WHAT IS PULPOTOMY ?

• The complete amputation of the coronal

portion of the affected or infected dental
pulp , followed by placement of suitable
dressing or medicament that will
promote healing and preserve vitality
and function of the remaining tooth.
 TREATMENT
OBJECTIVES
• Amputate the infected coronal pulp
• Neutralize any residual infectious process
• Presevre the vitality of the radicular pulp
• Avoid breakdown of periradicular area
• Treat remaining pulp with medicament
• Avoid dystrophic pulpal changes
 INDICATIONS
1) Tooth exposure by caries or mechanical means
(when the retention is more advantageous than
extraction).
2) Inflammation limited to coronal pulp.
3) Absence of spontaneous pain.
4) Absence of swelling or alveolar abscess formation.
5) Tooth which is restorable.
6) Hemorrhage from the amputation site is pale red
and easy to control.
 CONTRAINDICATIONS
1) Spontaneous pain, especially at night.
2) Evidence of internal resorption.
3) Presence of radiolucency in the furcal or
periradicular areas due to inter-radicular bone
loss .
4) Swelling, abscess, fistula in relation to teeth.
5) Dystrophic calcification (pulp stones).
 CONTRAINDICATIONS
6)Caries penetrating the floor of the chamber.
7)Tooth close to natural exofoliation.
8) Tooth crown is nonrestorable.
9) Absent hemorrhage, Profuse hemorrhage.
10) Marked tenderness to percussion.
11) Mobility.
12) Necrotic pulp.
13) Primary root length less than 2/3
 MEDICAMENTS
 Formocresol (1/5 dilution)
 Mineral trioxide aggregate (MTA)
 Glutaraldehyde solution (2-4 %)
 Para-formaldehyde (5%)
 Calcium hydroxide powder
 Ledermix cement
 Ferric sulphate
 Beechwood creosote
 Camphorated mono-chlorophenol
 ZOE paste
 CLASSIFICATION
I. VITAL PULPOTOMY TECHNIQUES
1) Devitalization (mummification and cauterization
of the vital tissue)
 Single sitting : 1 . Formocresol
2 . Electro surgery
3 . Laser
 Two sitting : 1 . Gysi triopaste
2 . Easlick’s formaldehyde
3 . Paraform devitalising paste
 CLASSIFICATION
2) Preservation 1 . Glutaraldehyde
2. Ferric sulphate
3. MTA

3) Regeneration (inductive & reparative)

1. Bone morphogentic proteins

 CLASSIFICATION
II . NON-VITAL PULPTOMY TECHNIQUES (mortal
pulpotomy)

1. Beechwood cresol
2. formocresol
 1) DEVITALIZATION
• SINGLE SITTING PULPOTOMY
• Formocresol pulpotomy techniques
• First advocated by SWEET ( 1930)
• Buckley’s Formocresol solution
19 % formaldehyde
35 % cresol
15 % glycerine ( vehicle)
 Buckley’s Formula Of
Formocresol
• Buckley’s solution
• 1:5 conc of formocresol solution
• 3 part of glycerin with 1 part of distilled water
• 4 parts of this preparation with 1 part buckleys
formocresol and mix thoroughly
• Mechanism of action
• Formocresol prevents tissue autolysis by bonding to
protein.
Technique for pulpotomy of
the primary teeth
 STEP 1
• Profound anesthesia for tooth and tissue
 STEP 2
• Isolate the tooth to be treated with rubberdam
 STEP 3
• Excavate all caries and determine the size of
pulp exposure
 STEP 4
• Remove the dentin roof of the pulp chamber
 STEP 5
• Remove all coronal pulp tissue with a slow
speed.
 STEP 6
• Achieve hemostasis with moist cotton pellets
under pressure.
 STEP 7
• Apply diluted (1:5) formocresol to pulp on
cotton pellet for 3-5 mins. Pressure on pellets
 STEP 8
• Remove formocresol pledget after 5 mins and
check that the haemorrhage has stopped
 STEP 9
• Place a thick paste of ZnO Eug in contact
with pulp stumps
 STEP 10
• Place stainless steel crown or bonded
composites.
 DEVITALIZATION
• TWO STAGE PULPOTOMY
• Two stage procedure involves use of para-
formaldehyde to fix the entire coronal &
radicular pulp tissue.
• The medicaments used in this technique have a
devitalizing ,mummifying and bactericidal
action.
• INDICATIONS:
i. Bleeding
ii. Difficulty in controlling bleeding
iii. Spontaneous bleeding
iv. Slight purulence discharge
v. Thickened PDL
• CONTRAINDICATIONS :
i. Necrotic
ii. Non restorable
iii. Tooth soon to be exfoliated.
 FIRST APPOINTMENT
• Isolation of the affected teeth with rubber dam
• Preparation of the cavity
• On excavation of deep caries ,pulpal exposure is
encountered , ensure that the exposed site is free of debris
• Enlarge the cavity with round bur
• Cotton pellet with para-formaldehyde is placed in the
exposure site, seal it for 1-2 weeks.
• Formaldehyde gas liberated from the para-formaldehyde
permeates through the coronal and radicualr pulp , fixing
the pulp.
SECOND APPOINTMENT
• In the second appointment pulpotomy is
carried out with the help of L.A.
• The roof of the pulp chamber is removed and
cleaned with saline and dried with cotton
pellet.
• The pulp chamber is then filled with antiseptic
paste and the tooth is restored.
 PARTIAL PULPOTOMY
• A procedure in which the inflamed pulp tissue
beneath an exposure is removed to a depth of 1-3
mm to reach the deeper healthy tissue.
• Indicated for a vital , traumatically exposed ,young
permanent tooth , especially one with an
incompletely formed apex.
• Calcium hydroxide or MTA is used.
PARTIAL PULPOTOMY
Objectives

• Maintain vitality of radicular pulp

• Achieve root-end closure (Apexogenesis)

• Eliminate need for apicoectomy

• Facilitate GP obturation with apical stop

Anterior Trauma
Pre-Op Radiograph
Complicated crown
fractures
Isolated & Ready for care
Partial Pulpotomy
A clean and careful entry into the
pulp horn -- about 2 mm
Gentle hemostasis with sterile
saline or LA solution
Gentle placement of calcium
hydroxide onto the pulp
Protection of remaining dentin
Etching for the esthetic
restoration
Bonding agent placement
Early composite resin
coverage
Completed composite resin
coverage
Radiographic follow-up
 ELECTROSURGICAL
PULPOTOMY
• Mack & dean , 1993
• Non - pharmacological technique
• It is known as non chemical devitalization. Its
causes cauterization of the pulp tissue and
denaturation of bacterial contamination.
 ELECTROSURGICAL
PULPOTOMY
• After the removal of affected coronal pulp tissue, a
layer of coagulation necrosis is formed as a result
of electrosurgery application which provides a
barrier between healthy radicular tissue and the
base material placed in the pulp chamber.

• No undesirable systemic effects

 LASER PULPOTOMY
• Non-pharmacologic
hemostatic technique
• It creates superficial zone
of coagulation necrosis
that remain compatible
with underlying tissue&
isolate pulp from vigorous
effects of the sub-base.
 PRESERVATION
• Chemicals which induce minimal insult to the tissue
are used.
• They help to retain the maximum of vital tissue and
conserve vitality of the radicular pulp without
induction of reparative dentin.
• Chemicals used are glutaraldehyde (2 – 5% ) and
ferric sulphate
 REGENERATION
• The pulpotomy agent induces reparative dentin
formation. Ideally, it should leave the radicular
pulp vital, healthy and completely enclosed
within an odontoblast-lined dentin chamber ,
isolating the tissue from noxious restorative
materials, thereby diminishing the chances of
internal resorption.
 REGENERATION
• This involves use of BMP (bone morphogentic
protein) which contains a factor ( oeteogenic
proteins)capable of autoinduction of reparative
dentin formation (stimulating induction
&differentiation of mesenchymal cells with
varying degrees of dentinal bridge formation)
NON-VITAL PULPOTOMY
• Ideally, a non-vital tooth should be treated by
pulpectomy or root canal filling.

• However , pulpectomy of a primary molar may

sometime be impracticable due to non – negotiable
root canals and also due to limited patient co-
operation . Hence , a two stage pulpotomy technique
is advocated.
 SELECTION CRITERIA
• History of spontaneous pain

• Swelling , redness or soreness of mucosa

• Tooth mobility

• Tenderness to percussion

• Radiographic evidence of root resorption

 TECHNIQUE
• 1st Appointment
• Necrotic pulp is removed
• Pulp chamber is removed with saline and is
dried with cotton pellet
• Radicular pulp is treated with beechwood
cresol dipped cotton pellet
• Seal the cavity with temporary cement for 1-2
weeks
 TECHNIQUE
• 2nd Appointment
• Isolate the tooth
• Remove the temporary dressing and the pellet
containing beechwood cresol
• If signs & symptoms persists then repeat the
treatment or extract the tooth.
• If no symptoms pulp chamber is filled with
antiseptic paste.
• Restored with stainless steel crown
Pulpotomy is considered to be Successful
when following criteria have been fulfilled :
1. No pain, sensitivity, swelling or mobility, Signs
of infection and inflammation.

2. No radiographic evidence of pathologic or

external root resorption.

3. No evidence of calcification of canals is present

 PULPECTOMY
• Pulp is the soft tissue containing the
dental nerve inside the tooth and ectomy
means to cut

• Complete removal of dental pulp and root

canal
 PULPECTOMY OF PRIMARY
TEETH

• A non-vital technique

• Removal of necrotic pulp tissue followed

by filling of root canal with resorbable
cement
 TREATMENT OBJECTIVES
1. Maintain tooth free of infection

2. Biomechanically cleanse and obturate

the root canal

3. Promote physiological resorption

4. Hold the space for erupting permanent

tooth
 INDICATIONS
1. Teeth with poor
chance of vital
pulp treatment
2. Strategic
importance for
space
maintenance
3. Absence of
severe root
4. Absence of severe
bone loss from infection
5. Pulpless primary teeth
with sinus track
6. Pulpless primary teeth in
hemophiIliacs
7. Pulpless primary teeth
next to the line of palatal
fracture
 CONTRAINDICATIONS
1. Teeth with
nonrestorable
crowns

2. Periradicular
involvement
extending to the
permanent tooth
bud
3. Pathologic resorption of at least one-
third of the root with a fistulous sinus
tract,

4. Excessive internal resorption,

5. Extensive pulp floor opening into the
bifurcation

6. Systemic illness

7. Primary teeth with underlying

dentigerous or follicular cysts
 PULPECTOMY PROCEDURE

• When there is no abscess, the whole

procedure can be completed in single
visit

• Two visits are required when acute

discharge is present
SINGLE VISIT PULPECTOMY
• Local anesthesia
given

• Access cavity

• Extirpate the pulp

with broaches

• Irrigate
• Instrumentation
should be done
only to the point of
resistance

• Remove organic
debris
• Irrigate
periodically with
dilute sodium
hypochlorite or
saline
• Dry canal with
paper point
• Obturate with
absorbable
material
 OBTURATION:
• The chosen filling
material should be
mixed in creamy
consistency

• Carried to canals using

- pressure syringes
- lentulo spiral root
canal filler
• If material is mixed to thicker consistency
then it should be packed with plugger
• Commonly used obturating materials are
- Zinc oxide Eugenol
- Calcium hydroxide
- Iodoform paste
 coronal restoration

• Pulp chamber should

be packed with
suitable cement

• Tooth should be
restored by stainless
steel crown
 TWO VISITS PULPECTOMY
• Local anesthesia

• Access cavity

• Pulp extirpation

• Canal prep
• cotton pledget with medicament such as
forocresol is plugged in the chamber

• Temporary filling is done

• Recall the patient after one week for

obturation
• In review
EVALUATION OF SUCCESS
– Asymptomatic
– Radiographic
absence of
pathology
– Continued root
development
– Hard tissue
barrier at apex
– Responsive pulp
THANK YOU