Primary Molar Pulpotomy and Pulpectomy

Question 1

Give the clinical indications for vital pulpotomy

Answer 1

• Pulp minimally inflamed / reversible pulpitis
• Marginal ridge destroyed
• Caries extending >2/3rds into dentine on radiograph
• Pulp exposure due to caries or iatrogenic

Question 2

Aims of Vital pulpotomy

Answer 2

• Arrest bleeding
• Disinfect
• Preserve vitalilty of apical portion of radicular pulp

Question 3

Technique of Vital Pulpotomy Primary molar

Answer 3

• LA
• Dental dam
• Endodontic access
• Caries removal
• Removal roof of pulp chamber with sterile diamond fissure bur
• Remove coronal pulp 2-3mm with sterile excavator / large round steel bur
• Assess bleeding
  
  • Bright red colour means normal and uninflamed pulp
  • Deep crimson and ctd bleeding after P means inflamed pulp (bacterial ingress and colonistaion may have begun) and more needs to be removed
  • No bleeding means necrotic pulp and more need to be removed until normal bleeding
• Haemorrhage control
• May use ferric sulphate on cotton pledget over root stumps 20 secs (DO NOT USE ON PERMANENT AS CAN STAIN BLACK)
• Remove pledget
• Cover root stumps with CaOH or MTA
• RMGIC lining
• Etch and bond with normal comp or most likely SSC

Question 4

Give the signs and symptoms of a non vital primary tooth

Answer 4

Signs
- Hyperaemic pulp
- Pulp necrosis and furcation involvement

Symptoms
- Irreverisble pulpitis
- PA periodontitis
- Chronic sinus

Question 5

Indications and aims Primary molar pulpectomy

Answer 5

• Excellent pt coop
• Pt does not want XLA

AIMS
- Prevent/ control infection by extirpating radicular pulp followed by cleaning and obturation of canals

Question 6

Primary molar pulpectomy technique

Answer 6

• LA
• Dental dam
• Endodontic access
• Coronal pulp extirpation
• Root canal prep to 2mm short apex
• Obuturation with CaOH iodoform paste
• RMGIC lining and core
• SSC

Question 7

Give the clinical and radiographic signs of primary pulp therapies failure

Answer 7

Clinical failure
- Pathological mobility
- Fistula / chornic sinus
- Pain

Radiographic failure
- Increased radiolucency
- External / internal resorption
- Furcation bone loss