pulpotomy

Question 1

when is a pulpotomy done?

Question 2

how is a pulpotomy performed?

Answer 2

Coronal pulp is amputated at the entrance of the root canal and the radicular pulp is assessed to be normal and left intact.

Question 3

what are indications for pulpotomy?

Answer 3

Carious ,traumatic or mechanical exposure of pulpal tissue in primary teeth.

Question 4

what are the contraindications for pulpotomies?

Question 5

what are other factors to consider when planning for pulpotomy treatment?

Question 6

what is the rationale for performing a pulpotomy?

Question 7

What is the very first three things you should do?

Question 8

for a formocresol pulptotomy what should you do for occlusal reduction?

Answer 8

Occlusal Reduction 1-1.5mm (for stainless steel crown preparation)

Question 9

What should you do after occlusal reduction?

Answer 9

remove all caries

Question 10

What are the three groups of pulpotomy agents?

Answer 10

Three groups based on their histological effects on pulpal tissue:
Agents that devitalize pulp tissue:

Question 11

What is formocresol?

Answer 11

Buckley’s Formocresol 
19% formaldehyde 
35% cresol
15% glycerine 
31% water
1/5 dilution can be used. But difficult to keep accurate dilution due to evaporation.

Question 12

what’s the histology of formocresol?

Answer 12

Formocresol demonstrates unpredictable penetration through pulpal tissue. There is no significant difference between a 5 min or 5 day application in terms of pulpal penetration apically.
Coronal1/3: superficial eosinophilic fixed tissue over pulpstones poor cellular detail (necrosis)
Mid1⁄3:preserved cells tructure, weakly eosinophilic
thrombotic capillaries, endothelial cells and pericytes thickened edema
Apical 1⁄3: (can be vital but mostly non vital)
inflammatory cells (lymphocytes, macrophages, plasma cells)
some edema increased fibrils

Three layers formed (7-14 days) Acidophilic zone (fixation)
Pale staining zone (atrophy) Inflammatory zone

Question 13

what occurs with formocresol pulpotomy?

Question 14

What is the controversy with formocresol and is it valid?

Answer 14

Controversy:



Question 15

what about mixing formocresol with ZOE paste?

Answer 15

Do not mix formocresol into ZOE paste used to cover pulp stumps. No proven benefits shown in literature

Question 16

what is ferric sulfate pulpotomy?

Answer 16

Ferric Sulfate Fe2 (SO4)3
Used in 15.5-20% concentration. Fe ions form complexes with
blood proteins which mechanically occlude cut capillaries.
Applied to pulp for 10-15 seconds.
Greater prevalence of internal resorption seen radiographically.

Question 17

what is MTA pulpotomy?

Answer 17

Formulation:

Question 18

What are the success rates of the different pulpotomy agents?

Answer 18

formocresol - 62-97% - toxic potential

ferric sulfate 77-95% - expensive

MTA - 95-97% - expensive

calcium hydroxide - 31-87% (50%) - internal resorption

ZOE - 57%

Electrosurgery - 84%-96% - heat damages pulp

Laser - 70-95% - not as many studies

USE FORMOCRESOL AND MTA

Question 19

What is the pulpotomy follow-up

Question 20

what is the diagnosis for pulpotomy in immature permanent teeth?

Answer 20

Remember that your best clues to pulpal status are history, clinical and radiographic examination.

Question 21

what are the indications for a pulpotomy in immature permanent teeth?

Question 22

what are the contraindications for pulpotomy in immature permanent teeth?

Question 23

What about doing an endodontic fill in immature permanent teeth?

Answer 23

Very difficult in immature teeth with open apices to adequately do a conventional gutta percha endodontic fill. Usually requires periapical surgery.
In mature teeth with closed apices, not common to do a calcium hydroxide pulpotomy as may cause pulp canal obliteration. This interferes with access for conventional endodontic treatment. (Defer to Endo Dept)

Question 24

What must you evaluate for pulptotomy in immature permanent teeth?

Answer 24

Must evaluate:

Question 25

what are the two types of pulpotomies for immature permanent teeth? and what agents are used?

Answer 25

Two types:
Partial Pulpotomy
Full Coronal Pulpotomy
Agents:
Calcium Hydroxide
Mineral Trioxide Aggregate

Question 26

what is a partial pulpotomy?

Answer 26

Removal of part of coronal pulp.

Question 27

what must you watch carefully with partial pulpotomies on immature permanent teeth?

Question 28

what is a full coronal pulpotomy for immature permanent teeth?

Question 29

What do you need to do after the coronal pulp removal for a calcium hydroxide polpotomy in an immature permanent tooth? then how do you do it?

Question 30

For an immature permanent tooth pulpotomy what should happen after you have placed your MTA or calcium hydroxide plus a glass ionomer and permanent restoration?