pulpectomy-pedo

PULPEC T
OMY
in p r im a r y t e e t h

D E F IN IT IO N
H IS T O R IC A L P E R S P E C T IV E
IN D IC A T IO N S F O R
P U L P E C TO M Y
C O N T R A -IN D IC A T IO N S F O R
P U L P E C TO M Y
T R E A T M E N T O B J E C T IV E S
T R E A T M E N T C O N S ID E R A T IO N S
R O O T C A N A L O B T U R A T IN G
M A T E R IA L S F O R P R IM A R Y
TE E TH

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 the tooth in a non –
Complet Partia
infected state.
e l

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.

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 were not debrided.

Indications:

Irreversible inflammation extending
to the radicular pulp

Primary teeth with necrotic pulp

Pulpless primary teeth without
permanent successors
Pulpless primary teeth with
sinus tracts
Primary teeth with evidence of
furcation pathology

Pulpless primary 2nd molars before eruption of
permanent 1st molar
Pulpless primary teeth in
hemophiliacs
Presence of
an abscess
Pulpless primary teeth next to the line of
palatal cleft
Pulpless primary molars supporting
orthodontic appliances
Pulpless primary teeth when space maintainers or
continued
supervision are not feasible

Contra-indications :

Teeth with non-restorable
crowns

Pathologic resorption of at least
1/3r d of the root with a fistulous
sinus tract
Peri-radicular involvement extending to
the permanent tooth bud
Extensive pulp floor opening into the bifurcation

Excessive internal resorption
Primary teeth with underlying dentigerous
or follicular cysts

M e d ic a l c o n t r a
in d ic a t io n s

Heart disease

Immuno-compromised children

Treatment Objectives:

To maintain the tooth free of
infection
To bio-mechanically clean &
obturate the root canals
To promote physiological root

Treatment Considerations:
GENERAL
The O N S should R A T I & co-operative.
C patient I D E be healthy
ONS
Informed consent, with a clear explanation of the procedure to
the parents, must be obtained.
D E N TA L
TheO N S I D beR A T I after the root canal treatment.
C teeth must E restorable
ONS
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.
Primary molar root anatomy along with proximity of underlying
succedaneous tooth must be evaluated.

Root canal obturating materials for primary teeth
Camphorated parachlorophenol mixed with 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
Frank’s paste Maisto’s

Ideal root canal obturating material for
primary teeth……..

uld not irritate the periapical tissues

not coagulate any organic remnants in canal

d have a stable disinfecting power
rb at a similar rate as the primary root

easily inserted into root canal & removed easily if n

ould not be soluble in water

be radioopaque & not discolour the tooth

dhere to the walls of the canal & should not shrink

Z O E P A S TE
Most commonly used root canal filling material for
primary teeth
Has bactericidal effect & decreases tooth pain
Overfilling causes a mild foreign body
reactionof resorption is slower than that
Rate
of the primary tooth root

a ( O H ) 2 P A S TE
Generally not used in pulp
treatment for primary teeth

EX { C a ( O H ) 2 + Io d o f o r m }
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

’ S P A S TE { C a(OH)2 + C PC }
Is well tolerated by the adjacent periapical tissue without
any inflammation & with deposition of osteodentin

D O F O R M ( K R I) P A S T E
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
G U TTA P E R C H A
Contains Iodoform 80.8%, Camphor 4.86%,
Parachlorophenol 2.025%, Menthol 1.215%
Is not resorbable & so, is generally not used in pulp
therapy for primary teeth
May be used only when succedaneous tooth bud is absent

ALKHOFF P A S TE

Is a mixture of parachlorophenol, camphor &
menthol

M A IS T O P A S TE

Contains zinc oxide 14 gms, iodoform 42 gms,
thymol 2 gms, chlorophenol,
camphor 3cc, lanolin 0.50 gms

COMPARISON OF MATERIALS USED
FOR OBTURATION IN PRIMARY TEETH
PROPE ZOE KRI
Rate ofE S
R TI S lo w e r S TA y
V lIi g h t lP E F aA t e r E
P sS T
resorption tha n tha t fa s te r tha n tha t
o f t ooon e
th
X a n tha t
th of to o th
Toxicity N
root of to o th root
Overfill Occurs Nooonte
r None
resorption O c c urs O c c urs
Antiseptic action
P re s e nt P re s e nt P re s e nt
Application
Eas y
Adherence to
canal wall Good Good Good
Removal

Radioopacity Eas y Eas y

Discoloration of R a d io o p R a d io o p a q R a d io o p a
tooth aque ue ne
No que
None None

The pulpectomy procedure

Partial
Complet (Single -
e visit)
(Two -
visit)

P A R T IA L ( S IN G L E -
V IS IT ) P U L P E C T O M Y :

Indicatio
ns
Asymptomatic primary tooth with
necrotic pulp tissue.
Presence of inflamed but vital
radicular pulp.
Presence of an
abscess.

C O M P L E TE ( TWO -
V IS IT ) P U L P E C T O M Y :
Indicati
ons
Presence of an acute abscess with or
without cellulitis.
Presence of active & persistent
discharge from root canals.
Stages
Stage-1 / Visit-1
Emergency management of the acute
abscess.
Stage-2 / Visit-2
Final root canal obturation.

Procedure

Achieve regional
local analgesia.

Isolate tooth with rubber dam.

Remove caries
& identify
exposure site.

Remove roof of
pulp chamber
using fissure
bur.

Remove coronal pulp with
an excavator.

Remove radicular pulp
tissue.

Clean out root
canals with H-
files.

Irrigate canals
with saline.

Dry root canals
with paper points
& place a
pledget of
formocresol in
the pulp

Fill canals with
slurry of zinc
oxide paste.
O B T U R A T IO N T E C H N IQ U E S

Incremental fill technique
Lentulo spiral technique
Endodontic pressure syringe
technique

Fill pulp
chamber with
thick mix of
ZOE cement.

Restore the
tooth with
stainless steel
crown.

References
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
Curzon M E J, Roberts J F, Kennedy D B. Kennedy’s

pulpectomy-pedo

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