Objectives[ edit ] In primary tooth[ edit ] After the pulpotomy treatment, the radicular pulp should remain asymptomatic without any adverse clinical signs or symptoms such as sensitivity, pain, or swelling. From the radiographs, there should be absence of postoperative evidence of pathologic root resorption. There should be absence of clinical signs of infection and inflammation and no harm to the succedaneous tooth. For example, the aspects we considered are the extension of caries in the primary tooth, and the development of the succedaneous permanent tooth. The radiograph shows a primary tooth with succedaneous permanent teeth. Radiographs are needed to determine if pulpotomy can be carried out.
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Objectives[ edit ] In primary tooth[ edit ] After the pulpotomy treatment, the radicular pulp should remain asymptomatic without any adverse clinical signs or symptoms such as sensitivity, pain, or swelling. From the radiographs, there should be absence of postoperative evidence of pathologic root resorption. There should be absence of clinical signs of infection and inflammation and no harm to the succedaneous tooth. For example, the aspects we considered are the extension of caries in the primary tooth, and the development of the succedaneous permanent tooth.
The radiograph shows a primary tooth with succedaneous permanent teeth. Radiographs are needed to determine if pulpotomy can be carried out. In mature permanent tooth[ edit ] The tooth should be asymptomatic. There should be no clinical signs and symptoms.
From the radiographs, there should be absence of postoperative evidence of pathology. Caries do not have to develop significantly before they reach the pulp chamber. When the soft tissue in the pulp chamber is infected has bacteria in it or affected is inflamed , it can be removed by a dentist or dental therapist under local anaesthetic.
If the soft tissue in the canals is still healthy enough, a special medicated filling can be put into the chamber in an attempt to keep the remaining pulp in the canals alive. The process of removing the pulp from the chamber is the actual "pulpotomy", though the word is often used for the entire process including placement of the medication. There are many medicaments that can be used to fill the pulp chamber including zinc-oxide eugenol as well as mineral trioxide aggregate.
There are two types of pulpotomy techniques depending the extent of caries in a tooth and the symptoms it presents. A vital pulpotomy or a non-vital pulpotomy can be carried out. However, recent research shows that non-vital pulpotomies are rarely indicated due to their low success rates and it is therefore sometimes better to extract the tooth.
Afterwards the tooth is restored with a regular filling, either composite or amalgam, or a stainless steel crown. Due to the process of a pulpotomy causing the tooth to become slightly brittle, a stainless steel crown is normally indicated as the preferred choice of definitive restoration. A pulpotomy can be done to both permanent and primary teeth. Primary teeth[ edit ] The indication of this pulpotomy procedure is when pulp exposure occurs during caries removal in a primary tooth with a normal pulp or reversible pulpitis or after a traumatic pulp exposure.
The radicular pulp was theoretically sterilized and devitalized, thereby reducing infection and internal resorption. Another form of nonchemical devitalization emerged: electrosurgical pulpotomy. Electrocautery releases heat that denatures pulp and reduces bacterial contamination.
Experimentally, electrosurgery has been shown to reduce pathologic root resorption and periapical pathology, and a series of pulpal effects including acute and chronic inflammation, swelling and diffuse necrosis. It is reported that this method has high success rate in pulpotomies.
However, this method may prove to be more diagnosis and technique sensitive, and it may not be suitable if apical root resorption has occurred. In recent years, glutaraldehyde has been proposed as an alternative to formocresol based on: its superior fixative properties, and low toxicity. A nonaldehyde chemical, ferric sulfate, has received some attention recently as a pulpotomy agent. It minimizes the chances for inflammation and internal resorption.
This category of pulp therapy is still in flux, although major changes in the future are not likely. Calcium hydroxide was the first agent used in pulpotomies that demonstrated any capacity to induce regeneration of dentin. However, the success rate is not that high. Recent advances in the field of bone and dentin formation have opened exciting new vistas for pulp therapy, which is a factor called bone morphogenetic protein BMP.
It has bone inductive properties, that can predictably induce bone for use in the fields of orthopedic, oral, and periodontal surgery. Most importantly for dentistry, these osteogenic proteins hold promise for pulp therapy. It is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1 to 3mm or deeper to reach the level of healthy pulp tissue.
Pulpal bleeding can be controlled by irrigation of sodium hypochlorite or chlorhexidine. The site is then covered with a pulpal medicament, calcium hydroxide or MTA, followed by a final restoration that provides a complete seal to prevent any leakage and bacterial contamination following the restoration.
Immature teeth should continue its normal development and apexogenesis. Partial pulpotomy due to a traumatic exposure is also known as Cvek Pulpotomy.
The surface of the remaining pulp is then irrigated with bacteriocidal irrigants such as sodium hypochlorite or chlorhexidine until bleeding has ceased. The site is then covered with a pulpal medicament, either calcium hydroxide or MTA.
There should be no signs of pain, swelling, or sensitivity after the procedure. Formocresol use has been questioned due to toxicity concerns.
Calcium enriched mixtures have been used in permanent molar teeth with irreversible pulpitis showing positive outcomes. This metal-protein clot at the surface of the pulp may act as a barrier to external irritants. The physiological clot formation is thought to be able to minimise inflammation and internal resorption compared to calcium hydroxide. Most importantly, ferric sulphate causes minimal devitalization and subsequent preservation of the pulp tissue.
Formocresol is both a bactericidal and devitalizing agent. It kills bacteria and converts the pulp tissue into inert compounds. This action fastens the vital pulp, maintaining them inert and conserves the primary tooth until it falls off physiologically.
Formaldehyde is a hazardous substance and has perceived the need to reevaluate the use of formocresol. In addition, it also has local anesthetic or soothing effect on the dental pulp. However, it also leads to superficial necrosis of the pulp tissue in contact with the medication and has been shown to be toxic to cells in tissue culture. Mineral Trioxide Aggregate MTA [ edit ] MTA is a more recent material that constitutes of tricalcium silicate, dicalcium silicate, tricalcium aluminate, tetracalcium aluminoferrite, bismuth oxide and calcium sulphate.
MTA is known to have excellent physical characteristics, biocompatibility and has the ability to stimulate cytokine release from pulpal fibroblast, which can stimulate hard tissue formation. It has better structural integrity and forms a thicker, more localized dentinal bridge. However, the cost, availability and difficulty in handling this material remains its current drawback.
It can control bleeding without chemical coagulation and is antibacterial. However, it is considered as a sensitive technique. Tissue is removed by ablation through conversion of the laser beam to heat.
The carbon dioxide laser appears to be a promising alternative for pulpotomy therapy. The high success rate reported for pulpotomy suggests that this procedure offers hope as an alternative to root canal treatment in teeth with a diagnosis of irreversible pulpitis.
Cvek pulpotomy – revisited
Cvek pulpotomy - revisited.