بسمِ اللهِ الرَحمنِ الرَحيم

PULPECTOMY

PULPECTOMY Justification Pulpectomy -general PULPECTOMY Complete removal of necrotic pulp tissue from the root canals and coronal portion of devital primary teeth to maintain the tooth in the dental arch Justification Removal of diseased tissue Space management

INDICATIONS 1. Strategically important tooth Pulpectomy -general INDICATIONS 1. Strategically important tooth (in case of the deciduous second molar where the permanent first molar has not erupted) 2. Irreversible pulpits 3. Minimal periapical changes with sufficient bone support 4. At least 2/3rd of the root length available 5. Internal resorption without any obvious perforation

CONTRAINDICATIONS 1. Excessively mobile and/or reduced bone support Pulpectomy -general CONTRAINDICATIONS 1. Excessively mobile and/or reduced bone support 2. Non restorable tooth 3. Internal resorption of the pulp chamber and root canal 4. Underlying dentigerous or follicular cyst 5. Pathology extending to the developing permanent tooth bud 6. Less than2/3rd of root length remaining 7. Perforation of pulpal floor 8. Medically compromised children

The procedure of pulpectomy can be performed in :-- 1. Single-visit Pulpectomy -general The procedure of pulpectomy can be performed in :-- 1. Single-visit 2. Multi-visit Single-visit Partially vital pulp Multi-visit Non-vital pulp

VARIOUS CAPPING MATERIALS REACTION OF THE PULP TO VARIOUS CAPPING MATERIALS

Pulpotomy in primary teeth Big clinical problem ? CMCP

Gutta Percha 2. Iodoform paste 3. Calcium hydroxide Filling of the primary root canals Gutta Percha Not indicated for primary teeth Since it is not a resorbable material, its use is contraindicated in primary teeth No material currently available meets al the criteria The filling material most commonly used for primary pulp canals are : 1. Zinc oxide - Eugenol paste 2. Iodoform paste 3. Calcium hydroxide

Standard

Stainless Steel Crown

Introduction It is a semi-permanent restoration used in primary & young permanent teeth . It was introduced as chrome-steel crowns by Humphrey in 1950. Now it is commonly called as stainless steel crown. The stainless steel crown is used more frequently in deciduous dentition because of two reasons:-

1st in a relatively small deciduous teeth neglected carious can destroy tooth’s integrity faster than in large teeth in permanent dentition. 2nd the deciduous teeth pulp is larger than permanent pulp whereas the enamel and dentin is less in thickness, thus it is difficult to make dentinal stump for a gold casting or to use a pin system of retention for more extensive amalgam restoration.

? Composition Stainless Steel Crowns 17-19% chromium 10-13% nickel 67% iron 4% minor element These crowns are available in various sizes. Mostly these crowns are used in posterior teeth which undergone pulp therapy…....why??? ?

Indication of SSC Extensive decay in primary & young permanent teeth. For teeth deformed by developmental defects or anomalies. For teeth with hypoplastic defects. Following pulp therapy. As preventive restoration. As an abutment. Temporary restoration of a fractured tooth. In sever cases of bruxism.

Factor to be considered in preoperative Dental age of the patient. Cooperation of the patient. Motivation of the parents. Medically compromised/disabled child.

Tooth preparation L.A. should be administrated Isolation by rubber dam or cotton rolls Remove the decay

Crown contouring Initial crown contouring is performed with a 114 plier in the middle 1/3rd of the crown to produce a belling effect. This will give the crown a more even curvature. Crown crimping The tight marginal fit aids in: Mechanical retention of the crown. Maintenance of gingival health. Protect of cement from exposure to oral fluids.

Crown contouring

Cementation SSC should be cemented only on clean dry mouth, isolation of teeth with cotton roll is recommended. Rinse and dry the crown inside & out side and prepare to cement it. A zinc phosphate, polycarboxylate or GIC is preferred.

Before the cements set ask the patient to close into centric occlusion by applying pressure through a cotton roll and confirm that the occlusion has not been altered. Remove the excess cement by an explorer or scaler & for interproximal area can be cleaned by passing dental floss through them.

Clinical case

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