1. Pulp Therapy in Pediatric Dentistry
Dr. S.E.Jabbarifar
Pediatric Dentistry
Department Isfahan Dental School

2. Pulp Therapy in Pediatric Dentistry --Vital Pulp Therapy--
Permanent Tooth Pulpotomy
Objectives
Maintain vitality of radicular pulp
Achieve root-end closure (Apexogenesis)
Eliminate need for apicoectomy
Facilitate GP obturation with apical stop

3. Pulp Therapy in Pediatric Dentistry --Vital Pulp Therapy--
Permanent Tooth Pulpotomy Agents
Formocresol

4. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
Objectives of Non-Vital Pulp Treatment (Primary Teeth)
Maintain tooth free of infection
Achieve biomechanical cleansing and canal obturation
Promote physiologic resorption
Maintain space and function

5. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
Non-Vital Pulp Treatment (Primary Teeth)
Choices
Pulpectomy (most are partial due to anatomy)
Extraction

6. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
Pulpectomy Indications/Considerations
Strategic importance of tooth (2nd primary molar with unerupted 6-yr molar)
Sufficient remaining tooth structure
Poor chance of vital pulp treatment success
Adequate remaining root
Cooperative patient

7. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
Pulpectomy Contraindications
A non-restorable tooth
A tooth with a mechanical or carious perforation of the floor of the pulp chamber
Pathologic root resorption involving more than one-third of the root
Pathologic loss of bone support resulting in loss of the normal periodontal attachment
The presence of a dentigerous or follicular cyst
Radiographically visible internal root resorption

8. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
Pulpectomy Technique
Achieve adequate anesthesia and rubber dam isolation.
Remove all caries.
Remove the roof of the pulp chamber with a high-speed handpiece.
Amputate the coronal aspect of the pulp tissue with a large round bur in a slow-speed handpiece.
The remaining pulp tissue occupying the root canals is removed using endodontic files at a predetermined working length, approximately 1 to 2 mm short of the root apices.
The canals should be enlarged several sizes beyond the size of the first file that fits snugly into the canal to a minimum final size of 30 to 35.
Throughout root canal instrumentation, the canals should be irrigated with sodium hypochlorite to aid in debridement.

9. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
Pulpectomy Technique (continued)
8. Dry the canals with sterile paper points.
9. The canals are filled with a treatment paste (Zinc Oxide/Eugenol at UKCD) using a pressure syringe.
10. The tooth is restored with a stainless steel crown.

10. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--

11. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
Criteria for an ideal pulpectomy obturant (treatment paste)
Antiseptic
Resorbable
Harmless to the adjacent tooth germ
Radiopaque
Non-impinging on erupting permanent tooth
Easily inserted
Easily removed

12. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
Apexification (Young Permanent Teeth)
Apical closure of an incompletely formed root
Implemented when apexogenesis has failed
Necrotic tissue removal short of the apexification site
Agent is placed in canals to achieve closure/apical stop
Apexification Recall Schedule
Calcium Hydroxide Rotation
3-6 month intervals (Andreasen, 1994)

13. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
Action of Calcium Hydroxide in Apexification
Bactericidal
Low grade irritation inducing hard tissue barrier formation
Dissolves necrotic debris
Forms of Calcium Hydroxide
Caliscept
Self-mixed (CaOH + sterile water or local anesthetic)

14. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
Evaluation of Success
Asymptomatic
Radiographic absence of pathology
Continued root development
Hard tissue barrier at apex
Responsive pulp

15. Pulp Therapy in Pediatric Dentistry --Non-Vital Pulp Therapy--
In Review. . .

16. FYI Comparison between File Size and Needle for Pressure Syringe
Standard File Needle Gauge

17. References
Barr Elizabeth, Flaitz Catherine, Hicks John. “A retrospective radiographic evaluation of primary molar pulpectomies”. Pediatric Dentistry, Vol. 13, Number 1, 1991: 4-9.
Dummett, Cliff. “Pulp Therapy in Pediatric Dentistry”. Louisiana State University School of Dentistry, April 16, 2003.
Georig Albert C., Camp Joe H. “Root canal treatment in primary teeth: a review”. Pediatric Dentistry, Vol. 5, Number 1, 1983:
Nash David A. “Pulpal Therapy, Module 6”. West Virginia University School of Dentistry.
Mink, John R. and Spedding, Robert. “Pediatric Pulp Treatment”. University of Kentucky College of Dentistry.
Pinkham, J. R., senior editor. Pediatric Dentistry, Infancy through Adolescence, Third Edition. W.B. Saunders Company, 1999.
Walton, Richard E. and Torabinejad, Mahmoud. Principles and Practice of Endodontics, Second Edition. W.B. Saunders Company, 1996.
The Handbook, Second Edition. American Academy of Pediatric Dentistry, 1999.