PULPECTOMY

Dr.M.Ganesh,MDS(Pediatric Dentistry)

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
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

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
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

PROBLEMS ASSOCIATED WITH PULPECTOMY:

Multiple, tortuous root canals mechanical debridement & filling are difficult Connection between floor of pulp chamber & furcation area

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

PROCEDURE:
1.
2. 3.

4.
5. 6. 7.

Local anaesthesia Isolation- rubber dam Caries excavation Access cavity preparation Coronal pulp amputation Locating the canals Pulp extirpation
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

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
7.
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

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
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

ROOT CANAL FILLING MATERIAL FOR PRIMARY TEETH (CONTD):

Insoluble in water Radioopaque Should not discolour tooth No material currently meets all the criteria

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

ROOT CANAL FILLING MATERIALS:

1. Zinc oxide Eugenol paste: most commonly used without catalyst

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

ADVANTAGES

DISADVANTAGES

Antiseptic Easy application Radioopaque Does not cause discolouration of tooth Adheres to walls

Slow resorption Foreign body reaction Overfilling does not resorb Deflection of permanent tooth Difficult removal

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

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
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

OTHERS:
Walkhoff paste
Parachlorophenol Camphor Menthol

KRI paste
Iodoform 80.8% Camphor 4.86% Parachlorophenol 2.025% Menthol 1.215%
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

Maisto paste
Zno 14g Iodoform 42g Thymol 2g Camphor lanolin

Ca(OH)2 paste also being tried

OBTURATING METHODS:

Lentulo spiral Endodontic pressure syringe

Single Visit Vs Multiple Visit Pulpectomy

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

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
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

CALCIUM HYDROXIDE PULPOTOMY:

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

Normal root end closure

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

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

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

INDICATION:

Pulpless, immature permanent teeth

OBJECTIVE:

Induce root end closure

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

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
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

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
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

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

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)

DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)