Pulpotomy Access Technique

Cynthia Christensen, DDS, MS

Department of Pediatric Dentistry

Pulp Therapy for Primary Teeth

Michael Kanellis, DDS, MS

Department of Pediatric Dentistry

Pulpotomy

• Pulpotomy is the extirpation of vital inflamed pulp from the coronal chamber followed by medicament placement over radicular pulp stumps to fix (mummification) or stimulate repair of the remaining vital radicular pulp.

Pulpotomy

• Rationale: The radicular pulp tissue is healthy, and can either heal after the surgical amputation of the coronal pulp, or be fixed/mummified.

• Signs or symptoms of inflammation extending beyond the coronal pulp is a contraindication for a pulpotomy

Pulpotomy - Indications

• When the pulp is exposed (either through carious exposure or through trauma)

• When it is desirable to maintain tooth (primarily for space, function, guidance of permanent teeth)

• When there are no contraindications to pulpal therapy

Pulpotomy Procedure

1. Rubber Dam Isolation

2. Remove caries

3. Open pulp chamber and de-roof

4. Amputate pulp with round bur in slow speed running in reverse

5. Control hemorrhage with dry cotton pellet

6. Place Endo Bleach or FMC?????

7. Place Glass Ionomer over floor?????

Although the Medicaments and Materials May Change…

The Access Opening Technique Will Remain the Same

Pulpotomy Access Technique

•Remove caries

•Pulp exposed

•Primary Pulp Chambers

Short vertical dimension

Thin floor

Therefore: Perforation of Floor is Much Greater Risk in Primary

Molars

What happened here?

Pre Post

Radiographic Appearance

Perforation Proper Appearance

11/17/03

•Access Opening Must Be LARGE

•Root orafices splayed to accommodate succedaneous tooth.

•Access Opening Must Be LARGE

•Convenience Form to Amputate Radicular Orafice

Edontontic Department Will Teach You to Do A Conservative

Access Opening

Edontontic Department Will Teach You to Do A Conservative

Access OpeningThat is correct for Permanent

Teeth!!

PRIMARY TEETH ARE DIFFERENT

Why Not Do an Access That Conserves Tooth Structure?

• Has nothing to do with SSC Restoration Retention– Cervical Bulge Intact

• Convenience Form Needed– Not using flexible files

•Place cotton pellet and pressure to control initial hemhorrage

•Remove cotton pellet

•Irrigate with NaOH?

•Place GI?

•Place stainless steel crown

Rubber dam isolation

Remove caries

Deep caries with pulp exposure

Open pulp chamber and “de-roof”

Amputate pulp with slow speed in reverse.

Control Hemorrhage with Cotton Pellet

Remove cotton pellet: Residual Bleeding Why???

Tissue Tags Remain: Not Amputated at Canal Orafices

Let’s Try A Larger Access Opening

Caries removal with pulp exposure

Outline of access opening

Access opening complete and pulp chamber tissue amputated

Placement of cotton pellet

Hemostasis Acheived

Place Medicaments and Liner

Restore with SSC

Mandibular First Primary Molar

Thank You!