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PRIMARY DENTITION
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index
A. Definition
B. Classification
C. Technique
D. Formocresol pulpotomy
E. Ca(OH)2 pulpotomy
F. Other procedures
G. Summary
H. References
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DEFINITION
A pulpotomy is defined as the surgical removal
of the entire coronal pulp pre-sumed to be
partially or totally inflamed and quite possibly
infected, leaving intact the vital radicular pulp
within the canals.
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classification
Pulpotomy
calcium hydroxide
formocresol
pulpotomy
pulpotomy
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CLASSIFICATION
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Vital pulpotomy technique
Devitalization Single sitting –
Formocresol
Preservation Electrosurgery
1. Glutaraldehyde Laser
2. Ferric sulphate Two stage –
Gysi triopaste
Easlick’s formaldehyde
Regeneration Paraform devitalising pastePreservation
1. Bone morphogenetic
protein
2. Dentin chips
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Formocresol pulpotomy
Formocresol was introduced in 1904 by
Buckley, who contended that equal parts of
formalin and tricresol would react chemically
with the intermediate and end products of pulp
inflammation to form a “new, colorless, and non-
infective compound of a harmless nature.”
Buckley’s formula
formocresol, consists of tricresol, 19% aqueous
formaldehyde, glycerine, and water.
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indications
1. Carious / mechanical exposure in vital
asymptomatic tooth
2. Tooth free of radicular pulpitis
3. Presence of atleast 2/3rd root length
4. Absence of abscess or fistula.
5. Absence of inter radicular bone loss
6. Absence of internal root resorption
7. Permanent posterior teeth for the expedient
treatment of pulpalgia. (it relieves pain in
emergency as formocresol fixes the contiguous
pulp left in the root canal.)
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Contraindications
Local : -
Spontaneous pain / pain at night
Pathologic mobility
Swelling or fistula
Internal resorption
Less than 2/3rd root remaining
Periapical inter radicular radiolucency
Pus / serous exudate at exposure site
Uncontrolled haemorrhage from amputed pulp
Excesive pulp calcification
Medical : -
Cardiac condition
Immunocompromised children
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TECHNIQUE
The formocresol pulpotomy technique was first advocated by
SWEET [1930]
He used a multiple sitting technique, which has been
subsequently modified to either a single or two stage technique.
FORMULA :- 19% Formaldehyde
35% cresol
15% Glycerin & Water
To prepare 1.5%concentration of this formula, first
mix 3 parts of glycerin with 1 part of distilled water ,
then add 4 parts of this preparation to 1 part buckley’s
formocresol , and throughly mix again.
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Mechanism of action
Formocresol causes coagulation necrosis in
tissues in immediate vicinity of the application
with fixation of tissue cells and micro
organism.
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One-Appointment
Pulpotomy.
Indications :-
only on those restorable teeth in which it has
been determined that inflammation is confined to the
coronal portion of the pulp.
Contraindications :-
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Isolate the tooth with rubber dam
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Remove caries & determine
site of pulp exposure
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Remove coronal pulp with a large
excavator or a large round bur
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Apply formocresol on the pledge of cotton wool
for 4 minute
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Remove formocresol pledget
after 4 min. & check that
haemorrhage has stopped
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Restore the tooth with stainless steel crown
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Take a post operative photograph
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Two-Appointment
Pulpotomy.
Indications
Contraindications.
(1) Nonrestorable
(2) Soon To Be Exfoliated
(3) Necrotic.
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Procedure
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Partial pulpotomy (pulp
curretage )
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REASONS FOR FAILURE
Pulp is highly vascular so, even with slightest
infection in any corner of pulp , the whole of
it gets infected very quickly.
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DEVITALIZATION
PULPOTOMY
It is two stage procedure involving the use
of paraformaldehyde to fix the entire coronal
& radicular pulp tissue.
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TECHNIQUE
First appointment :-
Same as formocresol pulpotomy but place
the paraformaldehyde paste in cotton pellete
over the exposure & seal the tooth for 1 to 2
weeks.
Formaldehyde gas liberates from the
paraformaldehyde permeates through the coronal
and radicular pulp, fixing the tissue.
Second appointment :-
pulpotomy is carried out with the help of
local anaesthesia
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ELECROSURGICAL
PULPOTOMY
Given by mack & dean (1933 )
It is a non chemical devitalizaton
technique.
Electrocautery carbonizes and heat
denatures the pulp & bacterial
contamination
After amputation of coronal pulp,the
pulp stumps are cauterized through this
method
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Laser pulpotomy
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Glutaraldehyde
by kopel (1979 )
2-5 % concentration
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Ferric sulphate
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references
• Restorative technique for paediatric dentistry - Ms DUGGAL,
MEJ CURZON, SA FAYLE, KJ TOUMBA, AJ ROBERTSON
• INTERNET ( www.google.com)
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