Pulpotomy vs pulpectomy| Pulp Therapeutics of Milky Teeth

Pulpotomy vs pulpectomy| Pulp Therapeutics of Milky Teeth

Pulpotomy and pulpectomy are both therapeutic techniques for milky teeth. Pulpotomy is the partial removal or Amputation of the pulp, pulpectomy the complete removal of the pulp.

Pulpotomy Vs Pulpectomy Overview

In pulpotomy inflamed coronal pulp(pulp tissue in crown portion) is removed while healthy root pulp is protected. In pulpectomy all pulp tissues are removed from the tooth and more offen the pulp canal is filled with biocompatible materials.

Early childhood caries is a serious public health problem. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure, there is a trend among many dentists to perform pulpectomies in vital primary incisors.

The pulpotomy is given when the pulp is partially inflamed or bacterial contamination is to be feared. Pulpectomy is the complete removal of the tooth pulp (pulp) as part of a root canal treatment under local anesthesia.

The most common materials used for pulpotomy are formocresol, ferric sulfate, also calcium hydroxide has been used, but with less long term success and more recently mineral trioxide aggregate (MTA) which is much more expensive.

According to the latest recommendations of the American Academy of Pediatric Dentistry, both formocresol and MTA are strongly recommended to be used in pulpotomy with moderate quality of evidence. Ferric sulfate, laser and sodium hypochlorite are conditionally recommended but as for calcium hydroxide there is a recommendation against its use in pulpotomy.

In pulpectomy, a resorbable material such as nonreinforced zinc/oxide eugenol (ZOE), a combination paste of iodoform and calcium hydroxide (Vitapex, Metapex) or a combination paste of zinc oxide and eugenol, iodoform and calcium hydroxide (Endoflas) are used to fill the canals.

According to a Cochrane systematic review, there was no conclusive evidence supporting the superiority of one material for use in pulpectomy. Zinc oxide and eugenol, Metapex and Endoflas were found to be equally effective while with low quality of evidence zinc oxide and eugenol may be better than Vitapex but further research is required for confirmation.

Pulpotomy and pulpectomy are exclusive care of milk teeth, they do not concern permanent teeth.

Pulpotomy involves removing part of the dental pulp or nerves, which is replaced with material with the remaining nerves, and reconstruction is performed.

Pulpotomy is done because the dental pulp must be kept healthy , without signs of clinical or radiological intervention such as pain, tenderness, inflammation and the presence of resorbed roots.

Treating the nerve of the milk tooth DOES NOT INTERFERGE the permanent tooth at all since each one has its own nerve.

Pulpotomy Indications And Techniques

Pulpotomy / vital amputation
The pulpotomy procedure is the most frequently performed endodontic treatment measure in the deciduous dentition. It is indicated if the pulp is exposed in the carious dentin, if the cervical opening is artificial or if the pulp is opened over a large area, e.g. due to trauma to the clinically symptom-free tooth.

Occasionally, it is divided into partial, full, and high (cervical) pulpotomy according to the level of the amputation site. However, all three types pursue the same goal, namely the removal of inflamed coronal pulp tissue, the preservation of vitality of the radicular pulp and the preservation of the tooth up to natural exfoliation.

The prerequisite for this is a non-pathological root situation, i.e. that there is physiological root resorption of less than a third of the root length, that no periapical and furcal inflammatory processes as well as internal and external resorptions are radiologically detectable.

Clinically, the tooth should be symptom-free, and in the extreme case should only have caused temporary pain. Spontaneous pain is an absolute contraindication.

If the partial and / or full pulpotomy does not provide adequate hemostasis, the inflammation can be assumed to be more extensive, with the high (cervical) pulpotomy being the next logical step. In this case, pulp tissue is also removed with a diamond in the entrance area of the root canals. The transition to pulpectomy is almost fluid.

Practical procedure:
The caries is completely removed under local anesthesia, then the pulp chamber roof is completely removed, for example with a Batt drill, and the coronal pulp tissue - if possible - "cut off" with a sterile diamond.

The color of the bleeding can give an indication of possible hemostasis. The sole application of a cotton wool pellet soaked with isotonic saline solution to the pulp stumps should lead to adequate hemostasis within four minutes.

Alternatively, other hemostatic agents can be used. Iron (III) sulfate, sodium hypochlorite, hydrogen peroxide, adrenaline-soaked pellets, etc. are available. a far-reaching inflammation of the remaining tissue can be assumed. Pulpectomy or even extraction come into consideration, since the formation of a blood clot at the amputation site would have negative effects on the success of the therapy.

A blood clot would promote the development of an inflammatory reaction, prevent the formation of a hard tissue bridge and promote internal resorption processes up to and including pulp necrosis.

After successful hemostasis, the radicular pulp stumps are covered with a wound dressing. You can find out more about this in the Materials section.

A blood clot would promote the development of an inflammatory reaction, prevent the formation of a hard tissue bridge and promote internal resorption processes up to and including pulp necrosis.

After successful hemostasis, the radicular pulp stumps are covered with a wound dressing. You can find out more about this in the Materials section. A blood clot would promote the development of an inflammatory reaction, prevent the formation of a hard tissue bridge and promote internal resorption processes up to and including pulp necrosis.

After successful hemostasis, the radicular pulp stumps are covered with a wound dressing. You can find out more about this in the Materials section.

Pulpectomy Techniques and indications

The possibility of obtaining a milk tooth through pulpectomy with subsequent root canal filling depends on the condition of the milk tooth and the cooperation of the child and parents.

In pulpectomy, the focus is on removing the inflamed or necrotic tissue of the radicular pulp and carefully cleaning and shaping the canal system. The requirements for the root filling material are an adequate resorption time (equal to the root resorption) and rapid degradation in the event of overstuffing or at least no foreign body reaction.

A deciduous tooth can be preserved even if the high (cervical) pulpotomy is unsuccessful, there are signs of interradicular or apical osteolysis. In principle, the pulpectomy can be performed as a single visit, depending on whether the root canals have to be dried after opening.

Practical procedure:
There are several details about processing, but they differ only slightly. The working length should be 2-3mm from the apex, the canals should be prepared up to about ISO 30 (further preparation only in exceptional cases).

A forced processing is to be avoided. Sodium hypochlorite (0.1%), chlorhexidine (0.4%) or common salt (0.9%) can be used as rinsing solutions.

When drying the canals, over-instrumentation of the canals must be avoided.

A suitable root filling material is to be introduced into the canals.

Bawazir, et al. have investigated that it makes no difference whether the root canal filling paste is introduced using the lentulo in the handpiece or by hand.

Some providers have developed special cannulas, which allow the material to be introduced deep into the canal. Data on effectiveness are still pending here.

The statement that a distance of up to 2mm from the apex should be kept during preparation and filling is based on the fact that failure with a root canal filling is more likely to be due to overfilling than underfilling. Pulpectomy success rates are reported to be up to 90%. There are reports that pulpectomy is more successful than pulpotomy (here with iron sulfate). However, since iron sulphate is only one of many materials used, this statement should be viewed with caution.

Pulpotomy vs. Pulpectomy Results

Studies has shown that there is no statistical significant difference in clinical success rates of pulpotomy and pulpectomy with different medicaments in the treatment of carious vital pulp exposure in primary incisors while radiographically, pulpectomy may have a higher risk for radiographic failure than pulpotomy and this refutes the misconception among some pediatric dentists that pulpotomy does not work in primary incisors.

Epidemiological data show a significant endodontic treatment failure rate of 20 to 50% worldwide, probably directly related to the difficulty of the procedure.

A successful pulpotomy enables the maintenance of a vital radicular pulp in the root canal. The presence of biological tissue in the root canal is definitely more efficient than a & quot; complete & quot;

The accepted management for any pulp intervention on a vital tooth pulp is pulpectomy (ablation of the entire tooth pulp, preparation and filling of the entire root canal system, which is difficult and invasive). However, it has been shown that radicular pulp a has repair potential and interesting immune defense properties.

A pulp chamber pulpotomy (ablation of the coronal part of the pulp, simpler and less invasive) may therefore be a better alternative. Its feasibility, known on decidual and immature permanent teeth (where it is a routine treatment), has been demonstrated on mature permanent teeth.


References for Pulpotomy Vs Pulpectomy

Den Tim


Practicing Dentistry for 20 years