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

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?

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

Pulpotomy Procedure

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

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

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

Root Canal Procedure

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

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

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

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

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

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

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

Post and Core Buildup