 24: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/24.jpg)
Contraindications for pulpotomy
• Preoperative symptoms.
Spontaneous pain
may be the result of
food impaction
Swelling,
spontaneous pain,
etc.
![Page 25: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/25.jpg)
Contraindications for pulpotomy
• Positive percussion test.
The result of behavior
problems and/or
food impaction.
![Page 26: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/26.jpg)
Contraindications for pulpotomy
• Tooth restorability.
![Page 27: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/27.jpg)
Contraindications for pulpotomy
• Proximity of exfoliation, <2/3
of root length. (?)
![Page 28: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/28.jpg)
Contraindications for pulpotomy
• Irreversible pulp damage.
![Page 29: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/29.jpg)
Contraindications for pulpotomy
• Irreversible pulp damage.
![Page 30: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/30.jpg)
Pulpotomy treatment
for primary teeth Topics
Definition and rationale.
Indications and contraindications.
Materials and techniques.
Pulpotomy technique (clinical procedures).
Pulpotomy follow up.
Summary and conclusions.
![Page 31: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/31.jpg)
What should be
the
characteristics
of an ideal
pulpotomy
material/
technique?
Pulpotomy: materials / techniques
![Page 32: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/32.jpg)
Pulpotomy: materials / techniques The ideal pulpotomy technique / dressing material should be:
simple.
done 1 appointment
and require a short
period of time.
have a high success
rate.
be bactericidal.
promote healing.
![Page 33: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/33.jpg)
Pulpotomy: materials / techniques
harmless to the pulp
and surrounding
structures and
promotes healing
(“biological”).
compatible with the
normal process of root
resorption.
not expensive.
The ideal pulpotomy technique / dressing material should be:
![Page 34: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/34.jpg)
• Calcium hydroxide.
• Electrosurgery.
• Laser.
• Glutaraldehyde.
• Collagen.
• Mineral trioxide aggregate (MTA).
• Formocresol.
• Diluted formocresol.
• Ferric sulfate.
Pulpotomy: materials / techniques
![Page 35: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/35.jpg)
• Calcium hydroxide.
• Electrosurgery.
• Laser.
• Glutaraldehyde.
• Collagen.
• Mineral trioxide aggregate (MTA).
• Formocresol.
• Diluted formocresol.
• Ferric sulfate.
Pulpotomy: materials / techniques
![Page 36: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/36.jpg)
Pulpotomy: calcium hydroxide
Rationale
The use of calcium
hydroxide as a pulp
dressing material after
pulpotomy in primary
teeth is expected to
facilitate the formation of
a dentine bridge
(“barrier”) and promote
the healing of the
radicular pulp tissue.
![Page 37: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/37.jpg)
Pulpotomy: calcium hydroxide
Radiographic study,103 teeth
Success rate of 31%. Among the
unsuccessful teeth, 69% showed evidence of
internal resorption.
The high failure rate in calcium hydroxide
pulpotomies can be attributed to:
Calcium hydroxide has no beneficial
effect on the inflamed pulp.
The creation of an extrapulpal blood cloth. Via W. Evaluation of deciduous molars treated by pulpotomy andcalcium hydroxide. J Oral
Surg 3:171, 1974.
![Page 38: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/38.jpg)
• Calcium hydroxide.
• Electrosurgery.
• Laser.
• Glutaraldehyde.
• Collagen.
• Mineral trioxide aggregate (MTA).
• Formocresol.
• Diluted formocresol.
• Ferric sulfate.
Pulpotomy: materials / techniques
![Page 39: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/39.jpg)
Rationale
• Is a non pharmaceutical
technique.
• Its mechanism of action is
the cauterization of the
superficial pulp tissue Sheller B. Electrosurgical pulpotomy: a pilot study in humans.
Journal of endodontics 13:69-76,1987
Pulpotomy: electrosurgery
![Page 40: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/40.jpg)
Rationale
• A layer of coagulation necrosis that is
caused by the electrosurgery
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. Sheller B. Electrosurgical pulpotomy: a pilot study in humans.
Journal of endodontics 13:69-76,1987
Pulpotomy: electrosurgery
![Page 41: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/41.jpg)
Requires the purchase of special
equipment; an electrosurgery dental
electrode.
±$ 1000.00
Pulpotomy: electrosurgery
![Page 42: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/42.jpg)
• Calcium hydroxide.
• Electrosurgery.
• Laser.
• Glutaraldehyde.
• Collagen.
• Mineral trioxide aggregate (MTA).
• Formocresol.
• Diluted formocresol.
• Ferric sulfate.
Pulpotomy: materials / techniques
![Page 43: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/43.jpg)
Pulpotomy: laser
Rationale
Non-pharmaceutical technique.
It creates a superficial zone of
coagulation necrosis that
remains compatible with the
underlying tissue.
pulps retain their vitality and
capability of normal pulp
healing.
![Page 44: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/44.jpg)
Pulpotomy: laser
![Page 45: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/45.jpg)
• Calcium hydroxide.
• Electrosurgery.
• Laser.
• Glutaraldehyde.
• Collagen.
• Mineral trioxide aggregate (MTA).
• Formocresol.
• Diluted formocresol.
• Ferric sulfate.
Pulpotomy: materials / techniques
![Page 46: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/46.jpg)
Rationale.
Has been suggested as an
alternative to formocresol as
a pulpotomy agent , based on
its superior fixative
properties, low antigenicity,
and low toxicity.
Pulpotomy: glutaraldehyde
![Page 47: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/47.jpg)
high molecular weight that
limits its tissue penetration.
has a self-limiting penetration,
hence, reduces the extent of
inflammatory response.
superficial fixation with very
little underlying inflammation.
Pulpotomy: glutaraldehyde
![Page 48: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/48.jpg)
• In a 2% solution destroys fungi,
viruses, and bacteria.
• It is considered to be better than
formocresol since:
GA does not diffuse trough the
apical foramen.
GA does not penetrate the
periapical tissues as
formocresol.
Pulpotomy: glutaraldehyde
![Page 49: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/49.jpg)
A normal pulp is seen below
“glutaraldehyde pulps”,
whereas below “formocresol
pulps” there is inflammation, or
“mummification”. However, the material/technique was
not well accepted by the pediatric
dentists; may be since it is still an
aldehyde (similar to formocresol).
Pulpotomy: glutaraldehyde
![Page 50: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/50.jpg)
• Calcium hydroxide.
• Electrosurgery.
• Laser.
• Glutaraldehyde.
• Collagen.
• Mineral trioxide aggregate (MTA).
• Formocresol.
• Diluted formocresol.
• Ferric sulfate.
Pulpotomy: materials / techniques
![Page 51: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/51.jpg)
Pulpotomy materials / collagen
Rationale Biological non pharmacological material
that may induce tissue healing.
Biological mineral formation initiates
within collagen fibers
Collagen gels may provide an appropriate
scaffolding for tissue formation.
Substantial tissue healing with an acid-
soluble autologous skin collagen solution. (Bimstein and Shoshan, 1981).
![Page 52: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/52.jpg)
Pulpotomy materials / collagen
However, • Animal product (skin)
• May cause allergies (to tissue or to
antibiotics).
• A commercial preparation of collagen was
associated with pulpal inflammation and
necrosis.
• Naturally sourced collagen is not a
promising material for biological
approaches to vital pulp therapy.
![Page 53: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/53.jpg)
• Calcium hydroxide.
• Electrosurgery.
• Laser.
• Glutaraldehyde.
• Collagen.
• Mineral trioxide aggregate (MTA).
• Formocresol.
• Diluted formocresol.
• Ferric sulfate.
Pulpotomy: materials / techniques
![Page 54: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/54.jpg)
Rationale
Prevents microleakage.
Biocompatible.
Promotes regeneration of
original tissues when it is
placed in contact with the
dental pulp or periradicular
tissues.
Pulpotomy: mineral trioxide aggregate
![Page 55: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/55.jpg)
Pulpotomy: mineral trioxide aggregate
Rationale
Not been found to
induce internal
resorption, which has
been observed in teeth
treated with some
other medicaments.
![Page 56: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/56.jpg)
• MTA is a fine hydrophilic powder developed
by Mahmoud Torabinejad in Loma Linda
University.
• Consists of tricalcium silicate, tricalicum
aluminate, tricalcium oxide, silicate oxide
and bismuth oxide.
• Each pack of MTA comes with a pre
measured unit dose of water for
convenience in mixing.
Pulpotomy: mineral trioxide aggregate
![Page 57: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/57.jpg)
Manf#: 1124-47
UPC#: 039645112441
Manf: QUIKRETE CO.
PORTLAND CEMENT 47LB
Retail Price: $10.55
Regular Price: $9.59
Checkout Price: $8.63
Pulpotomy: mineral trioxide aggregate
$330.00 to 425.00
![Page 58: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/58.jpg)
Pulpotomy: mineral trioxide aggregate
Portland cement may
serve as an effective
and less expensive
MTA substitute in
primary molars
pulpotomies. Sakai VT et al. Pulpotomy of human
primary molars with MTA and Portland
Cement: a randomized controlled trial.
British Dental Journal 2009.
![Page 59: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/59.jpg)
• Calcium hydroxide.
• Electrosurgery.
• Laser.
• Glutaraldehyde.
• Collagen.
• Mineral trioxide aggregate (MTA).
• Formocresol.
• Diluted formocresol.
• Ferric sulfate.
Pulpotomy: materials / techniques
![Page 60: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/60.jpg)
Rationale
• Excellent clinical success!
• Releases formaldehyde
which may diffuse trough
the pulp fixating (mummify)
the tissue (?).
• Does not promote pulp
healing.
Pulpotomy: formocresol (full strength or diluted)
![Page 61: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/61.jpg)
The rationale of fixation
is that we may create a
tolerable irritation
which replaces an
intolerable infection
caused by bacteria.
?????????????????
Pulpotomy: formocresol (full strength or diluted)
![Page 62: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/62.jpg)
• Calcium hydroxide.
• Electrosurgery.
• Laser.
• Glutaraldehyde.
• Collagen.
• Mineral trioxide aggregate (MTA).
• Formocresol.
• Diluted formocresol.
• Ferric sulfate.
Pulpotomy: materials / techniques
![Page 63: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/63.jpg)
Rationale
Is a nonaldehyde agent that produces
haemostasis at pulp stumps by
chemically sealing blood vessels.
The haemostasis takes place by
agglutination of blood protein, without
the presence of a blood clot, which
suggested that preventing clot formation
might minimize the chances for chronic
inflammation.
Pulpotomy: ferric sulfate
![Page 64: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/64.jpg)
Rationale
Induces favorable histological
results in the form of secondary
dentin and bridging.
Retention of maximum vital
tissue and virtual conservation
of the radicular pulp without
induction of reparative dentin.
Pulpotomy: ferric sulfate
![Page 65: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/65.jpg)
• Comparisons
Pulpotomy: materials / techniques
![Page 66: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/66.jpg)
Laser (n=68): 97 % and 94.1 % clinical and
radiographic success respectively, follow
up for 6 to 64 months.
Formocresol (n=69): 85.5and 78.3% clinical
and radiographic success respectively,
follow up for 9 to 66 months.
Liu J. Effect of ND:YAG laser pulpotomy on human primary
molars. J Endod 2006;32:404–407.
• Comparisons Pulpotomy: materials / techniques
![Page 67: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/67.jpg)
• Comparisons
Pulpotomy: materials / techniques
Currently available evidence
suggests MTA compared to
FC, FS and CH resulted in
significantly higher clinical
and radiographic success. Ng et al. Mineral trioxide aggregate as a pulpotomy medicament: an
evidence based assessment. Eur Arch Paediatr Dent 9:58-3, 2008.
![Page 68: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/68.jpg)
• Comparisons
Pulpotomy: materials / techniques
MTA induces less
undesirable responses
and may be FC’s most
suitable replacement. Peng L et al. Evaluation of the formocresol versus
mineral trioxide aggregate primary molar pulpotomy: a
meta analysis. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 102:e40-e44, 2006.
![Page 69: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/69.jpg)
• Comparisons
Pulpotomy: materials / techniques
MTA is superior to CH and
equally effective as a pulpotomy
dressing in primary mandibular
molars . Internal resorption was
the most common radiographic
finding up to 24 months after
pulpotomy. Moretti et al. The effectiveness of mineral trioxide aggregate.
Calcium hydroxide and formocresol for pulpotomies in primary
teeth. International Endodontic Journal 41:545-555, 2008.
![Page 70: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/70.jpg)
Manf#: 1124-47
UPC#: 039645112441
Manf: QUIKRETE CO.
PORTLAND CEMENT 47LB
Retail Price: $10.55
Regular Price: $9.59
Checkout Price: $8.63
Pulpotomy: mineral trioxide aggregate
$330.00 to 425.00
Portland cement may become the material
of choice for pulpotomies in primary teeth.
![Page 71: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/71.jpg)
Success %
Clinical Radiographic
Electrosurgery 96% 84%
Formocresol 100% 92%
Dean JA et al. Comparison of electrosurgical and formocresol pulpotomy
procedures in children (n=25/25, 5 month follow up).
http://onlinelibrary.wiley.com/doi (cited 09/02/2010
• Comparisons
Pulpotomy: materials / techniques
![Page 72: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/72.jpg)
• Comparisons
Pulpotomy: materials / techniques
In human carious primary
molars with reversible coronal
pulpitis, pulpotomies
performed with either
formocresol or ferric sulfate
are likely to have similar
clinical/radiographic success. Loh A et al. Evidence based assessment: evaluation of the
formocresol versus ferric sulfate. Pediar Dent 26:401-9, 2004.
![Page 73: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/73.jpg)
• Comparisons
Pulpotomy: materials / techniques
Ferric sulfate, because of its lower toxicity,
may become a replacement for
formocresol in primary molar teeth.
Ibricevic H et al. Ferric sulfate and formocresol in pulpotomy of primary
molars: long term follow-up study. Eur J Pediatr Dent. 4:28-32, 2003.
Success %
Clinical Radiographic
Ferric sulfate 96.4% 92.0%
Formocresol 97.5% 94.6%
![Page 74: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/74.jpg)
Pulpotomy treatment
for primary teeth Topics
Definition and rationale.
Indications and contraindications.
Materials and techniques.
Pulpotomy technique (clinical procedures).
Pulpotomy follow up.
Summary and conclusions.
![Page 75: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/75.jpg)
After completion of removing the caries
from the dentin - enamel junction
remove the caries located at the
surface(s) located close to the pulp with
a large round bur or large spoon sharp
excavator.
Technique: caries removal
![Page 77: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/77.jpg)
c. If a “small” carious pulp exposure is
disclosed, evaluate the pulp condition, and
perform a complete coronal pulpotomy,
complete caries removal.
Technique: caries removal
![Page 78: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/78.jpg)
Judge the condition of the
exposed pulp based on the pulp
tissue color, hemorrhage (none,
moderate, profuse).
Technique: caries removal
![Page 79: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/79.jpg)
If the pulp color is vivid red, the
bleeding is moderate, proceed
with the pulpotomy.
Technique: caries removal
![Page 80: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/80.jpg)
If the pulp color is dark, or there is
no bleeding, or profuse bleeding, a
pulpotomy is contraindicated and
a pulpectomy or extraction is
required.
Technique: caries removal
![Page 81: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/81.jpg)
Technique: pulpotomy
1.Open a wide access to the pulp
chamber with high-sped.
2. Judge the pulp condition based
on the pulp tissue color,
hemorrhage (none, moderate,
profuse).
3. Remove the coronal pulp tissue
with high speed, low speed or a
sharp large spoon excavator.
![Page 82: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/82.jpg)
4. Observe the pulp stumps and judge
the condition of the radicular pulp
(color, hemorrhage).
5. Obtain haemostasis (cotton pellet).
6. Place the pulp dressing material of
your choice and evaluate the pulp
stumps (no more bleeeding).
7. Fill the pulp chamber with IRM.
8. Restore the tooth (preferably with a crown)
Technique: pulpotomy
![Page 83: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/83.jpg)
Technique: pulpotomy 1. After complete removal of the caries,
open a wide access to the pulp chamber
with high-sped.
![Page 84: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/84.jpg)
Technique: pulpotomy 1. After complete removal of the caries,
open a wide access to the pulp chamber
with high-sped.
![Page 85: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/85.jpg)
Technique: pulpotomy 1. After complete removal of the caries,
open a wide access to the pulp chamber
with high-sped.
![Page 86: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/86.jpg)
Technique: pulpotomy
2. Judge the pulp condition based
on the pulp tissue color,
hemorrhage (none, moderate,
profuse).
![Page 87: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/87.jpg)
Technique: pulpotomy
3.The technique for removal of the
coronal pulp tissue is the same
for every material you decide to
use as a pulp dressing material.
You may use a sharp excavator,
slow speed with a large round
bur, or high speed with a 330
tungsten bur.
![Page 88: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/88.jpg)
Technique: pulpotomy
Removing the coronal pulp
![Page 89: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/89.jpg)
Technique: pulpotomy
Removing the coronal pulp
using a sharp excavator
![Page 90: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/90.jpg)
Technique: pulpotomy
Removing the coronal pulp
Using slow speed large round bur
![Page 91: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/91.jpg)
Technique: pulpotomy
Removing the coronal pulp
Using a 330 high speed bur
![Page 93: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/93.jpg)
Technique: pulpotomy
Evaluate hemostasis
“Unstoppable” bleeding No bleeding
![Page 94: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/94.jpg)
What if you do not
achieve hemostasis? Check for ledges and remove them if present, by widening the opening.
![Page 95: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/95.jpg)
Re-evaluate hemostasis
![Page 96: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/96.jpg)
What if you still do not
achieve hemostasis?
Perform a deeper
pulpotomy,
or “partial
pulpectomy” by
penetrating the
pulp canals with a
small round bur
or……..
![Page 97: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/97.jpg)
What if you still do not
achieve hemostasis?
![Page 98: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/98.jpg)
6. Place the pulp dressing material of
your choice and re-evaluate the
pulp stumps.
Technique: pulpotomy
![Page 99: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/99.jpg)
• Calcium hydroxide
• Formocresol.
• Diluted formocresol.
• Glutaraldehyde.
• Ferric sulfate.
• Mineral trioxide aggregate.
• Electrosurgery.
• Laser.
• Collagen.
Pulpotomy: materials / techniques
![Page 100: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/100.jpg)
• Calcium hydroxide
• Formocresol.
• Diluted formocresol.
• Glutaraldehyde.
• Ferric sulfate.
• Mineral trioxide aggregate.
• Electrosurgery.
• Laser.
• Collagen.
Pulpotomy: materials / techniques
![Page 101: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/101.jpg)
• Full strength or diluted
Pulpotomy materials / formocresol
1.Control hemorrhage with
cotton pellets.
2.Apply a cotton pellet
moistoned with FC to the pulp
stumps for 5 minutes.
3.Evaluate the pulp stumps.
4.Fill the pulp chamber with IRM.
![Page 102: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/102.jpg)
![Page 103: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/103.jpg)
• Calcium hydroxide
• Formocresol.
• Diluted formocresol.
• Glutaraldehyde.
• Ferric sulfate.
• Mineral trioxide aggregate.
• Electrosurgery.
• Laser.
• Collagen.
Pulpotomy: materials / techniques
![Page 104: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/104.jpg)
• Ferric sulfate
1. Control hemorrhage with
cotton pellets.
2. Apply (rub) FS to pulp
stumps for 15 seconds.
3. Rinse with water.
4. Evaluate the pulp stumps.
Pulpotomy: ferric sulfate
![Page 105: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/105.jpg)
Pulpotomy: ferric sulfate
![Page 106: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/106.jpg)
Technique: pulpotomy
Apply FS to pulp stumps
for 15 seconds.
![Page 107: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/107.jpg)
• Ferric sulfate
3. Rinse with water.
4. Evaluate the pulp stumps.
Pulpotomy: ferric sulfate
![Page 108: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/108.jpg)
Technique: pulpotomy
7. Fill the pulp chamber with IRM.
![Page 109: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/109.jpg)
Technique: pulpotomy
7. Fill the pulp chamber with IRM.
![Page 110: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/110.jpg)
8. Restore the tooth (preferably with a
crown)
Technique: pulpotomy
Pulpotomies
success rates were
79.9% for teeth
restored with a SSC
and 60% for those
restored with
amalgam. Sonmez et al. Success rate of calcium
hydroxide pulpotomy in primary molars
restored with amalgam and stainless steel
crowns. British Dental Journal 208:e18, 2010.
![Page 111: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/111.jpg)
Pulpotomy treatment
for primary teeth Topics
Definition and rationale.
Indications and contraindications.
Materials and techniques.
Pulpotomy technique (clinical procedures).
Pulpotomy follow up.
Summary and conclusions.
![Page 112: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/112.jpg)
Clinical and radiographic. • Gingival and periodonatal health.
Pulpotomy / follow up
![Page 113: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/113.jpg)
Clinical and radiographic. • Parulis / fistula.
Pulpotomy / follow up
![Page 114: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/114.jpg)
Clinical and radiographic. • Obliteration.
Pulpotomy / follow up
![Page 115: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/115.jpg)
Clinical and radiographic. • Interadicular radiolucencies.
Pulpotomy / follow up
![Page 116: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/116.jpg)
Clinical and radiographic. • Periodontal health.
Pulpotomy / follow up
![Page 117: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/117.jpg)
Clinical and radiographic. • Internal / external abnormal root
resorption.
Pulpotomy / follow up
Both, ferric sulfate
(22%) and formocresol
(20%) pulpotomies
can lead to internal
resorption Vargas KG. Radiographic success of ferric sulfate and
formocresol pulpotomies in relation to early exfoliation. Ped
Dent 27:233-7, 2005
![Page 118: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/118.jpg)
Internal resorption self-repair?
![Page 119: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/119.jpg)
Clinical and radiographic. • Early exfoliation.
Pulpotomy / follow up
Both ferric sulfate (11%)
and formocresol (10%)
pulpotomies can lead to
premature exfoliation of
primary teeth, with the
subsequent need for
orthodontic space
maintenance. Vargas KG. Radiographic success of ferric sulfate and formocresol
pulpotomies in relation to early exfoliation. Ped Dent 27:233-7, 2005
![Page 120: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/120.jpg)
Pulpotomy treatment
for primary teeth Topics
Definition and rationale.
Indications and contraindications.
Materials and techniques.
Pulpotomy technique (clinical procedures).
Pulpotomy follow up.
Summary and conclusions.
![Page 121: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/121.jpg)
The pulpotomy treatment in primary teeth
provides the possibility to preserve vital
primary teeth that had a carious pulp
exposure.
Formocresol is still a very popular
pulpotomy dressing material.
Ferric sulfate is a good alternative and
does not have the possible deleterious side effects of formocresol.
Pulpotomy / summary and conclusions
![Page 122: Pulpotomy treatment for primary teeth](https://reader034.vdocument.in/reader034/viewer/2022050722/588204f71a28abf0198b8c32/html5/thumbnails/122.jpg)