Devitalizing agents, non-vital methods of root canal therapy, non-vital pulpotomy and pulpectomy, indications, description of techniques

Pediatric pulp therapy for primary and young permanent teeth involves the following techniques: 1. Indirect pulp capping 2. Direct pulp capping 3. Coronal pulpotomy 4. Pulpectomy

INDIRECT PULP CAPPING Indirect pulp capping is defined as the application of a medicament over a thin layer of remaining carious dentin, after deep excavation, with no exposure of the pulp. Figure 17-4 Indirect pulp-capping technique. A, Medicament, either zinc oxide–eugenol cement, calcium hydroxide, or both, against remaining caries. B, Lasting temporary restoration. Following repair, both materials are removed along with softened caries, and final restorations are placed.

DIRECT PULP CAPPING Direct pulp capping involves the placement of a biocompatible agent on healthy pulp tissue that has been inadvertently exposed from caries excavation or traumatic injury (Figure 17-6). Figure 17-6 Direct pulp-capping technique. A, Capping material covers pulp exposure and the floor of the cavity. B, Protective base of zinc oxide–eugenol cement. C, Amalgam restoration.

PULPOTOMY Pulpotomy is the most widely used technique in vital pulp therapy for primary and young permanent teeth with carious pulp exposures. A pulpotomy is defined as the surgical removal of the entire coronal pulp presumed to be partially or totally inflamed and quite possibly infected, leaving intact the vital radicular pulp within the canals. A germicidal medicament is then placed over the remaining vital radicular pulp stumps at their point of communication with the floor of the coronal pulp chamber

Definition Pulpotomy-Partial pulpectomy Removal or amputation of the entire coronal pulp-leaving the remaining tissue intact in the canals.

Purpose of Non-vital pulpotomy Sterilization of the remaining pulp and fixation of subjacent tissue Non-vital pulpotomy: devitalization of the whole pulp, then amputation of the coronal pulp and mumification of the remaining root pulp.

Fixing material Devitalizing agent Glutaraldehyde N2 paste Devitalizing agent Paraformaldehyde paste-Toxavit

Non-vital pulpotomy.

TOXAVIT

DEPULPIN

Technique: 2 visits 1st.visit: application of paraformaldehyde paste, we apply it by cotton woll in the cavity and cover with temporary filling and then wait for 10-12 days 2st.visit: The coronal pulp is removed and the remaining pulp is covered with mumifying paste (Foredent) – resorcin-formaldehyde paste, then mumifying paste is covered with cement and amalgam.

Indication: In primary teeth only- its not recommended in permanent teeth because of development of chronic periapical involvement. In patients with blood diseases, when extraction is contraindicated Local factors-fine lumen/ tortuous canal anatomy

Non-vital pulpectomy Definition: extirpation or removal of the whole pulp which is before devitalized with devitalizing agent In the past: arsenic trioxide, formaldehyde was prefered devitalizing agents In the present time: paraphormaldehyde paraformaldehyde 1 g, lignocaine 0.06 g, carmine (colour) 0.01 g, carbowax 1500 1.3 g, propylene glycol 0.5 ml.

Pulpectomy Pulpectomy is a root canal procedure for pulp tissue that is irreversibly infected or necrotic due to caries or trauma. The root canals are debrided, enlarged, disinfected, and filled with a resorbable material such as nonreinforced zinc oxide-eugenol. The tooth then is restored with a restoration that seals the tooth from microleakage. • Indications: A pulpectomy is indicated in a primary tooth with irreversible pulpitis or necrosis or a tooth treatment planned for pulpotomy in which the radicular pulp exhibits clinical signs of pulp necrosis such as excessive hemorrhage. The roots should exhibit minimal or no resorption. The technique can be carried out in one or two visits.

The procedures need 2 appointments, in the first one devitalizing agent is put on the pulp, and in 2nd, root canal therapy is ended. Indication: When anaesthetic can not be administered due to heart diseases, hypertension, blood diseases With multirooted tooth, because performance of vital pulpectomy and complete root canal therapy in one-appointment is difficult or problematic.

Pulpectomy Technique Achieve adequate anesthesia and rubber dam isolation. Remove all caries. Remove the roof of the pulp chamber with a high-speed handpiece. Amputate the coronal aspect of the pulp tissue with a large round bur in a slow-speed handpiece. The remaining pulp tissue occupying the root canals is removed using endodontic files at a predetermined working length, approximately 1 to 2 mm short of the root apices. The canals should be enlarged several sizes beyond the size of the first file that fits snugly into the canal to a minimum final size of 30 to 35. Throughout root canal instrumentation, the canals should be irrigated with sodium hypochlorite to aid in debridement.

Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy-- Pulpectomy Technique (continued) 8. Dry the canals with sterile paper points. 9. The canals are filled with a treatment paste (Zinc Oxide/Eugenol at UKCD) using a pressure syringe. 10. The tooth is restored with a stainless steel crown.

Pulpectomy Contraindications A non-restorable tooth A tooth with a mechanical or carious perforation of the floor of the pulp chamber Pathologic root resorption involving more than one-third of the root Pathologic loss of bone support resulting in loss of the normal periodontal attachment The presence of a dentigerous or follicular cyst Radiographically visible internal root resorption

Criteria for an ideal pulpectomy obturant (treatment paste) Antiseptic Resorbable Harmless to the adjacent tooth germ Radiopaque Non-impinging on erupting permanent tooth Easily inserted Easily removed

Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy-- Action of Calcium Hydroxide Bactericidal Low grade irritation inducing hard tissue barrier formation Dissolves necrotic debris Forms of Calcium Hydroxide Caliscept Self-mixed (CaOH + sterile water or local anesthetic)

Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy-- Evaluation of Success Asymptomatic Radiographic absence of pathology Continued root development Hard tissue barrier at apex Responsive pulp Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--

Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--