Vital Pulpotomy

By: Naghman Zuberi

 Pulpotomy

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 )

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 INDICATIONS
Cariously exposed primary teeth, when their retention is more advantageous than extraction.

Vital tooth with healthy periodontium

Pain, if present not spontaneous nor persists after removal of the stimulus
Tooth which is restorable

Tooth with-2/3rd root length

Hemorrhage from the amputation site is pale red & easy to control

In mixed dentition stage primary tooth is preferable to a space maintainer

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 CONTRAINDICATIONS

Evidence of internal resorption

Presence of inter radicular bone loss
Abscess , 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
Roots less than 2/3rd length

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 CLASSIFICATION
I.Vital Pulpotomy techniques

1. DEVITALIZATION: (mummification & cauterization)

Single Sitting: 1. Formocresol

2. Electrosurgery
3. Laser

Two sittting: 1. Gysi triopaste

2. Easlicks formaldehyde
3. Paraform devitalising paste

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2.PRESERVATION: 1.Glutaraldehyde
2.Ferric sulphate
3.MTA

3.REGENERATION: (inductive & reparative)

1.Bone morphogenic protein

II. Non-Vital pulpotomy techniques(mortal pulpotomy)

1.Beechwood cresol
2.formocresol
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 TREATMENT OBJECTIVES
>Amputate the infected coronal pulp,

>Neutralize any residual infectious process,

>Preserve the vitality of the radicular pulp.

>Avoid breakdown of periradicular area

>Treat remaining pulp with medicament

>Avoid dystrophic pulpal changes

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 A.DEVITALIZATION (SINGLE
SITTING)
FORMOCRESOL PULPOTOMY TECHNIQUE

First advocated by SWEET(1930)

FORMOCRESOL SOLUTION:
*19% formaldehyde
*35% cresol
*15% glycerine (veichle)
Buckleys solution: 1:5 conc. Of formocresol solution.

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 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

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 Technique for Pulptomy of the
Primary Teeth
1. Profound anaesthesia for tooth and tissue.

2. Isolate the tooth to be treated with a rubber dam.

3. Excavate all caries.

4. Remove the dentin roof of the pulp chamber.

5. Remove all coronal pulp tissue with a slow-speed No. 6 or 8 round bur
or sharp spoon excavator
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6. Achieve heamostasis with moist cotton pellets under pressure.

7. Apply diluted formocresol to pulp on cotton pellet for 3- 5 minutes. Pressure

on pellet.

9. Pulp chamber is dried with new cotton pellets .

10. Place a thick paste of ZOE in contact with pulp stumps.

11. Place stainless steel crown (or bonded composite)

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Ferric sulfate:
It is a non aldehyde haemostatic compound
(1)astringent;
(2)forms a ferric ion-protein complex that mechanically occludes capillaries;
(3) less inflammation than formocresol
(4) 92.7% radiographic success rate.
(5)100% clinical success
(6)root resorption is not accelerated
(7)internal resorption similar to formocresol ,no systemic or local side effects

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THANK YOU

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