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    Pulpectomy Pedo

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    FourthMolar.com
    This document discusses pulpectomy procedures for primary teeth. It defines pulpectomy as the technique to access and fill root canals in primary teeth to maintain the tooth in a non-infected state. The document covers indications for pulpectomy such as necrotic or infected pulps, contraindications like non-restorable teeth, and materials used to fill canals like zinc oxide with eugenol. It describes the complete two-visit procedure and partial single-visit procedure.

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    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Pulpectomy Pedo

    Uploaded by

    FourthMolar.com
    825 views30 pages
    This document discusses pulpectomy procedures for primary teeth. It defines pulpectomy as the technique to access and fill root canals in primary teeth to maintain the tooth in a non-infected state. The document covers indications for pulpectomy such as necrotic or infected pulps, contraindications like non-restorable teeth, and materials used to fill canals like zinc oxide with eugenol. It describes the complete two-visit procedure and partial single-visit procedure.

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    This document discusses pulpectomy procedures for primary teeth. It defines pulpectomy as the technique to access and fill root canals in primary teeth to maintain the tooth in a non-infected state. The document covers indications for pulpectomy such as necrotic or infected pulps, contraindications like non-restorable teeth, and materials used to fill canals like zinc oxide with eugenol. It describes the complete two-visit procedure and partial single-visit procedure.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    825 views30 pages

    Pulpectomy Pedo

    Uploaded by

    FourthMolar.com
    This document discusses pulpectomy procedures for primary teeth. It defines pulpectomy as the technique to access and fill root canals in primary teeth to maintain the tooth in a non-infected state. The document covers indications for pulpectomy such as necrotic or infected pulps, contraindications like non-restorable teeth, and materials used to fill canals like zinc oxide with eugenol. It describes the complete two-visit procedure and partial single-visit procedure.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 30

    PULPECTOM

    Y
    in primary teeth

    www.FourthMolar.com
    DEFINITION
    HISTORICAL PERSPECTIVE
    INDICATIONS FOR PULPECTOMY
    CONTRA-INDICATIONS FOR
    PULPECTOMY
    TREATMENT OBJECTIVES
    TREATMENT CONSIDERATIONS
    ROOT CANAL OBTURATING
    MATERIALS FOR PRIMARY TEETH
    PROCEDURE
    www.FourthMolar.com
    Definition
    It is the technique to gain an
    access to the root canals,
    remove as much dead &
    infected material as possible
    & fill the root canals with a
    suitable material to maintain
    Comple Parti
    the toothte in a non
    al – infected
    www.FourthMolar.com
    Complete/Total
    Pulpectomy:
    It is the extirpation of normal
    or diseased pulp to or near
    the apical foramen .
    Partial
    Pulpectomy:
    It is the extirpation of normal
    or diseased pulp of tooth with
    an incompletely formed root
    & an open apex.
    www.FourthMolar.com
    Historical Perspective:

    Sweet has described a 4-5 step


    technique using formocresol for
    the treatment of pulpless teeth
    with & without fistula.
    Hobson has described a
    pulpectomy technique for necrotic
    primary teeth in which the canals
    www.FourthMolar.com
    were not debrided.
    Indications:

    Irreversible inflammation
    extending to the radicular pulp

    Primary teeth with necrotic


    pulp

    Pulpless primary teeth without


    permanent
    Pulpless successors
    primary teeth with
    sinus tracts
    Primary teeth with evidence
    of furcation pathology
    www.FourthMolar.com
    Pulpless primary 2nd molars before
    eruption of permanent
    Pulpless primary 1st molar
    teeth in
    hemophiliacs
    Presence of
    an abscess
    Pulpless primary teeth next
    to the line of palatal cleft
    Pulpless primary molars
    supporting orthodontic
    Pulpless primary teeth when space
    appliances
    maintainers or continued
    supervision are not feasible
    www.FourthMolar.com
    Contra-
    indications :
    Teeth with non-
    restorable crowns

    Pathologic resorption of at
    least 1/3rd of the root with a
    fistulous sinus tract
    Peri-radicular involvement extending
    to the permanent tooth bud
    Extensive pulp floor
    opening into the
    bifurcation www.FourthMolar.com
    Excessive internal
    resorption
    Primary teeth with underlying
    dentigerous or follicular cysts
    www.FourthMolar.com
    Medical contra
    indications

    Heart disease

    Immuno-compromised childre

    www.FourthMolar.com
    Treatment
    Objectives:
    To maintain the tooth free of
    infection
    To bio-mechanically clean &
    obturate the root canals
    To promote physiological root
    www.FourthMolar.com
    Treatment
    Considerations:
    GENERAL
    CONSIDERATIONS
    The patient should be healthy & co-operative.
    Informed consent, with a clear explanation of the
    procedure to the parents, must be obtained.
    DENTAL
    CONSIDERATION
    The teeth must be restorable after the root canal
    S
    treatment.
    Chronologic & dental age must be evaluated to rule
    out teeth with eminent exfoliation.
    Psychological or cometic factors must be considered.
    The number of teeth to be treated & strategic
    importance to the developing occlusion must be
    evaluated.
    www.FourthMolar.com
    Primary molar root anatomy along with proximity of
    Root canal obturating materials for
    primary teeth parachlorophenol mixed with
    Camphorated
    calcium hydroxide [CPC + Ca (OH)2]
    CPC mixed with zinc oxide
    Formocresol mixed with ZOE
    Chlorhexidine mixed with ZOE
    Kri TM paste
    Zinc oxide eugenol Zinc
    oxide mixed with sterile water
    Calcium hydroxide with sterile water
    Vitapex TM
    www.FourthMolar.com
    Frank’s paste
    Ideal root canal obturating
    material for primary teeth……..

    not irritate the periapical tissues

    t coagulate any organic remnants in canal

    have a stable disinfecting power


    at a similar rate as the primary root

    www.FourthMolar.com
    sily inserted into root canal & removed easily

    uld not be soluble in water

    e radioopaque & not discolour the tooth

    ere to the walls of the canal & should not shri

    www.FourthMolar.com
    ZOE PASTE
    Most commonly used root canal filling
    material for primary
    Has bactericidal teeth
    effect & decreases tooth
    pain
    Overfilling causes a mild foreign
    body reaction
    Rate of resorption is slower
    than that of the primary tooth
    root
    Ca(OH)2 PASTE
    Generally not used in pulp
    treatment for primary teeth

    www.FourthMolar.com
    APEX { Ca(OH)2 + Iodoform }
    Nearly ideal material for filling primary root canals
    Mixture is easily applied
    Resorbs at a slightly faster rate than the primary
    tooth root
    Has no toxic effect on permanent successors
    Is radioopaque
    NK’S PASTE { Ca(OH)2 + CPC }
    Is well tolerated by the adjacent periapical tissue
    without any inflammation & with deposition of
    osteodentin
    www.FourthMolar.com
    IODOFORM (KRI) PASTE
    Resorbs rapidly & has no undesirable effects
    on succedaneous teeth
    Material extruded into periapical tissue is
    rapidly replaced by normal tissue
    Has superior antimicrobial action
    Does not set into hard mass & can be
    removed if re-treatment is required
    GUTTA PERCHA
    Contains Iodoform 80.8%, Camphor 4.86%,
    Parachlorophenol
    Is not resorbable &2.025%, Menthol not
    so, is generally 1.215%
    used in pulp
    therapy for primary teeth
    May be used only when succedaneous tooth bud is
    absent www.FourthMolar.com
    WALKHOFF PASTE

    Is a mixture of parachlorophenol,
    camphor & menthol

    MAISTO PASTE

    Contains zinc oxide 14 gms, iodoform 42


    gms, thymol 2 gms, chlorophenol,
    camphor 3cc, lanolin 0.50 gms

    www.FourthMolar.com
    COMPARISON OF MATERIALS USED
    FOR OBTURATION IN PRIMARY TEETH
    PROPERTI ZOE VITAPEX KRI
    ES PASTE
    Rate of Slower than Slightly fasterFaster than
    resorption that of than that ofthat of tooth
    tooth root tooth root root

    Toxicity None None None

    Overfill Occurs Occurs Occurs


    resorption

    Antiseptic
    action Present Present Present
    Application Easy
    www.FourthMolar.com

    Adherence to Good
    The pulpectomy procedure

    Partial
    Comple (Single -
    te visit)
    (Two -
    visit)

    www.FourthMolar.com
    PARTIAL (SINGLE-VISIT)
    PULPECTOMY :

    Indicati
    ons
    Asymptomatic primary tooth
    with necrotic pulp tissue.
    Presence of inflamed but vital
    radicular pulp.
    Presence of an
    abscess.
    www.FourthMolar.com
    COMPLETE (TWO-VISIT)
    PULPECTOMY :
    Indica
    tions
    Presence of an acute abscess with
    or withoutofcellulitis.
    Presence active & persistent
    discharge from root canals.
    Stage
    s Stage-1 / Visit-1
    Emergency management of the
    acute abscess.
    Stage-2 / Visit-2
    Final root canal obturation.
    www.FourthMolar.com
    Procedure

    Achieve regional
    local analgesia.

    olate tooth with rubber dam.

    www.FourthMolar.com
    Remove
    caries &
    identify
    exposure site.

    Remove roof
    of pulp
    chamber
    using fissure
    www.FourthMolar.com

    bur.
    Remove coronal pulp
    with an excavator.

    Remove radicular pulp


    tissue.

    Clean out
    root canals
    with H-files.
    www.FourthMolar.com
    Irrigate canals
    with saline.

    Dry root
    canals with
    paper points &
    place a
    pledget of
    www.FourthMolar.com
    formocresol in
    Fill canals with
    slurry of zinc
    oxide paste.
    OBTURATION TECHNIQUES

    Incremental fill technique


    Lentulo spiral technique
    Endodontic pressure syringe
    technique
    www.FourthMolar.com
    Fill pulp
    chamber with
    thick mix of
    ZOE cement.

    Restore the
    tooth with
    stainless
    steel crown.
    www.FourthMolar.com
    Reference
    s Grossman LI, Oliet S, Del Rio CE. Endodontic
    practice, 11th edn: Lea & Febiger, 1988: 182-187

    Duggal MS, Curzon MEJ, Fayle SA, Toumba KJ,


    Robertson AJ. Restorative techniques in
    paediatric dentistry- An illustrated guide to the
    restoration of carious primary teeth, 2nd edn:
    Martin Dunitz Ltd, 2002: 51, 59-74
    Ingel JI, Bakland LK. Endodontics, 5th edn: B.C.
    Decker Inc.2002: 554-8, 889-95
    McDonald RE, Avery DR, Dean JA. Dentistry for
    the child & adolescent, 8th edn: Mosby, 2004 :
    400-3 www.FourthMolar.com

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