1. PEDIATRIC ENDODONTICS
4/05/2014
Assalam Alekum
PEDIATRIC ENDODONTICS
Dr. Gaurav Garg, Lecturer
College of Dentistry, Zulfi, MU

2. Contents Treatment considerations in childrens
Endodontic treatment modalities in primary teeth
Endodontic treatment modalities in young permanent teeth

3. Treatment considerations
Child’s overall development & ability to cooperate
Medical fitness
Restorability of the tooth
Necessity to keep the tooth
Anatomy of deciduous teeth
Deciduous Permanent

4. Endodontic treatment modalities in primary teeth
Pulpotomy
Pulpectomy

5. Pulpotomy
“ Complete removal of the coronal portion of the pulp, followed by placement of a suitable dressing of medicament that will promote healing and preserve vitality of the tooth”

6. Indications Vital tooth with healthy periodontium Reversible pulpitis
Tooth which is restorable
Tooth that possesses at least 2/3rd of its root length
Bleeding from amputation site is easy to control
When primary tooth is preferable to a space maintainer

7. Contraindications Evidence of internal resorption
Interradicular bone loss/ weak periodontium
Abscess/ fistula in relation to the tooh

8. Agents used for pulpotomy
Formocresol
Beechwood cresol
Gluteraldehyde
Ferric sulphate
Bone Morphogenic Protein
MTA
Electrosurgery
Lasers

9. Formocresol Pulpotomy
Mechenism of action:
Formaldehyde present in formocresol preserve the pulp tissue by preventing its autolysis by bonding to proteins without changing their basic overall structure

10. Pulpotomy Procedure Tooth is anesthetized & Isolated Remove all decay
Remove entire roof of the pulp chamber to get access to coronal pulp

11. Remove the coronal pulp using sharp spoon excavator
Irrigate pulp chamber with water
Place moist cotton pellets in the pulp chamber and allowed to remain over pulp stump until a clot forms

12. Remove the pellet and dry the pulp chamber
Next, a cotton pellet moistened with 1:5 concentration of formocresol is placed in the chamber in contact with the pulp stumps for 5 minutes
Remove the pellet and dry the pulp chamber
Pellet with formocresol

13. Tooth is restored with stainless steel crown
A thick paste of Zinc oxide eugenol is placed over the pulp stumps followed by layer of zinc polycarboxylate cement
Tooth is restored with stainless steel crown
Znpolycarb
ZOE

14. Evaluation Absence of pain, fistula, abscess & Mobility
Absence of periapical pathology
Absence of internal/ External resorption

15. Pulpectomy
It involves removal of the roof and contents of the pulp chamber in order to gain access to the root canals which are debrided, enlarged , disinfected & filled with Resorbable material

16. Indications Irreversible pulpitis Internal resorption
Sufficient bone support
2/3rd of the root length is available
Strategically important tooth

17. Contraindication Exessive mobility/reduced bone support
Underlying dentigerous/follicular cyst
Less than 2/3rd of root is remaining
Pulpal floor perforation
Medically compromised children

18. Pulpectomy procedure 1. Access opening 2. Remove infected pulp
& do cleaning & shaping
3. Dry the canals
4. Place ZOE Paste
5. Apply apical pressure
6. Condense with moist
pellet

19. Commonly used root canal filling material In primary teeth:
ZOE paste
Iodoform paste
Calcium hydroxide
Colla Cote (Collagen Sponge)
Gutta percha being non resorbable, is contraindicated in primary teeth

20. Endodontic treatment modalities in young permanent teeth
Apexogenesis
Apexification

21. Apexogenesis
It is a histological term used to describe the result of vital pulp procedures that allow the continued physiologic development & formation of root apex.
Examples: Indirect pulp capping, Direct pulp capping, Pulpotomy etc.

22. Apexification
It is a method to induce a calcified barrier in a root with an open apex.

23. Procedure CaOH & CMCP ZOE/IRM Immature tooth with
periradicular disease
B. Working length measured & BMP done
C. Canal filled with CaOH & CMCP Paste & Provisional restoration done

24. Recall after 6 months and check for apical closure
If present- continue with obturation
If not- repeat the procedure
Alternative: Apexification using MTA- Fast & Predictable results

25. References Textbook of Pedodontics(2nd edition); Shobha Tandon
Textbook of Endodobtics; Ingle & Bakland

26. THANK YOU!