pulpotomy Flashcards
when is a pulpotomy done?
how is a pulpotomy performed?
Coronal pulp is amputated at the entrance of the root canal and the radicular pulp is assessed to be normal and left intact.
what are indications for pulpotomy?
Carious ,traumatic or mechanical exposure of pulpal tissue in primary teeth.
what are the contraindications for pulpotomies?
what are other factors to consider when planning for pulpotomy treatment?
what is the rationale for performing a pulpotomy?
What is the very first three things you should do?
for a formocresol pulptotomy what should you do for occlusal reduction?
Occlusal Reduction 1-1.5mm (for stainless steel crown preparation)
What should you do after occlusal reduction?
remove all caries
What are the three groups of pulpotomy agents?
Three groups based on their histological effects on pulpal tissue:
Agents that devitalize pulp tissue:
What is formocresol?
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.
what’s the histology of formocresol?
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
what occurs with formocresol pulpotomy?
What is the controversy with formocresol and is it valid?
Controversy:

what about mixing formocresol with ZOE paste?
Do not mix formocresol into ZOE paste used to cover pulp stumps. No proven benefits shown in literature
what is ferric sulfate pulpotomy?
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.
what is MTA pulpotomy?
Formulation:
What are the success rates of the different pulpotomy agents?
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
What is the pulpotomy follow-up
what is the diagnosis for pulpotomy in immature permanent teeth?
Remember that your best clues to pulpal status are history, clinical and radiographic examination.
what are the indications for a pulpotomy in immature permanent teeth?
what are the contraindications for pulpotomy in immature permanent teeth?
What about doing an endodontic fill in immature permanent teeth?
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)
What must you evaluate for pulptotomy in immature permanent teeth?
Must evaluate:
what are the two types of pulpotomies for immature permanent teeth? and what agents are used?
Two types: Partial Pulpotomy Full Coronal Pulpotomy Agents: Calcium Hydroxide Mineral Trioxide Aggregate
what is a partial pulpotomy?
Removal of part of coronal pulp.
what must you watch carefully with partial pulpotomies on immature permanent teeth?
what is a full coronal pulpotomy for immature permanent teeth?
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?
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?
