After all it depends on the case whether we will do a pulpectomy (Root Canal Treatment) or Pulpotomy. Pulpotomy is the removal of part of the pulp & leaving the other in the root portion to preserve its vitality.
Pulpotomy procedure is more commonly done in primary teeth, because the main goal of it is to preserve the vitality of the tooth to allow for the normal exfoliation (replacement with a permanent tooth) process. The pulp of the root portion should be healthy for this procedure to be performed correctly. However, there are certain contraindications that prevents us from performing this procedure & it includes:
- Positive percussion test: A pain will be elicited once the dentist taps on your teeth with a metal instrument. If this occurs, its most likely that the pulp is dead & the pain felt is due to inflammation and infection of the bone tissues around the root. Hence, pulpectomy or extraction might be required. The patient will also be complaining of pain on biting.
- Tooth Restorability: If the tooth is beyond any way to be restored, pulpectomy is required just to preserve the tooth in place & alleviate pain & prevent migration of other teeth if its to be extracted. If its badly damaged, an extraction might be indicated followed by the application of space maintainer to preserve the space left behind for the eruption of the permanent tooth underneath it.
- Proximity of Exfoliation: If the roots of the tooth is 1/3 – 2/3 resorbed, neither pulpotomy or pulpectomy is indicated. To alleviate pain however, a procedure called Direct Pulp Capping might be done. This procedure involves the removal of carious tooth structure and the placement of intracanal medication to reduce the pain. This procedure is not always successful as it differs from one child to another. An extraction is usually preferred.
- Irreversible pulp damage: if the pulp is dead as a result of caries for example, is an indication for pulpectomy or extraction.
First, a history of the patient along with proper x-rays shall be taken before attempting any kind of treatment. An anesthetic along with proper isolation of the tooth is performed. Once it has been indicated that pulpotomy is necessary, the dentist will start using his drill to remove all the carious defects and gain an access to the pulp. The pulp will then be removed and a dressing material of Ferric Sulphate is placed on the orifices (openings) of the root canal and Zinc Oxide Eugenol or any other paste is used to fill the space left behind after removal of the pulp. Build up of the tooth with composite or any other material is then performed and stainless steel crown is made to cover it for protection.
Do you have a child with this procedure performed? How was the experience?
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Haider Maitham, DDS