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Dr.M.Ganesh,MDS(Pediatric Dentistry)
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)
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)
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)
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)
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)
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
OBTURATING METHODS:
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)
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)
Traumatized immature permanent teeth with exposure > 2hours Carious exposure in immature, vital permanent teeth
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?
INDICATION:
OBJECTIVE:
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)
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
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)
DR.M.GANESH,MDS(PEDIATRIC DENTISTRY)