Brief about Pulpotomy

Pulpotomy is defined as the complete removal of coronal portion of dental pulp, followed by placement of suitable dressings or medicament to promote healing and preserved vitality of teeth.

Objective:

1. Removal of infected and inflammable coronal pulp, at the site of exposure.
2. Preserving the vitality of the radicular pulp and promotes its healing.
3. Maintain the tooth in the dental arch

Rational:

1. Radicular pulp is healthy and capable of healing after the surgical amputation of infected pulp.
2. Preserve the vitality of tooth.
3. Removal of infected or inflammed pulp.
4. Maintain the physiologic condition of tooth.

Indications:

1. Vital teeth with pulp exposures is more than those suitable for pulp capping:
   - Mechanical or carious exposures.
   - Inflammation limited to coronal pulp.
   - Absence of spontaneous pain
2. The tooth is free of radicular pulpitis.
3. The tooth is restorable.
4. Teeth possess at least 2/3rd of its root length.
5. There is no evidence of internal/external resorption.
6. No interadicular bone loss.
7. No absess or fistulas exists.
8. No pulp calcification.
9. hemorrhage from the amputation site is pale red and easy to control.
10. In young permanent tooth with vital exposed pulp and incompletely formed apices.

Contraindications of pulpotomy:

1. Persistent pain
2. Tender on percussion.
3. Root resorption more than 1/3rd of root length.
4. Large carious lesions which have non-restorable crowns.
5. Highly viscous, sluggish hemorrhage from canal orifice that is uncontrollable,
6. Evidence of necrotic/irreversible damaged pulp.
7. Swelling/Fistula.
8. External/Internal resorption
9. Pathological mobility
10. Mediocally containdication like heart diseases, immunocompromised patient.
11. Calcification of pulp.

Criteria for Case Selection :

1. Teeth with deep carious lesion (radiographically approaching the pulp).
2. Teeth should be restorable after completion of procedure.
3. Absence of symptoms indicative of advanced pulpal inflammation like spontaneous pain or history of nocturnal pain.
4. Absence of clinical signs and symptoms.
5. Absence of clinical radiographic signs of purpal necrosis.
6. Hemorrhage should stop within 5 minutes from amputated pulp stumps using sterile pellet of moist cotton.