Devitalizing agents, non-vital methods Devitalizing agents, non-vital methods of root canal therapy, non-vital of root canal therapy, non-vital

pulpotomy and pulpectomy, pulpotomy and pulpectomy, indications, description of techniquesindications, 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 softenedcaries, 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 materialcovers pulp exposure and the floor of the cavity. B, Protective baseof 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

DefinitionDefinition

Pulpotomy-Partial pulpectomyPulpotomy-Partial pulpectomy Removal or amputation of the entire Removal or amputation of the entire

coronal pulp-leaving the remaining coronal pulp-leaving the remaining tissue intact in the canalstissue intact in the canals..

Purpose of Non-vital pulpotomyPurpose of Non-vital pulpotomy

Sterilization of the remaining pulp and Sterilization of the remaining pulp and fixation of subjacent tissuefixation of subjacent tissue

Non-vital pulpotomy: Non-vital pulpotomy: devitalization of the devitalization of the whole pulp, then amputation of the whole pulp, then amputation of the coronal pulp and mumification of the coronal pulp and mumification of the remaining root pulp.remaining root pulp.

Fixing materialFixing material

GlutaraldehydeGlutaraldehyde N2 pasteN2 paste

Devitalizing agentDevitalizing agent Paraformaldehyde paste-Paraformaldehyde paste-ToxavitToxavit

Non-vital pulpotomy.

TOXAVITTOXAVIT

DEPULPINDEPULPIN

Technique: 2 visitsTechnique: 2 visits 1st.visit:1st.visit: application of paraformaldehyde paste, we application of paraformaldehyde paste, we

apply it by cotton woll in the cavity and cover apply it by cotton woll in the cavity and cover with temporary filling and then wait for 10-12 with temporary filling and then wait for 10-12 days days

2st.visit:2st.visit: The coronal pulp is removed and the remaining The coronal pulp is removed and the remaining

pulp is covered with mumifying paste pulp is covered with mumifying paste (Foredent) – resorcin-formaldehyde paste, then (Foredent) – resorcin-formaldehyde paste, then mumifying paste is covered with cement and mumifying paste is covered with cement and amalgam.amalgam.

Indication:Indication:

In primary teeth only- its not In primary teeth only- its not recommended in permanent teeth recommended in permanent teeth because of development of chronic because of development of chronic periapical involvement.periapical involvement.

In patients with blood diseases, when In patients with blood diseases, when extraction is contraindicatedextraction is contraindicated

Local factors-fine lumen/ tortuous canal Local factors-fine lumen/ tortuous canal anatomyanatomy

Non-vital pulpectomyNon-vital pulpectomy

Definition: Definition: extirpation or removal of the whole extirpation or removal of the whole pulp which is before devitalized with pulp which is before devitalized with devitalizing agentdevitalizing agent

In the pastIn the past: arsenic trioxide, formaldehyde was : arsenic trioxide, formaldehyde was prefered devitalizing agentsprefered devitalizing agents

In the present time: In the present time: paraphormaldehydeparaphormaldehyde 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 isirreversibly infected or necrotic due to caries or trauma. Theroot canals are debrided, enlarged, disinfected, and filled with aresorbable material such as nonreinforced zinc oxide-eugenol.The tooth then is restored with a restoration that seals the toothfrom microleakage.

• Indications: A pulpectomy is indicated in a primary tooth withirreversible pulpitis or necrosis or a tooth treatment planned forpulpotomy in which the radicular pulp exhibits clinical signs ofpulp necrosis such as excessive hemorrhage. The roots shouldexhibit minimal or no resorption. The technique can be carried out in one or two visits.

The procedures need 2 appointments, in the The procedures need 2 appointments, in the first one devitalizing agent is put on the pulp, first one devitalizing agent is put on the pulp, and in 2nd, root canal therapy is ended.and in 2nd, root canal therapy is ended.

Indication: Indication: When anaesthetic can not be When anaesthetic can not be administered due to heart diseases, administered due to heart diseases, hypertension, blood diseaseshypertension, blood diseases

With multirooted tooth, because performance With multirooted tooth, because performance of vital pulpectomy and complete root canal of vital pulpectomy and complete root canal therapy in one-appointment is difficult or therapy in one-appointment is difficult or problematic.problematic.

Pulpectomy TechniquePulpectomy Technique1.1. Achieve adequate anesthesia and rubber dam isolation.Achieve adequate anesthesia and rubber dam isolation.2.2. Remove all caries.Remove all caries.3.3. Remove the roof of the pulp chamber with a high-speed Remove the roof of the pulp chamber with a high-speed

handpiece.handpiece.4.4. Amputate the coronal aspect of the pulp tissue with a large Amputate the coronal aspect of the pulp tissue with a large

round bur in a slow-speed handpiece.round bur in a slow-speed handpiece.5.5. The remaining pulp tissue occupying the root canals is The remaining pulp tissue occupying the root canals is

removed using endodontic files at a predetermined working removed using endodontic files at a predetermined working length, approximately 1 to 2 mm short of the root apices.length, approximately 1 to 2 mm short of the root apices.

6.6. The canals should be enlarged several sizes beyond the size The canals should be enlarged several sizes beyond the size of the first file that fits snugly into the canal to a minimum of the first file that fits snugly into the canal to a minimum final size of 30 to 35.final size of 30 to 35.

7.7. Throughout root canal instrumentation, the canals should be Throughout root canal instrumentation, the canals should be irrigated with sodium hypochlorite to aid in debridement.irrigated with sodium hypochlorite to aid in debridement.

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

Pulpectomy Technique Pulpectomy Technique (continued)(continued)

8. 8. Dry the canals with Dry the canals with sterile paper points.sterile paper points.

9.9. The canals are filled The canals are filled with a treatment paste (Zinc with a treatment paste (Zinc Oxide/Eugenol at UKCD) Oxide/Eugenol at UKCD) using a pressure syringe. using a pressure syringe.

10.10. The tooth is restored The tooth is restored with a stainless steel crown.with a stainless steel crown.

PulpectomyPulpectomy Contraindications Contraindications– A non-restorable toothA non-restorable tooth– A tooth with a mechanical or carious perforation of A tooth with a mechanical or carious perforation of

the floor of the pulp chamberthe floor of the pulp chamber – Pathologic root resorption involving more than one-Pathologic root resorption involving more than one-

third of the rootthird of the root– Pathologic loss of bone support resulting in loss of Pathologic loss of bone support resulting in loss of

the normal periodontal attachmentthe normal periodontal attachment– The presence of a dentigerous or follicular cystThe presence of a dentigerous or follicular cyst– Radiographically visible internal root resorptionRadiographically visible internal root resorption

– Criteria for an ideal pulpectomy obturant Criteria for an ideal pulpectomy obturant (treatment paste(treatment paste))

– AntisepticAntiseptic– ResorbableResorbable– Harmless to the adjacent tooth germHarmless to the adjacent tooth germ– RadiopaqueRadiopaque– Non-impinging on erupting permanent Non-impinging on erupting permanent

toothtooth– Easily insertedEasily inserted– Easily removedEasily removed

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

Action of Calcium Hydroxide Action of Calcium Hydroxide – BactericidalBactericidal– Low grade irritation inducing hard tissue barrier Low grade irritation inducing hard tissue barrier

formationformation– Dissolves necrotic debrisDissolves necrotic debris

Forms of Calcium HydroxideForms of Calcium Hydroxide

– Caliscept Caliscept – Self-mixed (CaOH + sterile water or local Self-mixed (CaOH + sterile water or local

anesthetic)anesthetic)

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

Evaluation of SuccessEvaluation of Success

– AsymptomaticAsymptomatic– Radiographic absence of pathologyRadiographic absence of pathology– Continued root developmentContinued root development– Hard tissue barrier at apexHard tissue barrier at apex– Responsive pulpResponsive pulp

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

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