Devitalizing agents, non-vital
methods of root canal therapy, nonvital pulpotomy and pulpectomy,
indications, description of techniques
 Pediatric pulp therapy for primary and
young permanent teeth involves the
following techniques:




1. Indirect pulp capping
2. Direct pulp capping
3. Coronal pulpotomy
4. Pulpectomy
INDIRECT PULP CAPPING
 Indirect pulp capping is defined as the
application of a medicament over a thin
layer of remaining carious dentin, after deep
excavation, with no exposure of the pulp.
Figure 17-4 Indirect pulp-capping
technique. A, Medicament,
either zinc oxide–eugenol cement, calcium
hydroxide, or both,
against remaining caries. B, Lasting
temporary restoration.
Following repair, both materials are
removed along with softened
caries, and final restorations are placed.
DIRECT PULP CAPPING
 Direct pulp capping involves the placement
of a biocompatible
 agent on healthy pulp tissue that has been
 inadvertently exposed from caries
excavation or traumatic injury (Figure 17-6).
Figure 17-6 Direct pulp-capping technique.
A, Capping material
covers pulp exposure and the floor of the
cavity. B, Protective base
of zinc oxide–eugenol cement. C,
Amalgam restoration.
PULPOTOMY
 Pulpotomy is the most widely used technique in
vital pulp therapy for primary and young
permanent teeth with carious pulp exposures.
 A pulpotomy is defined as the surgical removal of
the entire coronal pulp presumed to be partially or
totally inflamed and quite possibly infected, leaving
intact the vital radicular pulp within the canals.
 A germicidal medicament is then placed over the
remaining vital radicular pulp stumps at their point
of communication with the floor of the coronal pulp
chamber
Definition
 Pulpotomy-Partial pulpectomy
 Removal or amputation of the entire
coronal pulp-leaving the remaining
tissue intact in the canals.
Purpose of Non-vital pulpotomy
 Sterilization of the remaining pulp and
fixation of subjacent tissue
 Non-vital pulpotomy: devitalization of the
whole pulp, then amputation of the
coronal pulp and mumification of the
remaining root pulp.
Fixing material
 Glutaraldehyde
 N2 paste
Devitalizing agent
 Paraformaldehyde paste-Toxavit
Non-vital pulpotomy.
TOXAVIT
DEPULPIN
Technique: 2 visits
 1st.visit:
 application of paraformaldehyde paste, we
apply it by cotton woll in the cavity and cover
with temporary filling and then wait for 10-12
days
 2st.visit:
 The coronal pulp is removed and the remaining
pulp is covered with mumifying paste
(Foredent) – resorcin-formaldehyde paste, then
mumifying paste is covered with cement and
amalgam.
Indication:
 In primary teeth only- its not
recommended in permanent teeth
because of development of chronic
periapical involvement.
 In patients with blood diseases, when
extraction is contraindicated
 Local factors-fine lumen/ tortuous canal
anatomy
Non-vital pulpectomy
 Definition: extirpation or removal of the whole
pulp which is before devitalized with
devitalizing agent
 In the past: arsenic trioxide, formaldehyde was
prefered devitalizing agents
 In the present time: paraphormaldehyde
 paraformaldehyde 1 g, lignocaine 0.06 g, carmine
(colour) 0.01 g, carbowax 1500 1.3 g, propylene
glycol 0.5 ml.
Pulpectomy
 Pulpectomy is a root canal procedure for pulp tissue that is
irreversibly infected or necrotic due to caries or trauma. The
root canals are debrided, enlarged, disinfected, and filled with a
resorbable material such as nonreinforced zinc oxide-eugenol.
The tooth then is restored with a restoration that seals the tooth
from microleakage.
 • Indications: A pulpectomy is indicated in a primary tooth with
irreversible pulpitis or necrosis or a tooth treatment planned for
pulpotomy in which the radicular pulp exhibits clinical signs of
pulp necrosis such as excessive hemorrhage. The roots should
exhibit minimal or no resorption.
 The technique can be carried out in one or two visits.
 The procedures need 2 appointments, in the
first one devitalizing agent is put on the pulp,
and in 2nd, root canal therapy is ended.
 Indication: When anaesthetic can not be
administered due to heart diseases,
hypertension, blood diseases
 With multirooted tooth, because performance
of vital pulpectomy and complete root canal
therapy in one-appointment is difficult or
problematic.
Pulpectomy Technique
1.
2.
3.
Achieve adequate anesthesia and rubber dam isolation.
Remove all caries.
Remove the roof of the pulp chamber with a high-speed
handpiece.
4. Amputate the coronal aspect of the pulp tissue with a large
round bur in a slow-speed handpiece.
5. 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.
6. 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.
7. 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.
 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
– 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- Action of Calcium Hydroxide
– 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
Pulp Therapy in Pediatric Dentistry
Radiographic
absence
of pathology
--Non-Vital
Pulp Therapy-Continued root development
Hard tissue barrier at apex
Responsive pulp
Pulp Therapy in Pediatric Dentistry
--Non-Vital Pulp Therapy--