Trishna PokhrelToday in this article we will explore pulpectomy and various aspects to it. Pulpectomy is deined as the Removal of entire pulp and subsequent filling of the canals of primary teeth with suitable resorabable material.
Pulpectomy or root canal treatement for primary teeth is very valuable for the preservation of primary teeth that otherwise would be extracted.
Indications of Pulpectomy:
General Indications:
- Patient should be in good general health with no serious disease.
- Cooperative patient and parents.
- Children suffering from hemophilia.
Clinical Indications:
- Uncontrolled pulpal hemorrhage.
- Primary pulpless teeth without permanent successors.
- Primary teeth with necrotic pulps and minimum of root resorption.
- Pulplers primary teeth with stomas.
- Primary tooth with an abscess, or sinus opening.
- Pulpless primary anterior teeth when speech, esthetics are a factor.
- Pulpless primary molars holding orthodontic appliance.
Radiographic Indications:
- Adequate periodontal and bony support.
Contraindications of Pulpectomy:
A) General ContraIndication:
- Young patients with systemic illmess such as congenital/ schemic heart disease/ eukemia.
- children on long-term corticosteroids therapy.
B) Clinical Contraindications:
- Primary toothe with excessive mobility.
- A nonrestorable tooth.
- Communication between the root of the pulp chamber and the region of furcation.
- Insufficient tooth structure to allow isolation by rubberdam and extra coronal restoration.
C) Radiographic Contraindications:
- External root resorption.
- internal root resorption in the apical 3rd of root.
- Primary teeth underlying dentigerous or follicular cysts.
- Interradicular radiolucency.
Pulpectomy Technique:
- Access Opening
- Working length determination
- Pulp extirpitation and preparation of canals
- Obturation
Single Visit Pulpectomy:
- Extension of pulpotomy where inflammation extends beyond coronal pulp, indicated by hemorrhage from amputated radicular stumps that is oozing continuously and is uncontrollable.
Procedure:
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Tooth is anesthetized and isolated with rubber dam ↓ Access cavity is prepared ↓ Pulp chamber is derooted ↓ All accessible coronal and radicular pulp tissue is extirpated with broaches. ↓ Canals are irrigated with saline ↓ A diagnostic file radiograph is taken ↓ Clean out root canals with H files and remove remnants of pulp tissue and irrigate canals with saline (Shaping and Cleaning) ↓ Dry the canals with adsorbent paper points. ↓ Obturate the tooth completely sealing the coronal and radicular pulp with cement. ↓ Take a post-operative radiograph to check root filling ↓ Final restoration and stainless steel crown. |
