The document outlines techniques for pulp therapy in primary teeth, including pulpotomy and pulpectomy procedures. It discusses the pulpotomy technique which involves removing inflamed coronal pulp tissue and maintaining vital radicular pulp. Key steps include diagnosis, indications/contraindications, and the step-by-step pulpotomy procedure using formocresol or alternatives. It also discusses the pulpectomy technique which removes infected material from root canals and fills them. Indications, materials, and single-visit versus two-visit techniques are described. Success rates of primary tooth pulpectomies are also mentioned.

1. OUTLINE
A. The Pulpotomy Technique
1- Diagnosis
2- Indications / Contraindications
Pulp Therapy for Primary Teeth 3- Step-by-step pulpotomy technique
Step- by-
4- Mechanism of action of formocresol
5- Alternatives to formocresol
B. The Pulpectomy Technique
1- Rationale for pulpectomy
Reporter: 許修銘 2- Indications / Contraindications
3- Root canal filling material
4- Types of pulpectomy techniques
2004/03/30 5- Success rates for primary tooth pulpectomies
Introduction Introduction
Preservation of primary teeth in the arch Use of pulp therapy to conserve carious
– Management of developing dentition primary teeth
– Nurturing a positive attitude in – Preserve pulp involved primary molar
children towards dental health when missing permanent successor
– Prevent possible aberrant habits
– Maintain masticatory function
– Preserve aesthetics
– Future dental attitudes
A pulpotomy is the procedure of
A. The Pulpotomy Technique removing coronal part of pulp
tissue, inflamed or infected as
a result of deep caries, &
maintenance of vital radicular
pulp tissue

2. A1- Diagnosis
A1-
1/5 dilution of Primary tooth with deep caries
the original Buckley’s formocresol
Buckley’
OD (with GIC)
or
Pulpotomy
Cresol 40mL
NISHIKA
Formalin 40mL
Root canal disinfectant Ethanol 20mL
A1- Diagnosis
A1- A1- Diagnosis
A1-
The reason for this is that
caries in primary teeth
compromises pulp very early on,
with pulp inflammation setting in
even before pulp is exposed
A1- Diagnosis
A1- A1- Diagnosis
A1-
Hobson (1970) Duggal et al (1999)
In over 50% of the primary molars –The need for pulp therapy for
most primary molars where
Loss of marginal ridge proximal caries has involved the
irreversible pulp inflammation marginal ridge
–The importance of early
diagnosis of proximal caries with
the use of bitewing radiographs

3. A1- Diagnosis
A1- A1- Diagnosis
A1-
Proximal caries that involved less than half the
intercuspal distance from buccal to lingual cusp
A1- Diagnosis
A1- A1- Diagnosis
A1-
By the time the caries exposes the pulp, the inflammation is irreversible
irreversible
Direct pulp capping is contraindicated
A2- Indications
A2- A2- Contraindications
A2-
Large caries with substantial loss (≧1/3 )
(≧ An unrestorable tooth
of marginal ridge in restorable tooth Bi- or trifurcation involvement
Bi-
Tooth free of radicular pulpitis Less than 2/3 of root remaining
At least 2/3 of root remaining Presence of abscess or fistula
Absence of abscess or fistula Permanent successor close to eruption
No inter-radicular bone loss
inter- Medical contraindications
No evidence of internal resorption – Heart disease
Instances where extraction is C/I – Immuno-compromised children
Immuno-

4. A3- Step-by-step
A3- Step- by- A3- Step-by-step
A3- Step- by-
Step 1: Administer local analgesia with Step 2: Isolate tooth with rubber dam
the use of a topical analgesic
Nerve block Buccal infiltration
A3- Step-by-step
A3- Step- by- A3- Step-by-step
A3- Step- by-
Step 3: Remove caries & Step 4: Remove roof of pulp chamber
determine site of pulp exposure
A3- Step-by-step
A3- Step- by- A3- Step-by-step
A3- Step- by-
Step 5: Remove coronal pulp with Step 6: Apply FC on a pledget of
large excavator or large round bur cotton wool for 4 minutes

5. A3- Step-by-step
A3- Step- by- A3- Step-by-step
A3- Step- by-
Step 7: Remove FC pledget after 4 mins Step 8: Fill pulp chamber with cement
& check that haemorrhage has stopped
A3- Step-by-step
A3- Step- by- A3- Step-by-step
A3- Step- by-
Step 9: Restore tooth with SSC Step 10: Take a post-OP radiograph
post-
A3- Step-by-step
A3- Step- by- A3- Step-by-step
A3- Step- by-
Follow-up
Follow-
–Regularly reviewed both clinically &
radiographically 6-monthly
6-
–Appearance of rarefaction of bone Pre-OP
Pre- Post-OP
Post-
in furcation area or
a worsening of bone condition
in furcation
usually signifies failure of the procedure
3M 12 M

6. A4- Mechanism of action of FC
A4- A4- Mechanism of action of FC
A4-
FC acts through Reported
formaldehyde,
aldehyde group of formaldehyde, success rate
forming bonds with side-groups
side- of FC
of amino acids of both bacterial pulpotomy
proteins & remaining pulp tissue
Both bactericidal & devitalizing
agent
A5- Alternatives to FC
A5- A5- Alternatives to FC
A5-
Concern about possible toxicity of Ferric sulphate [Fe2(SO4)3, 15.5%]
FC, both locally & systemically – Excellent haemostatic agent
Alternatives (ferric ion-protein complex)
ion-
– Ferric sulphate [Fe2(SO4)3] – As effective as FC
– Glutaraldehyde – No “fixative” effect
fixative”
– Calcium hydroxide
– Other experimental methods
A5- Alternatives to FC
A5- A5- Alternatives to FC
A5-
Glutaraldehyde Calcium hydroxide
– Introduced by s’Gravenmade (1975) – Poor (around 60%) success rate
– Better fixative agent – Extensive internal resorption
– Toxic properties below amputation
• Allergic reactions
• Eye irritation

7. A5- Alternatives to FC
A5-
Other experimental methods
– Electrosurgery B. The Pulpetomy Technique
– CO2 lasers
– Enriched collagen solution
B1- Rationale for pulpectomy
B1-
It is true that some primary teeth Gain access to the root canals
do have a complex root Remove as much dead &
Remove
morphology (with many fine infected material as possible
accessory root cancals),
cancals), Fill the root canals with a suitable
but this does not contraindicate material
pulpectomy
Maintain primary tooth in a non-
non-
infected state
B2- Indications
B2- B2- Contraindications
B2-
Irreversible inflammation Unrestorable crown
extending to radicular pulp Advanced pathological root
Primary teeth with necrotic pulps resorption
Evidence of furcation pathology Medical contraindications
– Heart disease
Presence of an abscess
– Immuno-compromised
Immuno-
children

8. B3- Root canal filling material
B3- B3- Root canal filling material
B3-
Being totally resorbed at the
same rate as the roots
– Pure zinc oxide & eugenal mixed
as a slurry
– Maisto’s paste
Maisto’
– Iodoform paste 3 M later
– Vitapex
B3- Root canal filling material
B3- B4- Types of pulpectomy
B4-
Ca(OH)2-Iodoform Mixture One-stage / single-visit
- Vitapex, Endoflas
pulpectomy
- Machida (1983): Ca(OH)2-iodoform mixture to
be a nearly ideal primary tooth filling material
1) easy to apply
2) resorbs at a slightly faster rate Two-stage / two-visit
than that of the roots pulpedctomy
3) has no toxic effects on the
permanent successor
4) radiopaque
B4- Single-visit of pulpectomy
B4- B4- Single-visit of pulpectomy
B4-
Indications Step 1: Give local analgesia &
– Presence of inflamed but vital isolate tooth with rubber dam
radicular pulp
– An asymptomatic primary tooth
with necrotic pulp tissue without
any associated acute symptoms,
such as cellulitis
– Presence of a chronic buccal
lesion without any active
discharge or acute symptoms

9. B4- Single-visit of pulpectomy
B4- B4- Single-visit of pulpectomy
B4-
Step 2: Remove caries & Step 3: Remove roof of pulp chamber,
identify exposure site & identify opening of root canals
B4- Single-visit of pulpectomy
B4- B4- Single-visit of pulpectomy
B4-
Step 4: Take a diagnostic radiograph Step 5: Clean out root canals with H files
with files in the root canals & remove remnants of pulp tissue
& irrigate canals with saline
Within 1-2 mm
1-
File lightly
Reaming is not advisable
File to no more than size 30
B4- Single-visit of pulpectomy
B4- B4- Single-visit of pulpectomy
B4-
Step 6: Dry root canals with paper points Step 7: Select a spiral root canal filler of
& place a pledget of FC in pulp chamber appropriate size
for 4 minutes

10. B4- Single-visit of pulpectomy
B4- B4- Single-visit of pulpectomy
B4-
Step 8: Mix ZnO & eugenol as a slurry, Step 9: Fill pulp chamber with cement
& spin it into root canals using
spiral root canal filler
B4- Single-visit of pulpectomy
B4- B4- Single-visit of pulpectomy
B4-
Step 10: Restore the tooth with SSC Step 11: Take a post-op radiograph to
post-
check root filling
B4- Single-visit of pulpectomy
B4- ingle- B4- Single-visit of pulpectomy
B4- ingle-
Follow-up
Follow-
–Regularly reviewed both clinically &
radiographically 6-monthly
6-
Pre-OP
Pre- 3 M later
Pre-OP
Pre- Post-OP
Post- 6 M later
Post-OP
Post- 12 M later

11. B4- Single-visit of pulpectomy
B4- ingle-
92/08/21
(F/U 9M)
Pre-OP
Pre- Pre-OP
Pre-
91/11/12
(Root canal filling)
92/12/29
(F/U 13M)
6 M later Post-OP
Post-
B4- Single-visit of pulpectomy
B4- ingle- B4- Two-visit of pulpectomy
B4-
Spiral root filler Indications
– Presence of an acute abscess
with or without associated
cellulitis
– Presence of active & persistent
discharge from the root canals
B4- Two-visit of pulpectomy
B4- B4- Two-visit of pulpectomy
B4-
Visit 1: Emergency management of Visit 2: Final root canal filling
the acute abscess – 7~10 days later
– Gaining drainage through carious cavity – Rubber dam
or puncturing fistula Access root canals
– LA Filed to drain Pulpectomy procedure
FC pledget IRM
– Antibiotics: 2-dose regimen of amoxycillin
2-

12. B4- Two-visit of pulpectomy
B4- B5- Success rates
B5-
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