PULPECTOMY

in primary teeth
DEFINITION
HISTORICAL PERSPECTIVE
INDICATIONS FOR PULPECTOMY
CONTRA-INDICATIONS FOR PULPECTOMY
TREATMENT OBJECTIVES
TREATMENT CONSIDERATIONS
ROOT CANAL OBTURATING MATERIALS FOR
PRIMARY TEETH
PROCEDURE
Definition
It is the technique to gain an
access to the root canals, remove
as much dead & infected material
as possible & fill the root canals
with a suitable material to
maintain the tooth in a non –
Complet Partia
infected state.
e l
Complete/Total Pulpectomy:

It is the extirpation of normal or

diseased pulp to or near the
apical foramen .
Partial Pulpectomy:

It is the extirpation of normal or

diseased pulp of tooth with an
incompletely formed root & an
open apex.
Historical Perspective:
Sweet has described a 4-5 step
technique using formocresol for the
treatment of pulpless teeth with &
without fistula.
Hobson has described a pulpectomy
technique for necrotic primary teeth in
which the canals were not debrided.
Indications:

Irreversible inflammation extending

to the radicular pulp

Primary teeth with necrotic pulp

Pulpless primary teeth without

permanent
Pulpless successors
primary teeth with
sinus tracts
Primary teeth with evidence of
furcation pathology
Pulpless primary 2nd molars before
eruptionprimary
Pulpless of permanent
teeth 1st molar
in hemophiliacs
Presence of
an abscess
Pulpless primary teeth next to
the line of palatal cleft
Pulpless primary molars supporting
orthodontic appliances
Pulpless primary teeth when space maintainers or
continued
supervision are not feasible
Contra-
indications :
Teeth with non-
restorable crowns

Pathologic resorption of at least

1/3rd of the root with a fistulous
sinus tract
Peri-radicular involvement extending to
the permanent tooth bud
Extensive pulp floor opening
into the bifurcation
Excessive internal resorption
Primary teeth with underlying dentigerous
or follicular cysts
Medical contra
indications

Heart disease

Immuno-compromised c
Treatment
Objectives:
To maintain the tooth free of
infection
To bio-mechanically clean &
obturate the root canals
To promote physiological root
Treatment
Considerations:
GENERAL
CONSIDERATIONS
The patient should be healthy & co-operative.
Informed consent, with a clear explanation of the procedure to
the parents, must be obtained.
DENTAL
CONSIDERATIONS
The teeth must be restorable after the root canal treatment.
Chronologic & dental age must be evaluated to rule out teeth
with eminent exfoliation.
Psychological or cometic factors must be considered.
The number of teeth to be treated & strategic importance to
the developing occlusion must be evaluated.
Primary molar root anatomy along with proximity of
underlying succedaneous tooth must be evaluated.
Root canal obturating materials for primary
teeth
Camphorated parachlorophenol mixed with calcium
hydroxide [CPC + Ca (OH)2]
CPC mixed with zinc oxide
Formocresol mixed with ZOE
Chlorhexidine mixed with ZOE Kri
TM paste
Zinc oxide eugenol Zinc oxide
mixed with sterile water
Calcium hydroxide with sterile water Vitapex
TM
Frank’s paste Maisto’s
Ideal root canal obturating material
for primary teeth……..

Should not irritate the periapical tissues

Should not coagulate any organic remnants in ca

Should have a stable disinfecting power

Resorb at a similar rate as the primary root
Should be easily inserted into root canal & remo

Should not be soluble in water

Should be radioopaque & not discolour the toot

Should adhere to the walls of the canal & should

 ZOE PASTE
Most commonly used root canal filling material for
primary teeth effect & decreases tooth pain
Has bactericidal
Overfilling causes a mild foreign body
reaction
Rate of resorption is slower than
that of the primary tooth root

Ca(OH)2 PASTE
Generally not used in pulp
treatment for primary teeth
 VITAPEX { Ca(OH)2 + Iodoform }
Nearly ideal material for filling primary root canals
Mixture is easily applied
Resorbs at a slightly faster rate than the primary tooth root
Has no toxic effect on permanent successors
Is radioopaque

FRANK’S PASTE { Ca(OH)2 + CPC }

Is well tolerated by the adjacent periapical tissue without
any inflammation & with deposition of osteodentin
 IODOFORM (KRI) PASTE
Resorbs rapidly & has no undesirable effects on
succedaneous teeth
Material extruded into periapical tissue is rapidly
replaced by normal tissue
Has superior antimicrobial action
Does not set into hard mass & can be removed if re-
treatment is required
GUTTA PERCHA
Contains Iodoform 80.8%, Camphor 4.86%,
Parachlorophenol
Is not resorbable &2.025%, Mentholnot
so, is generally 1.215%
used in pulp
therapy for primary teeth
May be used only when succedaneous tooth bud is absent
 WALKHOFF PASTE

Is a mixture of parachlorophenol, camphor &

menthol

MAISTO PASTE

Contains zinc oxide 14 gms, iodoform 42 gms,

thymol 2 gms, chlorophenol,
camphor 3cc, lanolin 0.50 gms
COMPARISON OF MATERIALS USED FOR
OBTURATION IN PRIMARY TEETH
PROPERTIE ZOE VITAPEX KRI
S PASTE
Rate of Slower than Slightly faster Faster than
resorption that of tooth than that of that of tooth
root tooth root root
Toxicity None None None
Overfill Occurs Occurs Occurs
resorption
Antiseptic action Present Present Present
Application Easy
Adherence to Good Good Good
canal wall
Removal Easy Easy
Radioopacity
The pulpectomy procedure

Partial
Complet (Single -
e visit)
(Two -
visit)
PARTIAL (SINGLE-VISIT)
PULPECTOMY :

Indicatio
ns
Asymptomatic primary tooth with
necrotic pulp tissue.
Presence of inflamed but vital
radicular pulp.
Presence of an
abscess.
COMPLETE (TWO-VISIT)
PULPECTOMY :
Indicati
ons
Presence of an acute abscess with or
without cellulitis.
Presence of active & persistent discharge
from
Stagesroot canals.
Stage-1 / Visit-1
Emergency management of the acute
abscess.
Stage-2 / Visit-2
Final root canal obturation.
Procedure

Achieve regional
local analgesia.

Isolate tooth with rubber dam.

Remove caries
& identify
exposure site.

Remove roof of
pulp chamber
using fissure
bur.
Remove coronal pulp with
an excavator.

Remove radicular pulp

tissue.

Clean out root

canals with H-
files.
Irrigate canals
with saline.

Dry root canals

with paper
points & place a
pledget of
formocresol in
the pulp
 Fill canals with
slurry of zinc
oxide paste.
OBTURATION TECHNIQUES

Incremental fill technique

Lentulo spiral technique
Endodontic pressure syringe
technique
Fill pulp
chamber with
thick mix of
ZOE cement.

Restore the
tooth with
stainless steel
crown.
Reference
s Grossman LI, Oliet S, Del Rio CE. Endodontic practice,
11th edn: Lea & Febiger, 1988: 182-187

Duggal MS, Curzon MEJ, Fayle SA, Toumba KJ,

Robertson AJ. Restorative techniques in paediatric
dentistry- An illustrated guide to the restoration of
carious primary teeth, 2nd edn: Martin Dunitz Ltd, 2002:
51, 59-74
Ingel JI, Bakland LK. Endodontics, 5th edn: B.C. Decker
Inc.2002: 554-8, 889-95
McDonald RE, Avery DR, Dean JA. Dentistry for the
child & adolescent, 8th edn: Mosby, 2004 : 400-3
Curzon M E J, Roberts J F, Kennedy D B. Kennedy’s