Primary Tooth Pulp Therapy - Dr. Elizabeth Berry
Primary Tooth Pulp Therapy - Dr. Elizabeth Berry
Primary Tooth Pulp Therapy - Dr. Elizabeth Berry
Therapy
History
Clinical Examination
Radiographic Examination
HISTORY
Chief Complaint, Past Medical Hx
Healthy
Immuno-compromised
Soft Tissue
redness, parulis and/or swelling
around a tooth
CLINICAL EXAMINATION
Mobility
excessive mobility can indicate
pathology in surrounding tissue
Physiologic resorption
Percussion
sensitivity to percussion may indicate
pathology
child’s response variable
RADIOGRAPHIC
INTERPRETATION
Depth and location of caries
Pulpotomy
Pulpectomy
DIRECT PULP CAP
Placing a base and liner over a small mechanical pulp exposure
Coll, JA. Indirect pulp capping and primary teeth: is the primary tooth
pulpotomy out of date? Pediatr Dent 2008; 30: 230-236.
PULPOTOMY
Strands of tissue
between root
stumps
FORMOCRESOL
Bactericidal effect
Devitalizing effect
Fixation
Inhibits autolytic changes and bacterial growth
Preserves cellular detail
No dentinal bridging, but calcific changes present
Composition:
Formaldehyde (19%), cresol, glycerin, water
1/5 concentration of Buckley’s
FORMOCRESOL
Safety concern?
Formaldehyde is in the air, water, and
food (average 7.8 mg/day)
Formaldehyde dosage in 1 pulpotomy
procedure with a cotton pellet
squeezed dry = 0.02-0.1 mg
Low exposure
FERRIC SULFATE TECHNIQUE
Control bleeding prior to application of FS
Place ferric sulfate using syringe with cotton tip
or apply with cotton pellet for 15 seconds
FERRIC SULFATE TECHNIQUE
Control bleeding
Powder composed of tricalcium silicate, bismuth oxide,
dicalcium silicate, tricalcium aluminate, tetracalcium
aluminoferrite, and calcium sulfate dihydrate
Place MTA over dry pulp stumps
Fill pulp chamber with cement/IRM and restore
Less known, expensive
COMPARISON OF DIFFERENT
PULP MEDICAMENTS
Fuks AB. Vital pulp therapy with new materials for primary teeth: New
directions and treatment perspectives. Pediatr Dent 2008; 30: 211-218
OTHER PULPOTOMY
TECHNIQUES
Electosurgery
CO2 Laser
Gluteraldehyde
Calcium Hydroxide – not used in primary teeth
as it causes internal resorption
SUCCESSFUL PULPOTOMY
Elimination of infection within the tooth
Tooth is preserved in healthy, non-pathologic
condition
Arch space is maintained
Normal resorption of primary tooth and eruption
of permanent successor
Success
Failure
PULPECTOMY
Removal of the
tissue from
the coronal
pulp chamber
and the root
canals
INDICATIONS FOR
PULPECTOMY
Inflammation extending
beyond coronal pulp
Primary teeth with necrotic
pulps
Roots and surrounding bone
free of pathology
(success rate falls with
furcation involvement)
At least 1/2 of root length
remaining
Second primary molar
retention for the erupting
first permanent molars
No permanent successor
PULPECTOMY TECHNIQUE
Remove caries and determine site of pulp
exposure
Remove roof of pulp chamber
Remove coronal pulp tissue and identify root
canals
Clean out canals and remove pulp tissue
Dry canals with paper points
Fill root/coronal chamber with ZnOE/restore
PULPECTOMY TECHNIQUE
Clean out canals and remove pulp tissue
Dry canals with paper points
Fill root/coronal chamber with
ZnOE/Vitapex and restore (SSC)
Fill pulp chamber with thickened mix of
paste
Restore tooth with stainless steel crown
ZOE versus Vitapex
ZOE= Zinc Oxide Eugenol
Vitapex= iodoform and calcium hydroxide
More short fills with ZOE and long fills with Vitapex
ZOE – potential to alter path of eruption of permanent teeth
Trairatvorakul et al found that Vitapex appears to resolve
furcation pathology at a faster rate than ZOE at 6 months,
while at 12 months both yielded similar results
Elimination of infection
within the tooth and
surrounding tissues
Tooth is preserved in
healthy, non-pathologic
condition
Arch space is
maintained
SUCCESS OF
PULPECTOMIES 1 year follow-up -
formocresol pulpectomy
on posterior teeth
% 82
81.5
82 82
S
U 81
C 80.5
C
E 80
S 79.5
80
S
79
Gould Coll Barr
1975 1985 1991
PULPECTOMY FAILURES
Not necessary
to fill canal to
the apex.
Do not force
filling material
past the apex
Possibility of
damaging
underlying tooth
PULPECTOMY
ANTERIOR TEETH
Coll et al found potential to alter path
of eruption of permanent successor
20% incidence of anterior crossbite or
palatal eruption following incisor
pulpectomies
Coll JA, Sadrian R. Predicting pulpectomy success and its relationship to exfoliation and
succedaneous dentition. Pediatr Dent 1996; 18: 57-63.
PULPECTOMY FAILURES
There is no
evidence of
radicular
pathology