Dr. Vivek Rana, Subharti Dental College,...

Dr. Vivek Rana, Subharti Dental College, SVSU

Dr. Vivek Rana Professor Dept. Of Pediatric & Preventive Dentistry


DEFINITION


Contraindications

1. Non-restorable tooth

2. Periradicular involvement extending to the permanent tooth bud

3. Root resorption-internal or external

4. Extensive mobility

5. Gross bone loss at the apex or at the furcation.


Types of Pulpectomy

Pulpectomy can be of two types

single visit

multi visit


SINGLE VISIT PULPECTOMY

Single visit pulpectomy is generally carried out

as an extension of pulpotomy procedure,

probably as an on the spot decision, when

hemorrhage from the amputated radicular

stumps is uncontrollable.

It is also done on a tooth with history of

spontaneous pain and not done on a tooth

with abscess, fistula (necrotic pulp).


Procedure of Single Visit Pulpectomy

• . Done under local anesthesia and rubber dam

isolation.

• . All caries should be removed.

• . Entire roof of the pulp chamber is cut with high-

speed bur and water spray.

• . The coronal pulp is removed with the round bur or

• spoon excavator.

• . Pulp chamber is washed thoroughly, to remove all

• debris.

• . All accessible radicular pulp is removed with

broaches


No attempt is made to extend the instrument beyond the apex. Filing is done with H files or K files along with the use of lubricants.

Five percent sodium hypochlorite, hydrogen peroxide, saline, etc. are used for irrigation. Hedstrom files are recommended since they remove hard

tissue only on withdrawal, which prevents pushing infected material through the apices. The canals should be instrumented to the resistance point,

that usually corresponds to 2-3 mm from the radiographic apex.

Each canal should be enlarged 3-4 instrument sizes greater than the first file.


Canal is filed with the aim of enlarging them to permit condensation of root canal filling material.

Canals are irrigated with saline and dried

Canals are filled with suitable filling material.

Radiograph should be taken for proper obturation.


PULPECTOMY PROCEDURE


Multivisit Pulpectomy

Used for non-vital primary teeth.

Clinical technique is similar to single visit.

Instrumentation of the canals are not recommended at the first visit.

Between appointments, an antibacterial drug is sealed in the pulp chamber.

If pus is present, the canal can be left open to drain for 24 hrs.

Systemic antibiotics are advised if cellulitisis present .

The number of appointments, timing and extent of instrumentation will be determined by the signs and symptoms at each visit,usually about 7-10 days apart.


Problems Encountered in Deciduous Tooth Pulpectomy Multiple ramification-makes

complete debridement impossible

Ribbon shaped or hour glass shaped canals-discourages gross enlargement of the canal.


Evaluation of Success of pulpectomy

Resolution of sinus tract, by 6 months No purulent discharge from the gingival

margin No abnormal mobility No postoperative pain No further resorption of root (except

physiological) Resolution of bifurcation radiolucency

by 6-12 months.


OBTURATION OF DECIDUOUS ROOT CANAL


ROOT CANAL FILLING MATERIAL

IDEAL PROPERTIES Resorb at a similar rate as the primary root.

Should be harmless to the periapical tissues and to the permanent tooth germ, resorb readily if pressed beyond the apex. It should have a stable disinfecting power.

It should be inserted easily into the root canal and be removed easily if necessary.


Should adhere to the walls of the canal and should not shrink.

It should not be soluble in water.

Be radiopaque and not discolour the tooth.

No material currently available meets all

these cri-teria.

The filling material most commonly used for primary pulp canals are Zinc Oxide –eugenol paste, iodoform & calcium hydroxide paste


Walkhoff paste

Parachlorophenol

Camphor

Menthol


KRI paste 1.Iodoform80.8% 2.Camphor 4.86% 3.Parachlorophenol

2.025% 4.Menthol 1.215%


Maisto paste Zinc Oxide 14 gms

Iodoform 42 gm

Thymol 2 gm

Chlorophenol Camphor 3cc

Lanolin 0.50 gms


VITAPEX Calcium hydroxide

Iodoform

Oily additives


Method of Obturation Lentulo spiral, pressure syringe, Jiffy's

syringe, amalgam condensor, local anesthetic syringe, tuberculin syringe, files, etc. can be used.

Zincoxide eugenol is mixed to the required consistency.

It is carried in a lentulo spiral and spun down the canal, just short of the apex


Cotton held with cotton pliers can be used as piston to push the material into the canal

Pressure syringe is also effective. Advantages are--

1. avoidance of air trap

2. even amount of material is deposited

3. 300 psi force produced allows the use of thick consistency.


GUTTA PERCHA IS NOT INDICATED AS DECIDUOUS ROOT CANAL FILLING MATERIAL BECAUSE IT IS NON RESORBABLE.

If the succedaneous permanent tooth is missing, canals can be obturated with gutta percha


Follow-up

• 6 monthly evaluation should be done

• IOPA X ray should be taken between

12-18 months post-operatively

• Following pulp therapy, it is

advisable to place stainless steel

crown to prevent fracture.


Dr. Vivek Rana, Subharti Dental College,...

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