PULPECTOMY


A nonvital technique.

The removal of necrotic pulp tissue followed by filling the root canals with resorbable cement.

Treatment Objectives for Primary Tooth Pulpectomy

1. Maintain the tooth free of infection,

2. Biomechanically cleanse and obturate the root canals,

3. Promote physiologic root resorption, and

4. Hold the space for the erupting permanent tooth.

Indications for Pulpectomy of Primary Teeth

1. Cooperative patient,

2. Teeth with poor chance of vital pulp treatment,

3. Strategic importance for space maintenance,

4 Absence of severe root resorption,

5 Absence of surrounding bone loss from infection,

6 Expectation of restorability,

7 Pulpless primary teeth with sinus tracts,

8 Pulpless primary teeth in hemophiliacs,

9 Pulpless primary teeth next to the line of a palatal cleft,

10 Pulpless primary teeth when space maintainers or continued supervision are not feasible (handicapped or isolated children.

Contraindications for Primary Tooth Pulpectomy

1. Teeth with nonrestorable crowns,

2. Periradicular involvement extending to the permanent tooth bud,

3. Pathologic resorption of at least one-third of the root with a fistulous sinus tract,

4. Excessive internal resorption,

5. Extensive pulp floor opening into the bifurcation,

6. Systemic illness such: as congenital or rheumatic heart disease, hepatitis, leukemia, and children on long-term corticosteroid therapy, or those who are immunocompromised,

7. Primary teeth with underlying dentigerous or follicular cysts.

Clinical Technique for Primary Tooth Pulpectomy

1. First, penicillin should be immediately prescribed for a period of 4 to 7 days in case of a nondraining alveolar abscess.

2. Enter pulp chamber. Extirpate the pulp with broaches. Irrigate.

3. File short of radiograpahic apex. Instrument only to point of resistance. Size 35 = largest file size for primary molars.

4. Remove organic debris: irrigate periodically with dilute sodium hypochlorite or saline.

5. Dry the canals with paper points.

6. Obturate with ZOE or resorbable Kri paste.

7. Mix ZOE as a slurry and carry into the canals using either paper points, a syringe, or a lentulo spiral root canal filler.

8. Then, pack the orfice area with a stiffer mix of ZOE.

9. Fill the remainder of pulp chamber with a reinforced ZOE or a glass ionomer.

10. Place stainless steel crown.

Using Iodoform Paste for Pulpectomy of Primary Teeth

Kri paste: highly resorbable, bacteriocidal, healthy tissue ingrowth at apex.

An iodoform 80% compound which also contains parachlorophenol 2%, camphor 5%, and menthol 1%.

Success rates of 84% with the Kri paste group versus 65% with the ZOE group.

Overfills more successful (Kri paste 79% vs. ZOE 41%).

Photogallery

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