Pulpotomy

pulpotomy

Pulpotomy

pulpotomy is the removal of a portion of the pulp, including the diseased aspect, with the intent of maintaining the vitality of the remaining pulpal tissue by means of a therapeutic dressing. A healthy tooth has a space inside it called the "pulp space" which is filled with soft tissues - nerves, blood vessels, and pink connective tissue. When a carious process develops in a tooth, the bacteria associated with it can cause pulpal inflammation, which is often what causes toothache.

Damage to the pulp of permanent teeth usually requires a root canal treatment or endodontic therapy. The pulp of primary or deciduous teeth, which only have to survive until an adult teeth come in, and because they have a better blood supply, can sometimes be saved.

Indications

Primary teeth
Primary/deciduous (baby) teeth in children have relatively large pulp spaces. Caries do not have to develop significantly before they reach the pulp chamber.

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Visual of tooth decay.

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.

Diagram of pulpotomy.

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.

pulpotomy in iran

Diagram of general tooth anatomy.

Types

Partial Pulpotomy for Carious Exposures
In some cases, radicular pulp (pulp within the root of a tooth) may remain healthy despite carious exposure of the pulp chamber. In cases where root formation is incomplete (as during adolescent years), a partial pulpotomy may keep radicular pulp vital long enough to allow the roots to develop fully.[2]

Partial Pulpotomy for Traumatic Exposures
A partial pulpotomy for traumatic exposures is also called a Cvek Pulpotomy. When a baby tooth or young permanent tooth is traumatised - say, hitting your teeth on the handlebars of a bike - it can be broken in such a way that the pulp is exposed. Again, a partial pulpotomy may help it to finish developing and be saved.

Adult Pulpotomy

Adult pulpotomies are not as popular with dentists today as they were 100 years ago. Historically, traditional endodontia has been reported to be a more reliable treatment than pulpotomy techniques, based on the rate of saved teeth and the longevity of their preservation.However, new research is changing this view. The pulpotomy, as a therapeutic dental treatment, has a long history. It has been used for thousands of years.[3]

Medicaments

In primary teeth medicaments such as formocresol, mineral trioxide aggregate, zinc oxide eugenol and calcium hydroxide can be used in pulpotomy. Formocresol use has been questioned due to toxicity concerns.[4]

Ferric sulphate, sodium hypochlorite[5][6] or a local anaesthetic solution containing a vasoconstrictor agent can be used to arrest any bleeding from the pulp prior to the placement of medicament.

Calcium enriched mixtures have been used in permanent molar teeth with irreversible pulpitis showing positive outcomes.[7]

Alternative pulpotomy techniques

Electro-surgery pulpotomy

Also known as non-chemical devitalization. Its mechanism of action is the cauterization of the pulp tissue. It carburizes heat-denaturated pulp and bacterial contamination.

Laser pulpotomy

This technique overcomes histological effects of electro-surgery. It creates a superficial zone of coagulation or necrosis that remains compatible with the underlying tissue and isolates the pulp from vigorous effects of the sub-base.

 

10 common question about pulpotomy

1Is a Pulpotomy the same as a root canal?
A pediatric root canal procedure is referred to as a “pulpotomy.” ... The pulpotomy root canal procedure removes the infected pulp tissue within the crown of the tooth. A medication is placed to calm the nerve of the tooth and prevent bacterial growth.
2Why is a Pulpotomy performed?
A pulpotomy is a dental procedure in which the pulp of the tooth in the crown (the crown is the part of the tooth that is visible) is removed and the pulp in the root canal is left intact. It is mainly performed on primary teeth (on children) and is used to treat tooth decay that has extended to the pulp
3What is the difference between Pulpectomy and Pulpotomy?
The difference is a pulpotomy procedure involves removing the pulpal tissue only in the crown of the tooth. In a pulpectomy, the tissue is removed in both the crown and the root of the tooth. Both procedures provide the benefit of sparing tooth loss when tooth preservation is desired.
4Is a Pulpotomy painful?
When a tooth has a bad cavity, the pulp of the tooth is exposed. This can be very painful, because the sensitive nerves and tissue are vulnerable. ... In this case, we'll need to do a pulpotomy to remove the damaged pulp. A pulpotomy is a fairly common procedure for decayed baby molars.
5How much is a Pulpotomy?
A pulpotomy on an adult tooth typically costs about $90-$250 for just the procedure; total costs can be $750-$3,900 or more, with the exam, x-rays and crown or filling. Dental insurance might cover some or all of the costs of a pulpotomy and tooth restoration, depending on the terms of the policy.
6Does a baby root canal hurt?
Will my child have pain after baby tooth root canal therapy is performed? Since the affected nerves of the tooth are removed, your child should have very minimal pain after the root canal therapy treatment. During the treatment itself, the tooth is completely numbed using local anesthesia.
7What is a CVEK Pulpotomy?
A partial pulpotomy for traumatic exposures is also called a Cvek Pulpotomy. When a baby tooth or young permanent tooth is traumatised - say, hitting your teeth on the handlebars of a bike - it can be broken in such a way that the pulp is exposed.
8Is Pulpotomy done in permanent teeth?
Pulpotomy is considered as a treatment for immature permanent teeth with pulp exposure due to caries or trauma that gives evidence of extensive coronal pulpitis, and also as an emergency procedure for permanent mature teeth until root canal treatment can be accomplished
9What is Formocresol Pulpotomy?
Primary tooth root canal therapy has superior out- comes to ferric sulfate pulpotomy but has never been com- pared directly to the formocresol pulpotomy.23 The canal. filling material, non-reinforced zinc oxide and eugenol. (ZOE), provokes a localized inflammatory response in soft.
10What is a Pulpectomy procedure?
Pulpectomy Procedure. Root canals are valuable dental procedures used to treat and preserve teeth with badly infected roots. The pulp is the live portion of the tooth that extends into the root and contains nerve endings and tissues.

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