(Pulpectomy) Definition of Pulpectomy for Primary Teeth • A nonvital technique. • The removal of necrotic pulp tissue followed by filling the root canals with resorbable cement. Treatment Objectives for Primary Tooth Pulpectomy • (1) Maintain the tooth free of infection, • (2) Biomechanically cleanse and obturate the root canals, • (3) Promote physiologic root resorption, and • (4) Hold the space for the erupting permanent tooth. Indications for Pulpectomy of Primary Teeth • (1) Cooperative patient, • (2) Teeth with poor chance of vital pulp treatment, • (3) Strategic importance for space maintenance, • (4) Absence of severe root resorption, • (5) Absence of surrounding bone loss from infection, • (6) Expectation of restorability, • (7) Pulpless primary teeth with sinus tracts, • (8) Pulpless primary teeth in hemophiliacs, • (9) Pulpless primary teeth next to the line of a palatal cleft, • (10) Pulpless primary teeth when space maintainers or continued supervision are not feasible (handicapped or isolated children. Contraindications for Primary Tooth Pulpectomy • 1. Teeth with nonrestorable crowns, • 2. Periradicular involvement extending to the permanent tooth bud, • 3. Pathologic resorption of at least one-third of the root with a fistulous sinus tract, • 4. Excessive internal resorption, • 5. Extensive pulp floor opening into the bifurcation, • 6. Systemic illness such: as congenital or rheumatic heart disease, hepatitis, leukemia, and children on long-term corticosteroid therapy, or those who are immunocompromised, • 7. Primary teeth with underlying dentigerous or follicular cysts. Clinical Technique for Primary Tooth Pulpectomy • 1. First, penicillin should be immediately prescribed for a period of 4 to 7 days in case of a nondraining alveolar abscess. • 2. Enter pulp chamber. Extirpate the pulp with broaches. Irrigate. • 3. File short of radiograpahic apex. Instrument only to point of resistance. Size 35 = largest file size for primary molars. • 4. Remove organic debris: irrigate periodically with dilute sodium hypochlorite or saline. • 5. Dry the canals with paper points. • 6. Obturate with ZOE or resorbable Kri paste. • 7. Mix ZOE as a slurry and carry into the canals using either paper points, a syringe, or a lentulo spiral root canal filler. • 8. Then, pack the orfice area with a stiffer mix of ZOE. • 9. Fill the remainder of pulp chamber with a reinforced ZOE or a glass ionomer. • 10. Place stainless steel crown. Using Iodoform Paste for Pulpectomy of Primary Teeth • Kri paste: highly resorbable, bacteriocidal, healthy tissue ingrowth at apex. • An iodoform 80% compound which also contains parachlorophenol 2%, camphor 5%, and menthol 1%. • Success rates of 84% with the Kri paste group versus 65% with the ZOE group. • Overfills more successful (Kri paste 79% vs. ZOE 41%). @islam.hawary
Posted on: Sun, 14 Jul 2013 18:33:54 +0000
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