pulpotomy

pulpotomy definition:

is a dental procedure used to removed decay from teeth. If your child has infection in the tooth’s pulp (pulpitis), your dentist may recommend pulpotomy . This procedure is also recommended when repair of a deep cavity exposes the pulp underneath, leaving it vulnerable to bacterial infection. With pulpotomy, pulp is removed. 

Because pulpotomy leaves the roots of a tooth intact and able to grow, it’s used primarily in children with primary teeth, which have an immature root formation.

procedure:

Your dentist will take X-ray of your teeth to determine you need  pulpotomy or any procedure.

Your dentist may prescribe antibiotics for you to start taking 5 or 7 days before the procedure.

Devitalization 

Multiple visits with application of formocresol in pulpotomy is used to fix the radicular pulp completely to reduce pulp infection. The radicular pulp was theoretically sterilized and devitalized, thereby reducing infection and internal resorption. Another form of nonchemical devitalization emerged: electrosurgical pulpotomy. Electrocautery releases heat that denatures pulp and reduces bacterial contamination. Experimentally, electrosurgery has been shown to reduce pathologic root resorption and periapical pathology, and a series of pulpal effects including acute and chronic inflammation, swelling and diffuse necrosis. It is reported that this method has high success rate in pulpotomies.However, this method may prove to be more diagnosis and technique sensitive, and it may not be suitable if apical root resorption has occurred.

Preservation

Zinc oxide-eugenol (ZOE) was the first agent to used for preservation. In recent years, glutaraldehyde has been proposed as an alternative to formocresol based on: its superior fixative properties, and low toxicity. A nonaldehyde chemical, ferric sulfate, has received some attention recently as a pulpotomy agent. It minimizes the chances for inflammation and internal resorption. This category of pulp therapy is still in flux, although major changes in the future are not likely.

Regeneration

The ideal pulpotomy treatment should leave the radicular pulp alive and healthy In this case, the tooth should be filled with noxious restorative materials within, thereby diminishing the chances of internal resorption, as well as formation of reparative dentin. Calcium hydroxide was the first agent used in pulpotomies that demonstrated any capacity to induce regeneration of dentin. However, the success rate is not that high. Recent advances in the field of bone and dentin formation have opened exciting new vistas for pulp therapy, which is a factor called bone morphogenetic protein (BMP). It has bone inductive properties, that can predictably induce bone for use in the fields of orthopedic, oral, and periodontal surgery. Most importantly for dentistry, these osteogenic proteins hold promise for pulp therapy.

Pulpotomy vs. pulpectomy

• Unlike pulpotomy, pulpectomy is done to remove all the pulp, plus the roots of an infected tooth. This procedure is required when the infection extends below the tooth’s crown.
• Pulpectomy is sometimes referred to as a baby root canal. In primary teeth, it’s done to preserve the tooth. In secondary teeth, it’s usually done as the first step in a root canal.

Young permanent teeth

Partial pulpotomy for carious exposures

Partial pulpotomy is also indicated in young permanent teeth with pulp exposure due to caries, provided that the bleeding can be controlled within several minutes. It is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1 to 3mm or deeper to reach the level of healthy pulp tissue. Pulpal bleeding can be controlled by irrigation of sodium hypochlorite or chlorhexidine. The site is then covered with a pulpal medicament, calcium hydroxide or MTA, followed by a final restoration that provides a complete seal to prevent any leakage and bacterial contamination following the restoration.

After the procedure, the remaining pulp should remain vital and the patient should be free of any adverse clinical signs or symptoms such as sensitivity, pain or swelling. Immature teeth should continue its normal development and apexogenesis.

Partial pulpotomy for traumatic exposures

Tooth crown fractures are one of the most common dental injuries and the pulp is exposed in approximately 25% of all crown fractures. Maintaining vitality of the pulp tissue in an immature tooth is important to allow continued growth of the tooth.

Partial pulpotomy due to a traumatic exposure is also known as Cvek Pulpotomy. The procedure involves removal of 1 to 3 mm (0.04 to 0.1 in) of inflamed pulp tissue beneath an exposure to reach  the level of healthy pulp tissue. The surface of the remaining pulp is then irrigated with bacteriocidal irrigants such as sodium hypochlorite or chlorhexidine until bleeding has ceased. The site is then covered with a pulpal medicament, either calcium hydroxide or MTA. The remaining cavity is then restored with a material that provides a complete seal to prevent any leakage and bacterial contamination following the restoration.

The remaining pulp tissue should continue to be vital after partial pulpotomy and teeth with immature roots should show continued normal development and apexogenesis. There should be no signs of pain, swelling, or sensitivity after the procedure. Cvek at al reported that partial pulpotomies after a traumatic exposure had a success rate of 96%.

Aftercare

Your tooth, gums, and the surrounding area of your mouth will be sufficiently numbed throughout the procedure so that you don’t feel any pain.

Afterward, children who received anesthesia or light sedation will be monitored for 30 minutes to 1 hour before they can leave the dentist’s office.

During this time, most children bounce back quickly. In some instances, sleepiness, vomiting, or nausea may occur.

You may also notice slight bleeding for several hours.

Avoid eating or drinking while your mouth is numb to avoid accidentally biting your inner cheek.

Once you’re able to eat, stick to soft food, such as soup or scrambled eggs, and avoid anything crunchy.