dr. vivek rana, subharti dental college,...
TRANSCRIPT
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Dr. Vivek Rana, Subharti Dental College, SVSU
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Dr. Vivek Rana Professor Dept. Of Pediatric & Preventive Dentistry
Dr. Vivek Rana, Subharti Dental College, SVSU
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DEFINITION
Dr. Vivek Rana, Subharti Dental College, SVSU
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Dr. Vivek Rana, Subharti Dental College, SVSU
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Contraindications
1. Non-restorable tooth
2. Periradicular involvement extending to the permanent tooth bud
3. Root resorption-internal or external
4. Extensive mobility
5. Gross bone loss at the apex or at the furcation.
Dr. Vivek Rana, Subharti Dental College, SVSU
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Types of Pulpectomy
Pulpectomy can be of two types
single visit
multi visit
Dr. Vivek Rana, Subharti Dental College, SVSU
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SINGLE VISIT PULPECTOMY
Single visit pulpectomy is generally carried out
as an extension of pulpotomy procedure,
probably as an on the spot decision, when
hemorrhage from the amputated radicular
stumps is uncontrollable.
It is also done on a tooth with history of
spontaneous pain and not done on a tooth
with abscess, fistula (necrotic pulp).
Dr. Vivek Rana, Subharti Dental College, SVSU
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Procedure of Single Visit Pulpectomy
• . Done under local anesthesia and rubber dam
isolation.
• . All caries should be removed.
• . Entire roof of the pulp chamber is cut with high-
speed bur and water spray.
• . The coronal pulp is removed with the round bur or
• spoon excavator.
• . Pulp chamber is washed thoroughly, to remove all
• debris.
• . All accessible radicular pulp is removed with
broaches
Dr. Vivek Rana, Subharti Dental College, SVSU
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No attempt is made to extend the instrument beyond the apex. Filing is done with H files or K files along with the use of lubricants.
Five percent sodium hypochlorite, hydrogen peroxide, saline, etc. are used for irrigation. Hedstrom files are recommended since they remove hard
tissue only on withdrawal, which prevents pushing infected material through the apices. The canals should be instrumented to the resistance point,
that usually corresponds to 2-3 mm from the radiographic apex.
Each canal should be enlarged 3-4 instrument sizes greater than the first file.
Dr. Vivek Rana, Subharti Dental College, SVSU
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Canal is filed with the aim of enlarging them to permit condensation of root canal filling material.
Canals are irrigated with saline and dried
Canals are filled with suitable filling material.
Radiograph should be taken for proper obturation.
Dr. Vivek Rana, Subharti Dental College, SVSU
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Dr. Vivek Rana, Subharti Dental College, SVSU
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PULPECTOMY PROCEDURE
Dr. Vivek Rana, Subharti Dental College, SVSU
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Multivisit Pulpectomy
Used for non-vital primary teeth.
Clinical technique is similar to single visit.
Instrumentation of the canals are not recommended at the first visit.
Between appointments, an antibacterial drug is sealed in the pulp chamber.
If pus is present, the canal can be left open to drain for 24 hrs.
Systemic antibiotics are advised if cellulitisis present .
The number of appointments, timing and extent of instrumentation will be determined by the signs and symptoms at each visit,usually about 7-10 days apart.
Dr. Vivek Rana, Subharti Dental College, SVSU
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Problems Encountered in Deciduous Tooth Pulpectomy Multiple ramification-makes
complete debridement impossible
Ribbon shaped or hour glass shaped canals-discourages gross enlargement of the canal.
Dr. Vivek Rana, Subharti Dental College, SVSU
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Evaluation of Success of pulpectomy
Resolution of sinus tract, by 6 months No purulent discharge from the gingival
margin No abnormal mobility No postoperative pain No further resorption of root (except
physiological) Resolution of bifurcation radiolucency
by 6-12 months.
Dr. Vivek Rana, Subharti Dental College, SVSU
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OBTURATION OF DECIDUOUS ROOT CANAL
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ROOT CANAL FILLING MATERIAL
IDEAL PROPERTIES Resorb at a similar rate as the primary root.
Should be harmless to the periapical tissues and to the permanent tooth germ, resorb readily if pressed beyond the apex. It should have a stable disinfecting power.
It should be inserted easily into the root canal and be removed easily if necessary.
Dr. Vivek Rana, Subharti Dental College, SVSU
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Should adhere to the walls of the canal and should not shrink.
It should not be soluble in water.
Be radiopaque and not discolour the tooth.
No material currently available meets all
these cri-teria.
The filling material most commonly used for primary pulp canals are Zinc Oxide –eugenol paste, iodoform & calcium hydroxide paste
Dr. Vivek Rana, Subharti Dental College, SVSU
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Dr. Vivek Rana, Subharti Dental College, SVSU
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Walkhoff paste
Parachlorophenol
Camphor
Menthol
Dr. Vivek Rana, Subharti Dental College, SVSU
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KRI paste 1.Iodoform80.8% 2.Camphor 4.86% 3.Parachlorophenol
2.025% 4.Menthol 1.215%
Dr. Vivek Rana, Subharti Dental College, SVSU
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Maisto paste Zinc Oxide 14 gms
Iodoform 42 gm
Thymol 2 gm
Chlorophenol Camphor 3cc
Lanolin 0.50 gms
Dr. Vivek Rana, Subharti Dental College, SVSU
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VITAPEX Calcium hydroxide
Iodoform
Oily additives
Dr. Vivek Rana, Subharti Dental College, SVSU
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Method of Obturation Lentulo spiral, pressure syringe, Jiffy's
syringe, amalgam condensor, local anesthetic syringe, tuberculin syringe, files, etc. can be used.
Zincoxide eugenol is mixed to the required consistency.
It is carried in a lentulo spiral and spun down the canal, just short of the apex
Dr. Vivek Rana, Subharti Dental College, SVSU
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Cotton held with cotton pliers can be used as piston to push the material into the canal
Pressure syringe is also effective. Advantages are--
1. avoidance of air trap
2. even amount of material is deposited
3. 300 psi force produced allows the use of thick consistency.
Dr. Vivek Rana, Subharti Dental College, SVSU
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GUTTA PERCHA IS NOT INDICATED AS DECIDUOUS ROOT CANAL FILLING MATERIAL BECAUSE IT IS NON RESORBABLE.
If the succedaneous permanent tooth is missing, canals can be obturated with gutta percha
Dr. Vivek Rana, Subharti Dental College, SVSU
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Follow-up
• 6 monthly evaluation should be done
• IOPA X ray should be taken between
12-18 months post-operatively
• Following pulp therapy, it is
advisable to place stainless steel
crown to prevent fracture.
Dr. Vivek Rana, Subharti Dental College, SVSU
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Dr. Vivek Rana, Subharti Dental College, SVSU