Pulpotomy of the primary tooth is indicated when caries has infiltrated the pulp or there has been a traumatic exposure of the pulp. The coronal tissue of the pulp is first amputated then a hemostastic agent is used to stop the bleeding of the pulp prior to placement of intermediate restoration, followed by a final restoration. Conservation of primary teeth is essential for the maintenance of arch length, esthetics, mastication, speech, and proper physiological eruption of succedaneous teeth.
Indications
Carious exposure of the pulp
History of spontaneous pain
Traumatic exposure of the pulp
No periradicular/furcal inflammation
No abcess/fistula
2/3 of root intact
Bleeding of the pulp can be controlled
Treatment Protocol:
After caries excavation, pulp access is made and coronal pulp tissue removed, drawing upwards with a round bur. Tip: The remaining pulp tissue can be cleared with the spoon excavator in order to avoid causing a furcation defect.
After removal of the coronal pulp, hemostasis is achieved by gently compressing a dry cotton pellet into the pulp.
The medication is placed into the pulp chamber – in this instant 5 minute application of fermecresol. Cotton pellet is removed, hemostasis verified. Ferris sulphate and MTA are commonly used medicaments and have gained much popularity in recent years Tip: Cotton pellet must be removed before intermediate restoration is placed.
After pulpotomy is completed, intermediate restoration is placed (Common materials include: IRM, ZOE, glass ionomer), prior to preparation for SSC.
Final words on primary pulpotomy
Primary teeth have thin enamel and dentin structure and large pulp horns. As a result caries in these teeth are prone to involve the pulp more frequently. Pulpotomy with fermecresol has been traditionally successful method in salvaging these teeth but due to its potential carcinogenic effects, practitioners have looked for other solutions.
Ferric Sulphate has hemostatic properties in the form of a metalprotein clot and forms a seal to protect the radicular pulp from irritation by the application of other materials applied afterwards.
MTA is also an attractive material for use in pulpotomies due to it’s biocompatibility and ability to prevent microleakages. However, MTA also tends to cost an arm and a leg. Diode lasers are less commonly used, but have been proven to provide great hemostasis.
The most crucial indicator of success in pulpotomy of primary teeth is prevention of marginal leakage of the restoration. Stainless steel crowns (SSC) are commonly used for final restorations as a resolution to this problem.
