1. Pulpotomy Access Technique
Cynthia Christensen, DDS, MS
Department of Pediatric Dentistry

2. Pulp Therapy for Primary Teeth
Michael Kanellis, DDS, MS
Department of Pediatric Dentistry

3. Pulpotomy
Pulpotomy is the extirpation of vital inflamed pulp from the coronal chamber followed by medicament placement over radicular pulp stumps to fix (mummification) or stimulate repair of the remaining vital radicular pulp.

4. Pulpotomy
Rationale: The radicular pulp tissue is healthy, and can either heal after the surgical amputation of the coronal pulp, or be fixed/mummified.
Signs or symptoms of inflammation extending beyond the coronal pulp is a contraindication for a pulpotomy

5. Pulpotomy - Indications
When the pulp is exposed (either through carious exposure or through trauma)
When it is desirable to maintain tooth (primarily for space, function, guidance of permanent teeth)
When there are no contraindications to pulpal therapy
In a 1995 landmark article, Edelstein and Douglass successfully dispelled the myth that tooth decay is no longer a serious public health problem for US children
Tooth decay in fact remains one of the most common diseases of childhood.
And children from low-income families are disproportionately affected.
When it comes to “cavities” low-income children get hit earlier, and they get hit harder
And the tooth decay they experience is not incidental.
OPPOSITE PICTURE FROM PUBLIC HEALTH REPORTS

6. Pulpotomy Procedure Rubber Dam Isolation Remove caries
Open pulp chamber and de-roof
Amputate pulp with round bur in slow speed running in reverse
Control hemorrhage with dry cotton pellet
Place Endo Bleach or FMC?????
Place Glass Ionomer over floor?????

7. Although the Medicaments and Materials May Change…
The Access Opening Technique Will Remain the Same

8. Pulpotomy Access Technique

9. Remove caries
Pulp exposed

10. Primary Pulp Chambers
Short vertical dimension
Thin floor

11. Therefore: Perforation of Floor is Much Greater Risk in Primary Molars

12. What happened here?
Pre
Post

13. Radiographic Appearance
Perforation
Proper Appearance
11/17/03

14. Access Opening Must Be LARGE
Root orafices splayed to accommodate succedaneous tooth.

15. Access Opening Must Be LARGE
Convenience Form to Amputate Radicular Orafice

16. Edontontic Department Will Teach You to Do A Conservative Access Opening

17. That is correct for Permanent Teeth!!
Edontontic Department Will Teach You to Do A Conservative Access Opening
That is correct for Permanent Teeth!!

18. PRIMARY TEETH ARE DIFFERENT

19. Why Not Do an Access That Conserves Tooth Structure?
Has nothing to do with SSC Restoration Retention
Cervical Bulge Intact
Convenience Form Needed
Not using flexible files

20. Place cotton pellet and pressure to control initial hemhorrage

21. Remove cotton pellet
Irrigate with NaOH?
Place GI?
Place stainless steel crown

22. Rubber dam isolation

23. Remove caries
Deep caries with pulp exposure

24. Open pulp chamber and “de-roof”

25. Amputate pulp with slow speed in reverse.

26. Control Hemorrhage with Cotton Pellet

27. Remove cotton pellet: Residual Bleeding Why???

28. Tissue Tags Remain: Not Amputated at Canal Orafices

29. Let’s Try A Larger Access Opening

30. Caries removal with pulp exposure

31. Outline of access opening

32. Access opening complete and pulp chamber tissue amputated

33. Placement of cotton pellet

34. Hemostasis Acheived

35. Place Medicaments and Liner

36. Restore with SSC

37. Mandibular First Primary Molar

38. Thank You!