Pulpotomy is defined as completely removing the coronal(crown) portion of the dental pulp, and placing a suitable dressing or medicament that helps in healing and hence preserving the vitality of tooth in pediatric patients.
- Vital tooth with healthy periodontium.
- Pain if present is either spontaneous or persistent.
- The tooth that is restorable.
- At least 2/3rd of root length is present.
- Also, bleeding from the amputation side is pale red and easy to control.
- In the mixed dentition stage, the primary tooth is preferable to a space maintainer.
- First of all, Evidence of internal resorption.
- Presence of bone loss.
- Presence of abscess and fistula in relation to teeth.
- Radiographic evidence of calcific globules in the pulp chamber.
- Caries reaching to the floor of the pulp chamber.
- And the tooth close to natural fall.
Firstly, injecting local anaesthesia to numb the tooth.
The second step is removing the roof of the pulp chamber.
- A sharp spoon excavator removes the coronal pulp.
- Cleaning and removing the pulp completely.
- Irrigating the pulp chamber with a light flow of water
- A moist cotton pellet is put inside the pulp chamber and allows to remain over the pulp chamber until a clot forms
- Drying the pulp chamber.
- Next, a cotton pellet moistened with a 1:5 concentration of Buckley’s formocresol is put in contact with pulp stump and allows to remain for 5 min.
- Removing the pellet and drying the pulp chamber with a new cotton pellet.
- A thick paste consisting of zinc oxide eugenol is made and put over the pulp chamber.
- A zinc polycarboxylate cement is finally put over the paste
- finally, tooth restoration is done with a stainless steel crown.
Pulpectomy involves removing the roof and contents of the pulp chamber in order to gain access to the root canals and then debriding, enlarging and disinfecting; and finally filling the canals with a restorative material.
- Strategically important tooth (e.g. in case of deciduous second molar where the permanent first molar has not come out).
- Irreversible pulpitis
- Minimal periapical pathology with sufficient bone support.
- At least 2/3rd of root length is available.
Step 1: Injecting local anaesthesia and isolating the tooth using the rubber dam.
Step 2: Preparing Access cavity and exposing the coronal pulp.
Then extirpation of all the accessible pulp tissue (coronal as well as radicular).
Step 3: After extirpation of pulp tissue is complete irrigation of the pulp chamber and canals with saline and then a diagnostic radiograph is taken for the working length of file.
Step 4: Shaping and irrigating the canals, and then drying the canals with paper points.
Step 5: Obturating of the canals.
Step 6: Placing the final restoration.