Endodontics in Primary Teeth

Question 1

List the disadvantages of unplanned primary tooth extractions.

(5)

Answer 1

• loss of space causing increased risk of malocclusion
• decreased masticatory funnction
• impeded speech development
• psychological disturbance
• trauma from anaesthesia/surgery

Question 2

What are the indications for pulp treatment in the primary dentition?

(5)

Answer 2

• good cooperation
• medical history precludes extraction
• missing permanent successor
• over-riding necessity to preserve the tooth (e.g. space maintainer)
• child under 9 years of age

Question 3

What are the contra-indications for pulp treatment in the primary dentition?

(6)

Answer 3

• poor cooperation
• poor dental attendance
• cardiac defect
• multiple grossly carious teeth
• advanced root resorption
• severe/recurrent pain or infection

Question 4

What are the pulp treatments that can be done for a vital primary tooth?

Answer 4

• pulp capping
• vital pulpotomy

Question 5

What is the pulp treatment that can be done on a non-vital tooth?

Answer 5

pulpectomy (RCT)

Question 6

What is the success rate of vital pulpotomy vs pulpectomy?

Answer 6

vital pulpotomy 85-100% over 3-5 years

pulpectomy 90%

Question 7

Describe the clinical techique for vital pulpotomy.

Answer 7

• administer LA
• use rubber dam
• remove caries/
• remove roof of pulp chamber
• remove coronal pulp with sterile excavator or slow running large round steel bur
• assess pulpal bleeding (normal bleeding is bright red colour and good haemostatis; abnormal bleeding is deep crimson and continued bleeding after pressure)
• place a cotton pledget with ferric sulphate for 20 seconds
• place zinc oxide eugenol in the pulp chamber over root stumps
• GIC core
• restore using a preformed metal crown

if bleeding is abnormal, proceed with pulpectomy

Question 8

What are the signs and symptoms of a non-vital primary molar?

Answer 8

Signs:
* hyperaemic pulp (abnormal bleeding)
* pulp necrosis and furcation involvement

Symptoms:
* irreversible pulpitis
* periapical periodontitis
* chronic sinus

Question 9

When is a primary molar pulpectomy indicated?

Answer 9

excellent patient co-operation

Question 10

What is the aim of a primary molar pulpectomy?

Answer 10

Prevent/control infection by extirpation of radicular pulp followed by cleaning and obturation of canals

Question 11

What are the potential complications of a primary molar pulpectomy?

Answer 11

• early resorption leading to early exfoliation
• over-preparation

Question 12

Describe the clinical techique for pulpectomy.

Answer 12

• administer LA
• rubber dam
• remove caries
• remove roof of pulp chamber
• remove contents of pulp chamber
• use files to remove pulpal tissues from canals to 2mm short of EWL
• irrigate with CHX and dry with paper points
• obturate canals with Vitapex (CaOH and iodoform paste) or a very thin mix of zinc oxide eugenol
• seal with thick mix of zinc oxide eugenol or GIC and restore with a preformed metal crown

Question 13

What is the follow-up regime for pulpotomy and pulpectomy?

Answer 13

Assess clinically after 6 months:
* pathological mobility
* fistula/chronic sinus
* pain

Assess radiographically after 12-18 months:
* increased radiolucency
* external/internal resorption
* furcation bone loss