Pulp Therapy in Pediatric Dentistry
Dr. Jeff Johnson
Division of Pediatric Dentistry
Department of Oral Health Science
University of Kentucky
Pulp Therapy in Pediatric Dentistry
--Vital Pulp Therapy-• Permanent Tooth Pulpotomy
– Objectives
• Maintain vitality of radicular pulp
• Achieve root-end closure (Apexogenesis)
• Eliminate need for apicoectomy
• Facilitate GP obturation with apical stop
Pulp Therapy in Pediatric Dentistry
--Vital Pulp Therapy-• Permanent Tooth Pulpotomy Agents
– Formocresol
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-• Objectives of Non-Vital Pulp Treatment
(Primary Teeth)
– Maintain tooth free of infection
– Achieve biomechanical cleansing and canal
obturation
– Promote physiologic resorption
– Maintain space and function
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-• Non-Vital Pulp Treatment (Primary Teeth)
– Choices
• Pulpectomy (most are partial due to anatomy)
• Extraction
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-• Pulpectomy Indications/Considerations
• Strategic importance of tooth (2nd primary
molar with unerupted 6-yr molar)
• Sufficient remaining tooth structure
• Poor chance of vital pulp treatment success
• Adequate remaining root
• Cooperative patient
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-• Pulpectomy Contraindications
– A non-restorable tooth
– A tooth with a mechanical or carious perforation
of the floor of the pulp chamber
– Pathologic root resorption involving more than onethird of the root
– Pathologic loss of bone support resulting in loss of
the normal periodontal attachment
– The presence of a dentigerous or follicular cyst
– Radiographically visible internal root resorption
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-•
Pulpectomy Technique
1.
2.
3.
4.
5.
6.
7.
Achieve adequate anesthesia and rubber dam isolation.
Remove all caries.
Remove the roof of the pulp chamber with a high-speed
handpiece.
Amputate the coronal aspect of the pulp tissue with a large round
bur in a slow-speed handpiece.
The remaining pulp tissue occupying the root canals is removed
using endodontic files at a predetermined working length,
approximately 1 to 2 mm short of the root apices.
The canals should be enlarged several sizes beyond the size of
the first file that fits snugly into the canal to a minimum final
size of 30 to 35.
Throughout root canal instrumentation, the canals should be
irrigated with sodium hypochlorite to aid in debridement.
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-•
Pulpectomy Technique
(continued)
8.
Dry the canals with
sterile paper points.
9. The canals are filled
with a treatment paste
(Zinc Oxide/Eugenol at
UKCD) using a pressure
syringe.
10. The tooth is restored
with a stainless steel
crown.
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy--
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-• Criteria for an ideal pulpectomy obturant
(treatment paste)
–
–
–
–
–
–
–
Antiseptic
Resorbable
Harmless to the adjacent tooth germ
Radiopaque
Non-impinging on erupting permanent tooth
Easily inserted
Easily removed
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-• Apexification (Young Permanent Teeth)
– Apical closure of an incompletely formed root
– Implemented when apexogenesis has failed
– Necrotic tissue removal short of the apexification
site
– Agent is placed in canals to achieve closure/apical
stop
• Apexification Recall Schedule
– Calcium Hydroxide Rotation
• 3-6 month intervals (Andreasen, 1994)
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-• Action of Calcium Hydroxide in Apexification
– Bactericidal
– Low grade irritation inducing hard tissue barrier formation
– Dissolves necrotic debris
• Forms of Calcium Hydroxide
– Caliscept
– Self-mixed (CaOH + sterile water or local anesthetic)
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-• Evaluation of Success
–
–
–
–
–
Asymptomatic
Radiographic absence of pathology
Continued root development
Hard tissue barrier at apex
Responsive pulp
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy-• In Review. . .
FYI
• Comparison between File Size and Needle for
Pressure Syringe
– Standard File
•
•
•
•
•
15-30
40
50
70-80
90-100
Needle Gauge
30
27
25
22
18
References
Barr Elizabeth, Flaitz Catherine, Hicks John. “A retrospective radiographic evaluation of
primary molar pulpectomies”. Pediatric Dentistry, Vol. 13, Number 1, 1991: 4-9.
Dummett, Cliff. “Pulp Therapy in Pediatric Dentistry”. Louisiana State University School of
Dentistry, April 16, 2003.
Georig Albert C., Camp Joe H. “Root canal treatment in primary teeth: a review”. Pediatric
Dentistry, Vol. 5, Number 1, 1983: 33-37.
Nash David A. “Pulpal Therapy, Module 6”. West Virginia University School of Dentistry.
Mink, John R. and Spedding, Robert. “Pediatric Pulp Treatment”. University of Kentucky College
of Dentistry.
Pinkham, J. R., senior editor. Pediatric Dentistry, Infancy through Adolescence, Third
Edition. W.B. Saunders Company, 1999.
Walton, Richard E. and Torabinejad, Mahmoud. Principles and Practice of Endodontics, Second
Edition. W.B. Saunders Company, 1996.
The Handbook, Second Edition. American Academy of Pediatric Dentistry, 1999.