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A vital pulpotomy removes part of a tooth's pulp, the center of the tooth that contains nerves and blood vessels. The part that is removed is inside the crown. That's the part of the tooth that you see above the gum line.

Pulpotomy | pulpectomy
A vital pulpotomy removes part of a tooth's pulp, the center of the tooth Pulpectomy removes all of the pulp, including the part in the roots of the tooth, below the gum line.

Vital pulpotomy usually is done in children when decay has reached the crown part of the pulp, but the nerve in the root of the tooth is still healthy. The procedure also is done when the pulp is exposed as a result of injury or trauma. The affected part of the pulp can be removed, leaving the healthy part in the root.

A successful vital pulpotomy relieves sensitivity and pain. It also prevents the supporting tissues around the tooth from breaking down.

What It's Used For

If the pulp in the crown of a tooth is injured or decayed, but the pulp in the root is healthy, a vital pulpotomy may save the nerve inside the root from dying. The tooth should not be loose or have any swelling or abscesses around it. If there is swelling or an abscess, another type of treatment may be needed.

Vital pulpotomies can be done in children's baby teeth (primary teeth) or in young permanent teeth. In primary teeth, the procedure is done to keep the primary tooth from being extracted. Extracting a primary tooth before it is ready to fall out can alter the way the permanent teeth come in.

If the pulp of a permanent tooth becomes injured or decayed soon after it emerges, the tooth may require root canal treatment. However, root canal treatment is not done until the tooth's roots are finished growing. In this case, a vital pulpotomy can be done instead. Root canal treatment can be done after the roots finish developing.

Technique for Pulptomy of the Primary Teeth

1. Profound anesthesia for tooth and tissue. 2. Isolate the tooth to be treated with a rubber dam. 3. Endo access opening. Excavate all caries. 4. Remove the dentin roof of the pulp chamber. 5. Remove all coronal pulp tissue with a slowspeed No. 6 or 8 round bur or sharp spoon excavator.

6. Achieve hemostasis with dry cotton pellets under pressure. 7. Apply diluted formocresol (or 16% ferric sulfate solution) to pulp on cotton pellet for 3- 5 minutes. Pressure on pellet. 8. Prepare tooth for SSC. 9. Pulp stumps should appear dry. 10. Place a glass ionomer, ZOE, IRM, or MTA in contact with pulp stumps. 11. Place stainless steel crown (or bonded composite).

Preparation take X-rays to review the tooth's position and anatomy, and to see whether the root is infected. A vital pulpotomy is done with the patient under local anesthesia. Sedation also may be used. This can include nitrous oxide or an oral medicine. Sedation may help to calm anxious or young children who can't cope with local anesthesia alone.

How It's Done

Use a drill and hand instruments to remove decayed areas from the tooth and gain access to the pulp. Remove damaged pulp and place medicine over the remaining root part of the pulp and put in a temporary filling. This will be left in the tooth until the root canal can be finished.

Follow-up Your child's gums may be sore in the area. The dentist will check on the tooth during future visits.

Risks Vital pulpotomy has a success rate of 90% to 95%. However, failures and other problems can occur. Some of the medicines used in vital pulpotomy can irritate tissues outside of the pulp. Child could feel a temporary burning sensation in the area of the affected tooth.

If the tooth's entire nerve is infected, the vital pulpotomy may fail. look for infection during the procedure, but if the nerve is in the early stages of infection it may look healthy. If the tooth still hurts after a vital pulpotomy, root canal treatment may be needed. This will be done to remove the rest of the affected pulp.

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