Pulpotomy and Pulpectomy in Children

When the principal or standing tooth nerve or pulp tissue is infected, it needs to be treated to evade dental abscess and tooth loss. The two methods of treating dental nerve tissue infections is pulpotomy and pulpectomy. The eventual objective of these procedures is to save the tooth, so that the integrity and function of the dental vault can be maintained.

Pulpotomy for Primary Teeth

The full coronal pulp surgical removal or excision, leaving intact the vital radicular pulp within the canals.

• To cut or take off the coronal pulp infection.
• Neutralize or counteract any residual infectious process.
• Conserve the radicular pulp vitality.

Pulpotomy Indications:

1. Decayed primary teeth exposed, when their detaining is more advantageous than extraction.
2. When inflammation is confined to the coronal portion of the pulp.

Contraindications for Pulpotomy

1. Fistula or swelling.
2. The tooth crown is nonrestorable.
3. Absence of hemorrhage; profuse hemorrhage.
4. Marked tenderness to percussion.
5. Mobility.
6. Radiolucency exists in the furcal or periradicular areas.
7. Voluntary pain, especially at night.
8. Necrotic pulp.
9. Dystrophic calcification (pulp stones).

Technique for Pulptomy of the Primary Teeth

1. Deep anesthesia for tooth and tissue.
2. Rubber dam is used to separate the tooth.
3. Caries excavation.
4. Dentin roof of the pulp chamber removal.
5. Coronal pulp tissue removal with a slow-speed No. 6 or 8 round bur or sharp spoon excavator.
6. Achieve hemostasis with dry cotton pellets under pressure.
7. Diluted formocresol applied to pulp on cotton pellet for 3- 5 minutes. Pressure on pellet.
8. Tooth prepared for SSC.
9. Dry pulp stumps.
10. Glass ionomer, ZOE, IRM, or MTA placed in contact with pulp stumps.
11. Place stainless steel crown.