PULPECTOM

Y
PULPECTOMY IN PRIMARY
TEETH:
♠ Removal of coronal & radicular pulp
♠ Subsequent filling of canals with a
resorbable material

INDICATIONS:
♠ Irreversible pulpitis; necrotic pulp
♠ Minimal periradicular changes with
sufficient bone support
♠ Root length – at least 2/3 of normal
♠ Internal resorption without
perforation
CONTRAINDICATIONS:

♠ Systemic conditions
♠ Lack of patient cooperation
♠ Non restorable tooth
♠ Excessive mobility
♠ Excessive root resorption
♠ Internal resorption with perforation
♠ Extensive periradicular involvement
extending to permanent tooth bud
PROBLEMS ASSOCIATED WITH
PULPECTOMY:

♠ Multiple, tortuous root canals

→ mechanical debridement &
filling are difficult
♠ Connection between floor of pulp
chamber & furcation area
 PROCEDURE:

1. Local anaesthesia
2. Isolation- rubber dam
3. Caries excavation
4. Access cavity preparation
5. Coronal pulp amputation
6. Locating the canals
7. Pulp extirpation
7. Working length determination
→ 2-3 mm short of radiographic
apex
8. Debridement
→ Chemical, mechanical
preparation of root canals
→ Irrigation
→ Relative pulpectomy
→ Selective filing
9. Dry root canals – paper points
10. Filling of root canals
ROOT CANAL FILLING
MATERIALS FOR PRIMAY
TEETH:
♠ Resorbable at same rate as root
♠ Safe for periradicular tissues &
permanent tooth bud
♠ Readily resorb if it flows
periapically
♠ Stable disinfection
♠ Easy insertion & removal
ROOT CANAL FILLING
MATERIAL FOR PRIMARY
TEETH (CONTD):

♠ Insoluble in water
♠ Radioopaque
♠ Should not discolour tooth
No material currently meets all
the criteria
ROOT CANAL FILLING
MATERIALS:

1. Zinc oxide – Eugenol

paste:
♠ most commonly used
♠ without catalyst
 ADVANTAGES DISADVANTAGE
S
♠ Antiseptic
♠ Easy ♠ Slow resorption
application ♠ Foreign body
♠ Radioopaque reaction
♠ Does not cause ♠ Overfilling does
discolouration not resorb
of tooth ♠ Deflection of
♠ Adheres to permanent tooth
walls ♠ Difficult removal
 2) Ca(OH)2 with iodoform paste:

Vitapex; Metapex

Advantages:
♠ Bactericidal
♠ Overfilling resorbs
♠ Easy removal- does not set into
hard mass
♠ Radioopaque
♠ Does not cause tooth discolouration
♠ Faster resorption than root
OTHERS:
Walkhoff Maisto
KRI paste
paste paste
Parachlorophe Iodoform
Zno 14g
nol 80.8%
Camphor Iodoform
Camphor
4.86% 42g
Parachloroph
Menthol Thymol 2g
enol 2.025%
Menthol Camphor
1.215% lanolin
Ca(OH)2 paste → also being tried

OBTURATING METHODS:
♠ Lentulo spiral
♠ Endodontic pressure syringe

Single Visit Vs Multiple Visit

Pulpectomy
ENDODONTIC MANAGEMENT
OF YOUNG PERMANENT
TEETH:
♠ APEXOGENESIS:
♠ Physiologic process of root development
♠ Large vital exposures in permanent
teeth with incompletely formed apex
Methods:
Direct pulp capping
→ Traumatic exposure
→ Traumatic injury < 1 – 2 hrs after
exposure
→ Pinpoint carious exposure with sound
surrounding dentin
CALCIUM HYDROXIDE
PULPOTOMY:

♠ Traumatized immature permanent

teeth with exposure > 2hours
♠ Carious exposure in immature,
vital permanent teeth

Normal root end closure

APEXIFICATION:

♠ Inducing development of root apex

in an immature pulpless tooth by
formation of osteocementum /
other bone like tissue
♠ Calcific barrier

WHY?
♠ Condensation of GP difficult
♠ Apicectomy cannot be done
INDICATION:

♠ Pulpless, immature
permanent teeth

OBJECTIVE:
♠ Induce root end closure
STEPS:
♠ L.A.
♠ Isolation
♠ Access cavity preparation, remove
necrotic tissue
♠ Working length determination
♠ Cleaning and shaping
♠ Irrigation – Na Hypochlorite, dry
♠ Seal CMCP pellet – 1-2 wks &
provisional restoration
♠ Recall visit after 1-2 weeks:
Remove temporary
Clean canal
 Ca(OH)2 + CMCP
↓
Force into apical area
↓
Radiograph
↓
Recall after 6 months
At recall, confirm apical barrier
formation :
IOPA radiograph
No. 35 file – tactile – apical stop
ROOT END CLOSURE TYPES:

♠ No apparent closure, resistance to

file
♠ Calcific barrier – at apex
♠ Apical closure without canal space
changes
♠ Normal continuance of root closure
♠ Evidence of resolving radiolucency

After apical closure – obturate with GP