Difference Between Pulpotomy and Pulpectomy

Difference between pulpotomy and pulpectomy1. 1. DIFFERENCE BETWEEN PULPOTOMY AND PULPECTOMY M.Owais Final year BDS 2. 2. PULPOTOMY It is defined as the removal of coronal portion of pulp followed by placement of medicament 3. 3. INDICATIONS  Large proximal carious lesion with involvement of marginal ridge  No history of spontaneous pain  Absence of abscess or fistula  Where extraction is contraindicated  Vital tooth with healthy peridontium 4. 4. PROCEDURE  Apply L.A and rubber dam  Remove the carious lesion  Access the pulp chamber  As soon as dip is felt don’t go deep but side to side to extend roof  Remove coronal pulp by round bur or excavator  Apply medicament 5. 5.  Remove cotton pledget and check for excessive haemorrhage  Fill chamber with zinc oxide eugenal  Place coronal restoration  Place stainless steel crown 6. 6. MATERIALS USE FOR MEDICAMENT  Formocresol  Ferric sulphate 7. 7. CONTRAINDICATIONS  Presence of abscess and fistula  Radicular pulp involvement  Inter radicular bone loss  Caries penetrating to floor of pulp chamber 8. 8. PULPECTOMY  A pulpectomy is a dental procedure in which all of the material in the pulp chamber and root canal of a tooth is removed. 9. 9. INDICATIONS  Irreversible pulpitis involving both coronal and radicular pulp  Non-vital primary molars or incisors that need to be maintained in arch  Abscessed primary molars  Primary molars with radiographic evidence of furcation pathology 10. 10. PROCEDURE 11. 11. CONTRAINDICATIONS  Teeth with non-restorable crowns  Extensive pulp floor opening into the bifurcation  Excessive internal resorption  Primary teeth with underlying dentigerous or follicular cysts  PULPOTOMY BY- Dr. SUMEET VINCENT TIGGA (G.D.C RAIPUR)  2. DEFINATION-: PULPOTOMY CAN BE DEFINED AS THE COMPLETE REMOVAL OF CORONAL PORTION OF THE DENTAL PULP , FOLLOWED BY PLACEMENT OF SUITABLE DRESSING OR MEDICAMENT THAT WILL PROMOTE HEALING & PRESERVE VITALITY OF THE TOOTH (Finn,1985 )  3. INDICATION-: <ul><li>Cariously exposed primary teeth, when their retention is more advantageous than extraction.  4. Vital tooth with healthy periodontium  5. Pain, if present not spontaneous nor persists after removal of the stimulus  6. Tooth which is restorable  7. Tooth with-2/3rd root length  8. Hemorrhage from the amputation site is pale red & easy to control Ferric sulphate 3.  20.  19. 7.EASLICK’S PARAFORMALDEHYDE FORMULA: *paraformaldehyde 1 gm *procaine base 0.  18. 2. 2. Easlick’s formaldehyde 3. 9. A. Apply diluted formocresol to pulp on cotton pellet for 3. Non-Vital pulpotomy techniques(mortal pulpotomy) 1. Of formocresol solution. . . >Avoid breakdown of periradicular area >Treat remaining pulp with medicament >Avoid dystrophic pulpal changes  13. . 6 or 8 round bur or sharp spoon excavator  16.GYSI TRIOPASTE FORMULA: *tricresol 10 ml *cresol 20 ml *glyserine 4 ml *paraformaldehyde 20 ml *zinc oxide 60 gm  22. Technique for Pulptomy of thePrimary Teeth 1. CONTRAINDICATION -: Evidence of internal resorption Presence of inter radicular bone loss Abscess . DEVITALIZATION:(mummification & cauterization) <ul><li> Single Sitting: 1. Isolate the tooth to be treated with a rubber dam.Soon to be exfoliated Formula of each agent used are as follows: 1.03 gm *powdered asbestos 0. Excavate all caries. Achieve heamostasis with moist cotton pellets under pressure. TREATMENT OBJECTIVES-: >Amputate the infected coronal pulp.Bone morphogenic protein II. ` Contraindication: . Profound anaesthesia for tooth and tissue.Non restorable .  10. Laser <ul><li> Two sittting: 1. Remove all coronal pulp tissue with a slow-speed No. Remove the dentin roof of the pulp chamber. In mixed dentition stage primary tooth is preferable to a space maintainer</li></li></ul><li>.Profuse bleeding .REGENERATION: (inductive & reparative) 1. 3. 5. mummifying and bactericidal action. >Neutralize any residual infectious process.5 minutes. 9.formocresol  12.VitalPulpotomy techniques 1.Difficulty in controlling bleeding . fistula in relation to teeth Radiographic sign of calcific globules in pulp chamber Caries penetrating the floor of pulp chamber Tooth close to natural exfoliation  11. 10. Electrosurgery 3. To prepare a 1:5 conc. DEVITALIZATION PULPOTOMY(TWO STAGE) ~Two stage procedure involves use of paraformaldehyde to fix the entire coronal & radicular pulp tissue.Slight purulence discharge . .Thickened PDL  21.Necrotic . 2.Glutaraldehyde 2. 11. >Preserve the vitality of the radicular pulp. ..PRESERVATION: 1. Pressure on pellet. CLASSIFICATION-: I.MTA 3. Gysitriopaste 2.05 gm *petroleum . Place a thick paste of ZOE in contact with pulp stumps. 4.DEVITALIZATION (SINGLE SITTING) FORMOCRESOL PULPOTOMY TECHNIQUE First advocated by SWEET(1930) FORMOCRESOL SOLUTION: *19% formaldehyde *35% cresol *15% glycerine (veichle)Buckley’s solution: 1:5 conc. Of this formula- First thoroughly mix 3 part of glycerinre with 1 part of distilled water Then add 4 parts of this preparation to 1 part Buckley’s formocresol & thoroughly mix again Mechanism Of Action:Formocresol prevents tissue autolysis by bonding to protein. This is reversible process and is accomplished without changing the basic overall structure of the protein molecules  15.Spontaneous pain .  14. Paraform devitalising paste</li></li></ul><li>. Indications: .Beechwood cresol 2. Pulp chamber is dried with new cotton pellets . Formocresol</li></ul> 2. 6. ~The medicaments used in this technique have a devitalizing. Place stainless steel crown (or bonded composite)  17. . especially one with an incompletely formed apex. Place a calcium hydroxide mixture over the radicular pulp stumps at the canal orifices and dry with a cotton pellet. USING MTA INSTEAD OF FORMOCRESOL FOR PULPOTOMY • In this new technique. -Calcium hydroxide or MTA is used  26. 6. fixing the  24. 2. CLINICAL TECHNIQUE FOR THE Ca(OH)₂ PULPOTOMY 1. . NON-VITAL PULPOTOMY Ideally. -Calcium sulfatedihydrate. OBJECTIVES FOR Ca(OH)₂ PULPOTOMY OF YOUNG PERMANANT TEETH-: Preserve radicular vitality.. Place quick-setting ZOE cement or resinreinforced glass ionomer cement over the calcium hydroxide to seal and fill the chamber. Control hemorrhage with a cotton pellet applied with pressure or a damp pellet of hydrogen peroxide  29. PROPERTIES OF CALCIUM HYDROXIDE Calcific bridge formation(91% success) Germicidal activity Vital pulp remains Clinical success to be 65% Hystological success 35%  28.seal it for 1 to 2 weeks (formaldehyde gas liberated from the paraformaldehyde permeates through the coronal & radicular pulp. a non-vital tooth should b treated by pulpectomy or root canal filling However. 8. The cement’s setting time is 3 to 4 hours. excavate the caries On excavation of deep caries pulp exposure is encountered . The roof of the pulp chamber is removed and cleaned with saline and dried with cotton pellet The pulp chamber is then filled with antiseptic paste and the tooth is restored. Remove the roof of the pulp chamber 5.A.Anesthetize the tooth and isolate under a rubber dam. . 7.06 gm *propylene glycol 0. Maximize the opportunity for apexogenesis (apical development and closure).jelly 125 gm *carimine to colour 3. -Bismuth oxide.  30. -Tricalciumaluminate. the MTA paste is allowed to cover the dry pulp stumps (instead of formocresol). Amputate the coronal pulp with a large low-speed round bur or a high-speed diamond stone with a light touch.05 ml *carbowax 1500 1. 3. young permanent tooth..Second appointment In the second appointment pulpotomy is carried with the help of L.30 gm *carmine to colour  23. pain or swelling  27.there should be no adverse clinical signs or symptoms of sensitivity. PARTIAL PULPOTOMY The partial pulpotomy for traumatic exposures is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1-3 mm to reach the deeper healthy tissue -Indicated for a vital .PARAFORM DEVITALIZING PASTE: *paraformaldehyde 1gm *lignocaine 0. traumatically exposed. • MTA is a powder composed of -Tricalcium silicate. pulpectomy of a primary molar may .  25. Irrigate the cavity and lightly dry with cotton pellets 4.First appointment: Isolation of the affected teeth with rubber dam Preparation of the cavity . -Tetracalciumaluminoferrite. Enhance continual root dentin formation. IRM is place over the MTA. PROPERTIES OF MTA (MINERAL TRIOXIDE AGGREGATE) 93% clinical success rate Better biocompatibility Better sealing ability-prevents leakage in pulpal & periapical tissues Less time needed for procedure Promotes regeneration of original pulp tissue Dentinal bridge formation is seen  31.  33. MTA paste is obtained by mixing MTA powder with sterile saline at a 3:1 powder/saline ratio. -Dicalcium silicate.  32. . . ensure that the exposed site is free of debris Enlarge the cavity with round bur Cotton pellet with paraformaldehyde is placed in the exposure site . Excavate all caries and establish a cavity outline. sometime be impracticable due to non-negotiable root canals and also due to limited patient co-operation. TCHNIQUE 1ST APPOINTMENT .no systemic or local side effects  42. PRESERVATION Chemicals which induce minimal insult to the tissue are used. ELECTROSURGICAL PULPOYOMY > Mack & Dean. REGENERATION: An ideal pulpotomy treatment should leave the radicular pulp vital . Hence. the pulp stumps are cauterized through this method.(5)100% clinical success(6)root resorption is not accelerated (7)internal resorption similar to formocresol . IN HIGHER CONC. It cannot eliminate radicular pulp inflammation  39.  40. It is a non aldehyde haemostatic compound(1)astringent.7% radiographic success rate.1979) (1) superior fixation by cross-linkage (2) diffusibility is limited (3) excellent antimicrobial agent (4) causes less necrosis of pulpal tissue. The tooth is then restored with stainless steel crown > Disadvantage: contaminated pulp tissue does not promote adequate current penetration .NECROTIC PULP IS REMOVED . SECOND APPOINTMENT-- ISOLATE THE TOOTH REMOVE THE TEMPORARY DRESSING & PELLET CONTAINING BEECHWOOD CRESOL IF SIGN & SYMPTOMS PERSIST THEN REPEAT THE TREATMENT OR EXTRACT THE TOOTH IF NO SYMPTOMS PULP CHAMBER IS FILLED WITH ANTISEPTIC PASTE THEN IT CAN B RESTORED WITH STAINLESS STEEL CROWN  37. CEMENT FOR 1-2 WEEKS  36.the pulp chamber is filled with ZnOE. LASER PULPOTOMY: > Non. SELECTION CRITERIA History of spontaneous pain Swelling . After completion . > After amputation of the coronal pulp . . a two-stage pulpotomy technique is advocated .PULP CHAMBER IS IRRIGATED WITH SALINE & DRIED WITH COTTON PELLET -RADICULAR PULP IS TREATED WITH BEACH WOOD CERSOL DIPPED COTTON PELLET -SEAL THE CAVITY WITH TEMP. (3) less inflammation than formocresol(4) 92. Ferric sulfate.redness or soreness of mucosa Tooth mobility Tenderness to percussion Radiographic evidence of root resorption  35. hear electrocautery carbonized & heat denatures the pulp & bacterial contamination  38. healthy and completely enclosed within an odontoblast-lined dentin chamber.  34. This involves use of BMP(bone morphogenic protein) which contains a factor(oeteogenic proteins) capable of auto induction of reparative dentin formation(stimulating induction & differentiation of mesenchymal cells with varying degrees of dentinal bridge formation)  43. (2)forms a ferric ion-protein complex that mechanically occludes capillaries. . FOR LONGER EXPOSURE GLUTERALDEHYDE SHOWS CYTOTOXIC & MUTAGENIC EFFECTS SAME AS FORMOCRESOL  41.pharmocologichemostatic technique > Jeng-fen Liu et al in 1999.1993 > Nonpharmacological technique > Non-chemical devitalisation . They help to conserve vitality of the radicular pulpChemicals used are glutaraldehyde (2-5%)and ferric sulphate Glutaraldehyde: (by Kopel.studied the effect of Nd:YAG laser for pulpotomy in primary tooth-100% success with no signs or symptoms. THANK YOU .

Difference Between Pulpotomy and Pulpectomy

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