BYDr. SUMEET VINCENT TIGGA
(G.D.C RAIPUR)
DEFINATION-:
 PULPOTOMY CAN BE DEFINED AS THE COMPLETE
REMOVAL OF CORONAL PORTION OF THE DENTAL
PULP , FOLLOWED BY PLACEMENT OF SUITABLE
DRESSING OR MEDICAMENT THAT WILL PROMOTE
HEALING & PRESERVE VITALITY OF THE TOOTH
(Finn,1985 )
INDICATION-:
 Cariously exposed primary teeth, when their retention is more
advantageous than extraction.
 Vital tooth with healthy periodontium
 Pain, if present not spontaneous nor persists after removal of the
stimulus
 Tooth which is restorable
 Tooth with-2/3rd root length
 Hemorrhage from the amputation site is pale red & easy to
control
 In mixed dentition stage primary tooth is preferable to a space
maintainer
.
CONTRAINDICATION -:
 Evidence of internal resorption
 Presence of inter radicular bone loss
 Abscess , fistula in relation to teeth
 Radiographic sign of calcific globules in pulp chamber
 Caries penetrating the floor of pulp chamber
 Tooth close to natural exfoliation
CLASSIFICATION-:
 I.Vital Pulpotomy techniques
1. DEVITALIZATION: (mummification & cauterization)

Single Sitting: 1. Formocresol
2. Electrosurgery
3. Laser

Two sittting: 1. Gysi triopaste
2. Easlick’s formaldehyde
3. Paraform devitalising paste
.
 2.PRESERVATION:
1.Glutaraldehyde
2.Ferric sulphate
3.MTA
 3.REGENERATION: (inductive & reparative)
1.Bone morphogenic protein
 II. Non-Vital pulpotomy techniques(mortal
pulpotomy)
1.Beechwood cresol
2.formocresol
TREATMENT OBJECTIVES-:
 >Amputate the infected coronal pulp,
 >Neutralize any residual infectious process,
 >Preserve the vitality of the radicular pulp.
 >Avoid breakdown of periradicular area
 >Treat remaining pulp with medicament
 >Avoid dystrophic pulpal changes
A.DEVITALIZATION (SINGLE SITTING)
 FORMOCRESOL PULPOTOMY TECHNIQUE
 First advocated by SWEET(1930)
 FORMOCRESOL SOLUTION:
*19% formaldehyde
*35% cresol
*15% glycerine (veichle)
Buckley’s solution: 1:5 conc. Of formocresol solution.

..
 To prepare a 1:5 conc. Of this formula First thoroughly mix 3 part of glycerinre with 1 part of
distilled water
 Then add 4 parts of this preparation to 1 part Buckley’s
formocresol & thoroughly mix again
 Mechanism Of Action:
Formocresol prevents tissue
autolysis by bonding to protein. This is reversible
process and is accomplished without changing the
basic overall structure of the protein molecules
Technique for Pulptomy of the
Primary Teeth
 1. Profound anaesthesia for tooth and tissue.
 2. Isolate the tooth to be treated with a rubber dam.
 3. Excavate all caries.
 4. Remove the dentin roof of the pulp chamber.
 5. Remove all coronal pulp tissue with a slow-speed No.
6 or 8 round bur or sharp spoon excavator
.
 6. Achieve heamostasis with moist cotton pellets under
pressure.
 7. Apply diluted formocresol to pulp on cotton pellet for 3- 5
minutes. Pressure on pellet.
 9. Pulp chamber is dried with new cotton pellets .
 10. Place a thick paste of ZOE in contact with pulp stumps.
 11. Place stainless steel crown (or bonded composite)
.
.
.
DEVITALIZATION
PULPOTOMY(TWO STAGE)
 ~Two stage procedure involves use of paraformaldehyde to
fix the entire coronal & radicular pulp tissue.
 ~The medicaments used in this technique have a
devitalizing, mummifying and bactericidal action.
 Indications:
.Profuse bleeding
.Difficulty in controlling bleeding
.Spontaneous pain
.Slight purulence discharge
.Thickened PDL
`
 Contraindication:
.Non restorable
.Necrotic
.Soon to be exfoliated
 Formula of each agent used are as follows:
 1.GYSI TRIOPASTE FORMULA:
*tricresol 10 ml
*cresol 20 ml
*glyserine 4 ml
*paraformaldehyde 20 ml
*zinc oxide 60 gm
.
 2.EASLICK’S PARAFORMALDEHYDE FORMULA:
*paraformaldehyde 1 gm
*procaine base 0.03 gm
*powdered asbestos 0.05 gm
*petroleum jelly 125 gm
*carimine to colour
 3.PARAFORM DEVITALIZING PASTE:
*paraformaldehyde 1gm
*lignocaine 0.06 gm
*propylene glycol 0.05 ml
*carbowax 1500 1.30 gm
*carmine to colour
. First appointment:
 Isolation of the affected teeth with rubber dam
 Preparation of the cavity , excavate the caries
 On excavation of deep caries pulp exposure is encountered ,
ensure that the exposed site is free of debris
 Enlarge the cavity with round bur
 Cotton pellet with paraformaldehyde is placed in the exposure
site ,seal it for 1 to 2 weeks

(formaldehyde gas liberated from the paraformaldehyde
permeates through the coronal & radicular pulp, fixing the
. Second appointment

In the second appointment pulpotomy is carried with
the help of L.A.
 The roof of the pulp chamber is removed and cleaned
with saline and dried with cotton pellet
 The pulp chamber is then filled with antiseptic paste and
the tooth is restored.
PARTIAL PULPOTOMY
The partial pulpotomy for traumatic exposures is a
procedure in which the inflamed pulp tissue beneath an
exposure is removed to a depth of 1-3 mm to reach the
deeper healthy tissue
 -Indicated for a vital , traumatically exposed, young
permanent tooth, especially one with an incompletely
formed apex.
 -Calcium hydroxide or MTA is used
NON-VITAL PULPOTOMY

Ideally, a non-vital tooth should b treated by
pulpectomy or root canal filling
 However, pulpectomy of a primary molar may
sometime be impracticable due to non-negotiable root
canals and also due to limited patient co-operation.
 Hence, a two-stage pulpotomy technique is advocated .
SELECTION CRITERIA
 History of spontaneous pain
 Swelling ,redness or soreness of mucosa
 Tooth mobility
 Tenderness to percussion
 Radiographic evidence of root resorption

TCHNIQUE
 1ST APPOINTMENT

- NECROTIC PULP IS REMOVED

- PULP CHAMBER IS IRRIGATED WITH
SALINE & DRIED WITH COTTON PELLET

-RADICULAR PULP IS TREATED WITH
BEACH WOOD CERSOL DIPPED COTTON PELLET

-SEAL THE CAVITY WITH TEMP. CEMENT
FOR 1-2 WEEKS


SECOND APPOINTMENT--
 ISOLATE THE TOOTH

REMOVE THE TEMPORARY DRESSING & PELLET
CONTAINING BEECHWOOD CRESOL

IF SIGN & SYMPTOMS PERSIST THEN REPEAT
THE TREATMENT OR EXTRACT THE TOOTH

IF NO SYMPTOMS PULP CHAMBER IS FILLED
WITH ANTISEPTIC PASTE

THEN IT CAN B RESTORED WITH STAINLESS
STEEL CROWN
ELECTROSURGICAL PULPOYOMY
 > Mack & Dean,1993

 > Non-pharmacological technique
 > Non-chemical devitalisation , hear electrocautery
carbonized & heat denatures the pulp & bacterial
contamination
.
 > After amputation of the coronal pulp , the pulp stumps
are cauterized through this method. After completion ,the
pulp chamber is filled with ZnOE.
 The tooth is then restored with stainless steel crown
 > Disadvantage: contaminated pulp tissue does not
promote adequate current penetration . It cannot eliminate
radicular pulp inflammation
LASER PULPOTOMY:

> Non- pharmocologic hemostatic technique
 > Jeng-fen Liu et al in 1999- studied the effect of
Nd:YAG laser for pulpotomy in primary tooth-100%
success with no signs or symptoms,
PRESERVATION
 Chemicals which induce minimal insult to the tissue are used.
 They help to conserve vitality of the radicular pulp
Chemicals used are glutaraldehyde (2-5%)and ferric sulphate
 Glutaraldehyde: (by Kopel,1979)
(1) superior fixation by cross-linkage
(2) diffusibility is limited
(3) excellent antimicrobial agent
(4) causes less necrosis of pulpal tissue;
IN HIGHER CONC. FOR LONGER EXPOSURE GLUTERALDEHYDE
SHOWS CYTOTOXIC & MUTAGENIC EFFECTS SAME AS
FORMOCRESOL
.
Ferric sulfate It is a non aldehyde haemostatic compound
(1)astringent;
(2)forms a ferric ion-protein complex that mechanically
occludes capillaries;
(3) less inflammation than formocresol
(4) 92.7% radiographic success rate.
(5)100% clinical success
(6)root resorption is not accelerated
(7)internal resorption similar to formocresol ,no systemic or
local side effects
REGENERATION:
An ideal pulpotomy treatment should leave the radicular
pulp vital , healthy and completely enclosed within an
odontoblast-lined dentin chamber.
This involves use of BMP(bone morphogenic protein) which
contains a factor(oeteogenic proteins) capable of auto
induction of reparative dentin formation(stimulating
induction & differentiation of mesenchymal cells with
varying degrees of dentinal bridge formation)
THANK YOU