PULP THERAPY IN CHILDREN Radiographic Exam:

1. Probable pulp exposure.

Pulp Therapy 2. Normal interradicular periapical tissues.
1. Pulp Capping 3. Normal root development, no calcifications in the pulpal chamber or root
a. Indirect Pulp Capping (IPC) canals
b. Direct Pulp Capping (DPC) 4. No internal root resorption.
2. Pulpotomy 5. No premature or abnormal external root resorption.
3. Pulpectomy
4. Apexification Indications of Failure in Pulpotomy:
1. Increased mobility.
Indirect Pulp Capping 2. Radiographic evidence of
Indications: interradicular or periapical radiolucency.
1. Mild pain associated with eating; no extreme throbbing or penetrating 3. Internal/external root resorption.
pain. 4. Premature exfoliation.
2. No gingival pathology. Cause of Failure:
3. No mobility. Poor diagnosis and treatment selection.
4. X-ray exam reveals normal periapical tissue with probable carious
exposure of the pulp. Pulpotomy Procedure: - refer to Technique Guide Manual

> A very thin layer of carious dentin, directly over the pulp is left in place,
over the soft carious dentin .
> The procedure is intended to avoid direct carious exposure.
> Goal is to promote pulpal healing by removing the majority of infective
bacteria and by sealing the lesion, which stimulates sclerosis of dentin and
reparative dentin.
> Observation should be for a minimum of 6 weeks.
Direct Pulp Capping
Indications:
1. Small mechanical exposure (less than 1 mm) caused by over preparation
and has occurred with a rubber dam in place.
2. Small carious exposure in a tooth without any spontaneous pain, redness,
swelling or fever associated with it.
3. If a traumatic injury has caused a coronal fracture involving the pulp and
the exposure is no longer than 2 mm in diameter, with the injury having
occurred within the past few hours.
> The objective is to preserve vital pulp tissue that is free of inflammation
and evetually be physiologically walled off by a calcific barrier which should
be evident radiographically in 2 – 3 months.
> A final restoration is seldom indicated because of two reasons:
1. The additional manipulation necessary to complete a final restoration
may be additive to any pulpal & periodontal damages already sustained from
the traumatic injury.
2. A final restoration that is esthetic pleasing in a pain free child may
discourage the parents from returning for important follow-up monitoring
visits.
Pulpectomy
> complete removal of pulp tissue from the crown and root
> it is the treatment of choice when degenerative changes in the radicular
pulp is irreversible; if left untreated, the tooth is potentially deleterious to:
1. succedaneous tooth: effects are the following:
a. formation of cyst enveloping the tooth bud
b. interruption in amelogenesis
c. enamel hypoplasia
d. discoloration
e. change in eruption sequence
f. ectopic eruption
g. axial rotation
2. the periapical tissue
3. systemic condition of the child
Pulpectomy Indications:
1. Tooth with exposed and infected pulp, but still with vital radicular tissue.
2. Absence of clinical signs such as pain, mobility or fistula
3. Absence of any radiographic signs of pathologic processes, such as
periapical radioluscency of bone or root resorption.
Apexification
> indicated to non-vital, immature permanent tooth with an open apex and in
cases of developing internal or pathologic external root resorption after a
traumatic injury
> calcium hydroxide is carried to the root apex to contact vital tissues
directly, to promote root elongation and/or induce calcific root closure

Pulpotomy
A. Formocresol Pulpotomy
B. Calcium Hydroxide Pulpotomy - indicated for young permanent teeth
with incomplete root formation
 Amputation of coronal pulp to preserve the radicular vital pulp
tissue
Objective is to remove, only the inflamed pulp tissue and to leave healthy
tissue in the root canal to remain vital, maintain the tooth in the dental arch
and to enhance physiologic maturation of the root in young permanent teeth
Indications:
Tooth:
1. Primary Teeth
2. Permanent Teeth
Pain:
1. No extreme night pain.
2. No unprovoked toothache.
3. Pain must not be frequent, continuous, sharp and penetrating.
Clinical Exam:
1. No excessive mobility.
2. No gingival pathology or evidence or chronic fistulous tract.
3. No disagreeable odor emanating from the pulp chamber.