PEDIATRIC ENDODONTICS 4/05/2014 Assalam Alekum PEDIATRIC ENDODONTICS Dr. Gaurav Garg, Lecturer College of Dentistry, Zulfi, MU

Contents Treatment considerations in childrens Endodontic treatment modalities in primary teeth Endodontic treatment modalities in young permanent teeth

Treatment considerations Child’s overall development & ability to cooperate Medical fitness Restorability of the tooth Necessity to keep the tooth Anatomy of deciduous teeth Deciduous Permanent

Endodontic treatment modalities in primary teeth Pulpotomy Pulpectomy

Pulpotomy “ Complete removal of the coronal portion of the pulp, followed by placement of a suitable dressing of medicament that will promote healing and preserve vitality of the tooth”

Indications Vital tooth with healthy periodontium Reversible pulpitis Tooth which is restorable Tooth that possesses at least 2/3rd of its root length Bleeding from amputation site is easy to control When primary tooth is preferable to a space maintainer

Contraindications Evidence of internal resorption Interradicular bone loss/ weak periodontium Abscess/ fistula in relation to the tooh

Agents used for pulpotomy Formocresol Beechwood cresol Gluteraldehyde Ferric sulphate Bone Morphogenic Protein MTA Electrosurgery Lasers

Formocresol Pulpotomy Mechenism of action: Formaldehyde present in formocresol preserve the pulp tissue by preventing its autolysis by bonding to proteins without changing their basic overall structure

Pulpotomy Procedure Tooth is anesthetized & Isolated Remove all decay Remove entire roof of the pulp chamber to get access to coronal pulp

Remove the coronal pulp using sharp spoon excavator Irrigate pulp chamber with water Place moist cotton pellets in the pulp chamber and allowed to remain over pulp stump until a clot forms

Remove the pellet and dry the pulp chamber Next, a cotton pellet moistened with 1:5 concentration of formocresol is placed in the chamber in contact with the pulp stumps for 5 minutes Remove the pellet and dry the pulp chamber Pellet with formocresol

Tooth is restored with stainless steel crown A thick paste of Zinc oxide eugenol is placed over the pulp stumps followed by layer of zinc polycarboxylate cement Tooth is restored with stainless steel crown Znpolycarb ZOE

Evaluation Absence of pain, fistula, abscess & Mobility Absence of periapical pathology Absence of internal/ External resorption

Pulpectomy It involves removal of the roof and contents of the pulp chamber in order to gain access to the root canals which are debrided, enlarged , disinfected & filled with Resorbable material

Indications Irreversible pulpitis Internal resorption Sufficient bone support 2/3rd of the root length is available Strategically important tooth

Contraindication Exessive mobility/reduced bone support Underlying dentigerous/follicular cyst Less than 2/3rd of root is remaining Pulpal floor perforation Medically compromised children

Pulpectomy procedure 1. Access opening 2. Remove infected pulp & do cleaning & shaping 3. Dry the canals 4. Place ZOE Paste 5. Apply apical pressure 6. Condense with moist pellet

Commonly used root canal filling material In primary teeth: ZOE paste Iodoform paste Calcium hydroxide Colla Cote (Collagen Sponge) Gutta percha being non resorbable, is contraindicated in primary teeth

Endodontic treatment modalities in young permanent teeth Apexogenesis Apexification

Apexogenesis It is a histological term used to describe the result of vital pulp procedures that allow the continued physiologic development & formation of root apex. Examples: Indirect pulp capping, Direct pulp capping, Pulpotomy etc.

Apexification It is a method to induce a calcified barrier in a root with an open apex.

Procedure CaOH & CMCP ZOE/IRM Immature tooth with periradicular disease B. Working length measured & BMP done C. Canal filled with CaOH & CMCP Paste & Provisional restoration done

Recall after 6 months and check for apical closure If present- continue with obturation If not- repeat the procedure Alternative: Apexification using MTA- Fast & Predictable results

References Textbook of Pedodontics(2nd edition); Shobha Tandon Textbook of Endodobtics; Ingle & Bakland

THANK YOU!