1. Mr. caputo Unit #2 Lesson #4
Pulpotomy
Mr. caputo
Unit #2 Lesson #4

2. Today’s Class
Driving Question: What is the procedure for endodontic treatment?
Learning Intentions: We will be able to explain the steps for endodontic procedures
Anchor: What are the tests for endodontic diagnosis?

3. Pulpotomy
Removal of entire coronal pulp in pulp chamber, leaving only vital pulp within roots
Root canal’s pulp is retained and treated with medication to preserve its vitality and function
Usually done on primary teeth
Contraindicated: fistula or an abscess, tooth crown is nonrestorable, profuse hemorrhage, extreme tenderness to percussion, mobility, necrotic pulp, or pulp stones

4. Pulpotomy Procedure

5. Pulpectomy Most common endodontic procedure
Involves removal of the entire pulp from pulp chamber and from root canals of a nonvital tooth
Indications:
cooperative patient
teeth with poor chance of vital pulp treatment
for space maintenance
absence of surrounding bone loss from infection
expectation of ability to restore tooth in the future

6. Procedure for Pulpectomy
Initial x-ray is taken
Anesthetic is administered
Dental dam is placed
Dentist cuts through enamel and dentin with a high-speed handpiece bur
Slow-speed handpiece round bur and possibly spoon excavator is used to remove all decayed tooth structure

7. Procedure for Pulpectomy
Tooth opening is deepened and widened to allow access into pulp chamber(s)
Location of each root canal is determined
Infected pulpal tissue is removed (extirpation)
File(s) are placed into canal of tooth prior to second x-ray
Second radiograph is exposed
Files are measured

8. Root Canal Procedure

9. Shaping and Cleaning Each root canal is prepared and shaped
Debridement on root canal is acheived
Smaller file or reamer is used first, then next larger size, to increase canal’s width
Tapered files are used either by hand or rotary instrument in a slow-speed handpiece
Filing is within 2 to 3 mm inside of tooth apex
Irrigation is done with bactericidal liquids
Absorbent paper points are used

10. Obturation
Necessary to ensure a good seal at apex of root and for root canals to have no voids
Common material used to obturate is gutta percha, a thermoplastic rubber-like material
Gutta percha points are tapered so they ideally fit the canal after it is shaped
Endodontic sealing cements are used to hold gutta percha filling material in place
Thermafil or injection techniques can be used

11. Obturating a Root Canal
Image courtesy Instructional Materials for the Dental Team, Lex. KY

12. Final Restoration
Temporary restorative materials may be used to fill tooth and seal it from moisture contamination after root canal therapy
Dentist can either continue to prepare tooth for a permanent restoration or refer patient to another dentist for permanent restoration procedure
Endodontist will refer patient back to general dentist for post and core procedure and crown preparation
Permanent filling must be done in order to protect the tooth against fracture and recurrent decay

13. Post and Core Buildup
Endodontically treated teeth are usually already broken down and will become brittle with time because they no longer have a moisture supply
Post and core may be needed
All endodontically treated teeth will require a crown as a final restoration to prevent future problems

14. Post Placed within one or two root canals
Serves to supply extra support for a core when sufficient tooth structure does not exist
Two main categories of posts:
custom fabricated
prefabricated

15. Core Buildup
Required when there is extensive loss of natural tooth structure
Placement of pins for additional retention will also be evaluated
Most common core buildup materials are gold, amalgam, and composite
Goal of the core buildup is to establish the greatest stability and longevity of the restoration

16. Post and Core Buildup