Trishna PokhrelToday in this article we will discuss regarding Devitalization Pulpotomy. Devitalization Pulpotomy is the vital pulpotomy. It is also known with its other name Mummification, Cauterization. It is intended to destroy or mummify the vital tissue.
Devitalization pulpotomy is done in different stages:
Single Sitting
- Formocresol
- Electrosurgery
- Laser
Two Stages:
- GysiTriopaste
- Easlick's formaldehyde
- Paraform devitalizing paste
Formocresol Pulpotomy / Single Stage Pulpotomy :
Mechanism of action: It prevents autolysis by binding to protein.
Procedure of Formocresol Pulpotomy:
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Anesthesize the tooth and isolate it with rubber-dam ↓ Remove caries, Enlarged exposute area ↓ Remove entire root of pulp chamber ↓ Remove any ledger or overhanging enamel. ↓ Remove coronal pulp with large spoon excavates or large round Bur ↓ Clean the pulp chamber with saline and remove all debris ↓ Apply formocresol using cotton pellet for 4 minutes at the exposure site ↓ Remove cotton pellets after 4 minutes and check for fixation, brownish discoloration of the pellet as well as the pulp stump is an indicator of fixation. ↓ Paste of zinc oxide eugenol (ZOE) cement is placed in the pulp chamber. ↓ Recall after 1 week and tooth is then restored if patient is asymptomatic ↓ Give stainless steel crown restoration ↓ Take a post-operative Radiograph |
Two Visit Devitalization Pulpotomy:
- It involves in using paraformaledehyde to fix entire coronal and radicular pulp tissue.
Indications:
- Evidence of sluggish bleeding at the amputation site that is difficult to control.
- Pus in the chamber but not at amputation site.
- Thickening of periodontal ligament.
- History of pain
Contraindications:
- Non-restorable tooth
- Tooth with necrotic pulp
Procedure:
First Visit:
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Anesthetize and isolate the tooth through rubber dam ↓ Prepare the cavity and deep caries excavated. ↓ Enlarge exposure site with round bur. ↓ Incorporate paraformaldehyde paste in a cotton pellet and apply over the exposure. ↓ Seal the tooth for 1-2 weeks, formaldehyde gas liberated from paraformaldehyde, enters coronal and radicular pulp, thereby fixing the tissue. |
Second Visit:
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Pulpotomy is carried out under local anesthesia. ↓ Remove old cotton pellet and deroof the pulp chamber. ↓ Clean the cavity with saline and dry with cotton pellet ↓ Pulp chamber filled with antiseptic paste and tooth is restored. |