Devitalizing agents, non-vital methods of root canal therapy, non-vital pulpotomy and pulpectomy, indications, description of techniques - PowerPoint PPT Presentation

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Devitalizing agents, non-vital methods of root canal therapy, non-vital pulpotomy and pulpectomy, indications, description of techniques

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Title: Devitalizing agents, non-vital methods of root canal therapy, non-vital pulpotomy and pulpectomy, indications, description of techniques


1
Devitalizing agents, non-vital methods of root
canal therapy, non-vital pulpotomy and
pulpectomy, indications, description of techniques
2
  • Pediatric pulp therapy for primary and young
    permanent teeth involves the following
    techniques
  • 1. Indirect pulp capping
  • 2. Direct pulp capping
  • 3. Coronal pulpotomy
  • 4. Pulpectomy

3
INDIRECT PULP CAPPING
  • Indirect pulp capping is defined as the
    application of a medicament over a thin layer of
    remaining carious dentin, after deep excavation,
    with no exposure of the pulp.

Figure 17-4 Indirect pulp-capping technique. A,
Medicament, either zinc oxideeugenol cement,
calcium hydroxide, or both, against remaining
caries. B, Lasting temporary restoration. Followin
g repair, both materials are removed along with
softened caries, and final restorations are
placed.
4
DIRECT PULP CAPPING
  • Direct pulp capping involves the placement of a
    biocompatible
  • agent on healthy pulp tissue that has been
  • inadvertently exposed from caries excavation or
    traumatic injury (Figure 17-6).

Figure 17-6 Direct pulp-capping technique. A,
Capping material covers pulp exposure and the
floor of the cavity. B, Protective base of zinc
oxideeugenol cement. C, Amalgam restoration.
5
PULPOTOMY
  • Pulpotomy is the most widely used technique in
    vital pulp therapy for primary and young
    permanent teeth with carious pulp exposures.
  • A pulpotomy is defined as the surgical removal of
    the entire coronal pulp presumed to be partially
    or totally inflamed and quite possibly infected,
    leaving intact the vital radicular pulp within
    the canals.
  • A germicidal medicament is then placed over the
    remaining vital radicular pulp stumps at their
    point of communication with the floor of the
    coronal pulp chamber

6
Definition
  • Pulpotomy-Partial pulpectomy
  • Removal or amputation of the entire coronal
    pulp-leaving the remaining tissue intact in the
    canals.

7
Purpose of Non-vital pulpotomy
  • Sterilization of the remaining pulp and fixation
    of subjacent tissue
  • Non-vital pulpotomy devitalization of the whole
    pulp, then amputation of the coronal pulp and
    mumification of the remaining root pulp.

8
Fixing material
  • Glutaraldehyde
  • N2 paste
  • Devitalizing agent
  • Paraformaldehyde paste-Toxavit

9
Non-vital pulpotomy.
10
TOXAVIT
11
DEPULPIN
12
Technique 2 visits
  • 1st.visit
  • application of paraformaldehyde paste, we apply
    it by cotton woll in the cavity and cover with
    temporary filling and then wait for 10-12 days
  • 2st.visit
  • The coronal pulp is removed and the remaining
    pulp is covered with mumifying paste (Foredent)
    resorcin-formaldehyde paste, then mumifying paste
    is covered with cement and amalgam.

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15
Indication
  • In primary teeth only- its not recommended in
    permanent teeth because of development of chronic
    periapical involvement.
  • In patients with blood diseases, when extraction
    is contraindicated
  • Local factors-fine lumen/ tortuous canal anatomy

16
Non-vital pulpectomy
  • Definition extirpation or removal of the whole
    pulp which is before devitalized with
    devitalizing agent
  • In the past arsenic trioxide, formaldehyde was
    prefered devitalizing agents
  • In the present time paraphormaldehyde
  • paraformaldehyde 1 g, lignocaine 0.06 g, carmine
    (colour) 0.01 g, carbowax 1500 1.3 g, propylene
  • glycol 0.5 ml.

17
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18
Pulpectomy
  • Pulpectomy is a root canal procedure for pulp
    tissue that is
  • irreversibly infected or necrotic due to caries
    or trauma. The
  • root canals are debrided, enlarged, disinfected,
    and filled with a
  • resorbable material such as nonreinforced zinc
    oxide-eugenol.
  • The tooth then is restored with a restoration
    that seals the tooth
  • from microleakage.
  • Indications A pulpectomy is indicated in a
    primary tooth with
  • irreversible pulpitis or necrosis or a tooth
    treatment planned for
  • pulpotomy in which the radicular pulp exhibits
    clinical signs of
  • pulp necrosis such as excessive hemorrhage. The
    roots should
  • exhibit minimal or no resorption.
  • The technique can be carried out in one or two
    visits.

19
  • The procedures need 2 appointments, in the first
    one devitalizing agent is put on the pulp, and in
    2nd, root canal therapy is ended.
  • Indication When anaesthetic can not be
    administered due to heart diseases, hypertension,
    blood diseases
  • With multirooted tooth, because performance of
    vital pulpectomy and complete root canal therapy
    in one-appointment is difficult or problematic.

20
Pulpectomy Technique
  • Achieve adequate anesthesia and rubber dam
    isolation.
  • Remove all caries.
  • Remove the roof of the pulp chamber with a
    high-speed handpiece.
  • Amputate the coronal aspect of the pulp tissue
    with a large round bur in a slow-speed handpiece.
  • The remaining pulp tissue occupying the root
    canals is removed using endodontic files at a
    predetermined working length, approximately 1 to
    2 mm short of the root apices.
  • The canals should be enlarged several sizes
    beyond the size of the first file that fits
    snugly into the canal to a minimum final size of
    30 to 35.
  • Throughout root canal instrumentation, the canals
    should be irrigated with sodium hypochlorite to
    aid in debridement.

21
Pulp Therapy in Pediatric Dentistry --Non-Vital
Pulp Therapy--
  • Pulpectomy Technique (continued)
  • 8. Dry the canals with sterile paper points.
  • 9. The canals are filled with a treatment paste
    (Zinc Oxide/Eugenol at UKCD) using a pressure
    syringe.
  • 10. The tooth is restored with a stainless steel
    crown.

22
  • Pulpectomy Contraindications
  • A non-restorable tooth
  • A tooth with a mechanical or carious perforation
    of the floor of the pulp chamber
  • Pathologic root resorption involving more than
    one-third of the root
  • Pathologic loss of bone support resulting in loss
    of the normal periodontal attachment
  • The presence of a dentigerous or follicular cyst
  • Radiographically visible internal root resorption

23
  • Criteria for an ideal pulpectomy obturant
    (treatment paste)
  • Antiseptic
  • Resorbable
  • Harmless to the adjacent tooth germ
  • Radiopaque
  • Non-impinging on erupting permanent tooth
  • Easily inserted
  • Easily removed

24
Pulp Therapy in Pediatric Dentistry --Non-Vital
Pulp Therapy--
  • Action of Calcium Hydroxide
  • Bactericidal
  • Low grade irritation inducing hard tissue barrier
    formation
  • Dissolves necrotic debris
  • Forms of Calcium Hydroxide
  • Caliscept
  • Self-mixed (CaOH sterile water or local
    anesthetic)

25
Pulp Therapy in Pediatric Dentistry --Non-Vital
Pulp Therapy--
  • Evaluation of Success
  • Asymptomatic
  • Radiographic absence of pathology
  • Continued root development
  • Hard tissue barrier at apex
  • Responsive pulp

Pulp Therapy in Pediatric Dentistry --Non-Vital
Pulp Therapy--
26
Pulp Therapy in Pediatric Dentistry --Non-Vital
Pulp Therapy--
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