Difference between pulpotomy and pulpectomy

1. 1. DIFFERENCE BETWEEN PULPOTOMY AND PULPECTOMY M.Owais Final

year BDS
2. 2. PULPOTOMY It is defined as the removal of coronal portion of pulp followed by
placement of medicament
3. 3. INDICATIONS Large proximal carious lesion with involvement of marginal ridge

No history of spontaneous pain Absence of abscess or fistula Where extraction is

contraindicated Vital tooth with healthy peridontium

4. 4. PROCEDURE Apply L.A and rubber dam Remove the carious lesion Access

the pulp chamber As soon as dip is felt dont go deep but side to side to extend roof
Remove coronal pulp by round bur or excavator Apply medicament
5. 5. Remove cotton pledget and check for excessive haemorrhage Fill chamber with

zinc oxide eugenal Place coronal restoration Place stainless steel crown

6. 6. MATERIALS USE FOR MEDICAMENT Formocresol Ferric sulphate

7. 7. CONTRAINDICATIONS Presence of abscess and fistula Radicular pulp

involvement Inter radicular bone loss Caries penetrating to floor of pulp chamber
8. 8. PULPECTOMY A pulpectomy is a dental procedure in which all of the material in

the pulp chamber and root canal of a tooth is removed.

9. 9. INDICATIONS Irreversible pulpitis involving both coronal and radicular pulp

Non-vital primary molars or incisors that need to be maintained in arch Abscessed

primary molars Primary molars with radiographic evidence of furcation pathology

10. 10. PROCEDURE

11. 11. CONTRAINDICATIONS Teeth with non-restorable crowns Extensive pulp

floor opening into the bifurcation Excessive internal resorption Primary teeth with
underlying dentigerous or follicular cysts

PULPOTOMY<br />BY- <br />Dr. SUMEET VINCENT TIGGA<br /> (G.D.C

RAIPUR)<br />
2. DEFINATION-:<br />PULPOTOMY CAN BE DEFINED AS THE COMPLETE
REMOVAL OF CORONAL PORTION OF THE DENTAL PULP , FOLLOWED BY
PLACEMENT OF SUITABLE DRESSING OR MEDICAMENT THAT WILL PROMOTE
HEALING & PRESERVE VITALITY OF THE TOOTH (Finn,1985 )<br />
3. INDICATION-:<br /><ul><li>Cariously exposed primary teeth, when their retention is
more advantageous than extraction.
4. Vital tooth with healthy periodontium
5. Pain, if present not spontaneous nor persists after removal of the stimulus
6. Tooth which is restorable
7. Tooth with-2/3rd root length
8. Hemorrhage from the amputation site is pale red & easy to control

 9. In mixed dentition stage primary tooth is preferable to a space

maintainer</li></li></ul><li>.<br />
10. CONTRAINDICATION -:<br />Evidence of internal resorption<br />Presence of
inter radicular bone loss<br />Abscess , fistula in relation to teeth<br />Radiographic sign of
calcific globules in pulp chamber<br />Caries penetrating the floor of pulp chamber<br
/>Tooth close to natural exfoliation<br />
11. CLASSIFICATION-:<br />I.VitalPulpotomy techniques<br /> 1.
DEVITALIZATION:(mummification & cauterization)<br /><ul><li> Single Sitting: 1.
Formocresol</li></ul> 2. Electrosurgery 3. Laser<br /><ul><li> Two sittting: 1.
Gysitriopaste 2. Easlicks formaldehyde 3. Paraform devitalising
paste</li></li></ul><li>.<br />2.PRESERVATION: 1.Glutaraldehyde 2.Ferric sulphate
3.MTA<br />3.REGENERATION: (inductive & reparative) 1.Bone morphogenic
protein<br />II. Non-Vital pulpotomy techniques(mortal pulpotomy) 1.Beechwood cresol
2.formocresol<br />
12. TREATMENT OBJECTIVES-:<br />>Amputate the infected coronal pulp,<br
/>>Neutralize any residual infectious process,<br />>Preserve the vitality of the radicular
pulp.<br />>Avoid breakdown of periradicular area<br />>Treat remaining pulp with
medicament<br />>Avoid dystrophic pulpal changes<br />
13. A.DEVITALIZATION (SINGLE SITTING)<br />FORMOCRESOL PULPOTOMY
TECHNIQUE<br />First advocated by SWEET(1930)<br />FORMOCRESOL SOLUTION:
*19% formaldehyde *35% cresol *15% glycerine (veichle)Buckleys solution: 1:5 conc. Of
formocresol solution.<br />
14. ..<br />To prepare a 1:5 conc. Of this formula-<br />First thoroughly mix 3 part of
glycerinre with 1 part of distilled water <br />Then add 4 parts of this preparation to 1 part
Buckleys formocresol & thoroughly mix again<br />Mechanism Of Action:Formocresol
prevents tissue autolysis by bonding to protein. This is reversible process and is accomplished
without changing the basic overall structure of the protein molecules<br />
15. Technique for Pulptomy of thePrimary Teeth<br />1. Profound anaesthesia for tooth
and tissue. <br />2. Isolate the tooth to be treated with a rubber dam.<br />3. Excavate all
caries.<br />4. Remove the dentin roof of the pulp chamber. <br />5. Remove all coronal pulp
tissue with a slow-speed No. 6 or 8 round bur or sharp spoon excavator<br />
16. .<br />6. Achieve heamostasis with moist cotton pellets under pressure. <br />7.
Apply diluted formocresol to pulp on cotton pellet for 3- 5 minutes. Pressure on pellet.<br
/>9. Pulp chamber is dried with new cotton pellets .<br />10. Place a thick paste of ZOE in
contact with pulp stumps.<br />11. Place stainless steel crown (or bonded composite)<br />
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18. .<br />
19. .<br />
20. DEVITALIZATION PULPOTOMY(TWO STAGE)<br />~Two stage procedure
involves use of paraformaldehyde to fix the entire coronal & radicular pulp tissue.<br />~The
medicaments used in this technique have a devitalizing, mummifying and bactericidal
action.<br />Indications:<br /> .Profuse bleeding<br /> .Difficulty in controlling
bleeding<br /> .Spontaneous pain<br /> .Slight purulence discharge<br /> .Thickened
PDL<br />
21. `<br />Contraindication:<br /> .Non restorable<br /> .Necrotic<br /> .Soon to be
exfoliated<br />Formula of each agent used are as follows:<br />1.GYSI TRIOPASTE
FORMULA:<br /> *tricresol 10 ml *cresol 20 ml *glyserine 4 ml *paraformaldehyde 20 ml
*zinc oxide 60 gm<br />
22. .<br />2.EASLICKS PARAFORMALDEHYDE FORMULA:<br
/>*paraformaldehyde 1 gm *procaine base 0.03 gm *powdered asbestos 0.05 gm *petroleum

jelly 125 gm *carimine to colour<br />3.PARAFORM DEVITALIZING PASTE:<br />

*paraformaldehyde 1gm *lignocaine 0.06 gm *propylene glycol 0.05 ml *carbowax 1500
1.30 gm *carmine to colour<br />
23. .First appointment:<br />Isolation of the affected teeth with rubber dam<br
/>Preparation of the cavity , excavate the caries<br />On excavation of deep caries pulp
exposure is encountered , ensure that the exposed site is free of debris<br />Enlarge the
cavity with round bur<br />Cotton pellet with paraformaldehyde is placed in the exposure
site ,seal it for 1 to 2 weeks<br /> (formaldehyde gas liberated from the paraformaldehyde
permeates through the coronal & radicular pulp, fixing the<br />
24. .Second appointment<br />In the second appointment pulpotomy is carried with the
help of L.A.<br />The roof of the pulp chamber is removed and cleaned with saline and dried
with cotton pellet<br />The pulp chamber is then filled with antiseptic paste and the tooth is
restored.<br />
25. PARTIAL PULPOTOMY<br /> The partial pulpotomy for traumatic exposures is 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 <br />-Indicated for a vital , traumatically exposed,
young permanent tooth, especially one with an incompletely formed apex.<br />-Calcium
hydroxide or MTA is used<br />
26. OBJECTIVES FOR Ca(OH) PULPOTOMY OF YOUNG PERMANANT
TEETH-:<br />Preserve radicular vitality,<br />Maximize the opportunity for apexogenesis
(apical development and closure),<br />Enhance continual root dentin formation..there
should be no adverse clinical signs or symptoms of sensitivity, pain or swelling<br />
27. PROPERTIES OF CALCIUM HYDROXIDE<br />Calcific bridge formation(91%
success)<br />Germicidal activity<br />Vital pulp remains<br />Clinical success to be 65%
<br />Hystological success 35%<br />
28. CLINICAL TECHNIQUE FOR THE Ca(OH) PULPOTOMY <br />1.Anesthetize
the tooth and isolate under a rubber dam.<br />2. Excavate all caries and establish a cavity
outline.<br />3. Irrigate the cavity and lightly dry with cotton pellets<br />4. Remove the roof
of the pulp chamber<br />5. Amputate the coronal pulp with a large low-speed round bur or a
high-speed diamond stone with a light touch..<br />6. Control hemorrhage with a cotton
pellet applied with pressure or a damp pellet of hydrogen peroxide<br />
29. .<br /> 7. Place a calcium hydroxide mixture over the radicular pulp stumps at the
canal orifices and dry with a cotton pellet.<br /> 8. Place quick-setting ZOE cement or resinreinforced glass ionomer cement over the calcium hydroxide to seal and fill the
chamber.<br />
30. PROPERTIES OF MTA (MINERAL TRIOXIDE AGGREGATE)<br /> 93% clinical
success rate<br />Better biocompatibility<br />Better sealing ability-prevents leakage in
pulpal & periapical tissues<br />Less time needed for procedure<br />Promotes regeneration
of original pulp tissue<br />Dentinal bridge formation is seen<br />
31. USING MTA INSTEAD OF FORMOCRESOL FOR PULPOTOMY <br /> In this
new technique, the MTA paste is allowed to cover the dry pulp stumps (instead of
formocresol).<br /> MTA is a powder composed of <br /> -Tricalcium silicate, <br />
-Bismuth oxide, <br /> -Dicalcium silicate, <br /> -Tricalciumaluminate,<br />
-Tetracalciumaluminoferrite,<br /> -Calcium sulfatedihydrate.<br />
32. .<br />The cements setting time is 3 to 4 hours.<br /> MTA paste is obtained by
mixing MTA powder with sterile saline at a 3:1 powder/saline ratio.<br /> IRM is place over
the MTA.<br />
33. NON-VITAL PULPOTOMY<br />Ideally, a non-vital tooth should b treated by
pulpectomy or root canal filling<br />However, pulpectomy of a primary molar may

sometime be impracticable due to non-negotiable root canals and also due to limited patient
co-operation. <br />Hence, a two-stage pulpotomy technique is advocated .<br />
34. SELECTION CRITERIA<br />History of spontaneous pain<br />Swelling ,redness
or soreness of mucosa <br />Tooth mobility <br />Tenderness to percussion <br
/>Radiographic evidence of root resorption<br />
35. TCHNIQUE<br />1ST APPOINTMENT<br /> - NECROTIC PULP IS REMOVED
<br /> - PULP CHAMBER IS IRRIGATED WITH SALINE & DRIED WITH COTTON
PELLET<br /> -RADICULAR PULP IS TREATED WITH BEACH WOOD CERSOL
DIPPED COTTON PELLET<br /> -SEAL THE CAVITY WITH TEMP. CEMENT FOR 1-2
WEEKS<br />
36. SECOND APPOINTMENT--<br />ISOLATE THE TOOTH<br /> REMOVE THE
TEMPORARY DRESSING & PELLET CONTAINING BEECHWOOD CRESOL <br /> IF
SIGN & SYMPTOMS PERSIST THEN REPEAT THE TREATMENT OR EXTRACT THE
TOOTH<br /> IF NO SYMPTOMS PULP CHAMBER IS FILLED WITH ANTISEPTIC
PASTE<br /> THEN IT CAN B RESTORED WITH STAINLESS STEEL CROWN<br />
37. ELECTROSURGICAL PULPOYOMY<br />> Mack & Dean,1993<br />> Nonpharmacological technique<br />> Non-chemical devitalisation , hear electrocautery
carbonized & heat denatures the pulp & bacterial contamination <br />
38. .<br />> After amputation of the coronal pulp , the pulp stumps are cauterized through
this method. After completion ,the pulp chamber is filled with ZnOE.<br />The tooth is then
restored with stainless steel crown<br />> Disadvantage: contaminated pulp tissue does not
promote adequate current penetration . It cannot eliminate radicular pulp inflammation<br />
39. LASER PULPOTOMY:<br />> Non- pharmocologichemostatic technique<br />>
Jeng-fen Liu et al in 1999- studied the effect of Nd:YAG laser for pulpotomy in primary
tooth-100% success with no signs or symptoms,<br />
40. PRESERVATION<br />Chemicals which induce minimal insult to the tissue are
used.<br />They help to conserve vitality of the radicular pulpChemicals used are
glutaraldehyde (2-5%)and ferric sulphate<br />Glutaraldehyde: (by Kopel,1979)<br /> (1)
superior fixation by cross-linkage<br /> (2) diffusibility is limited<br /> (3) excellent
antimicrobial agent<br /> (4) causes less necrosis of pulpal tissue; <br />IN HIGHER CONC.
FOR LONGER EXPOSURE GLUTERALDEHYDE SHOWS CYTOTOXIC &
MUTAGENIC EFFECTS SAME AS FORMOCRESOL <br />
41. .<br />Ferric sulfate- <br /> It is a non aldehyde haemostatic compound(1)astringent;
(2)forms a ferric ion-protein complex that mechanically occludes capillaries; (3) less
inflammation than formocresol(4) 92.7% radiographic success rate.(5)100% clinical
success(6)root resorption is not accelerated (7)internal resorption similar to formocresol ,no
systemic or local side effects<br />
42. REGENERATION:<br />An ideal pulpotomy treatment should leave the radicular
pulp vital , healthy and completely enclosed within an odontoblast-lined dentin
chamber.<br />This involves use of BMP(bone morphogenic protein) which contains a
factor(oeteogenic proteins) capable of auto induction of reparative dentin
formation(stimulating induction & differentiation of mesenchymal cells with varying degrees
of dentinal bridge formation)<br />
43. THANK YOU<br />