Dr.

Raed Pedodontics

A- Partial Pulpectomy
1) A Partial Pulpectomy may be performed on primary teeth when coronal pulp tissue and the tissue
entering the pulp canals are vital but show clinical evidence of hyperemia .
2) The tooth may or may not have a history of painful pulpits, but the contents of the root canals should
be show evidence of necrosis (suppuration .)
3) There should not be radiographic evidence of a thickened periodontal ligament or of radicular
disease. If any of these conditions are present, a complete pulpectomy, or an extraction, should be
performed.

The partial pulpectomy technique :

It may be completed in one appointment, involves the removal of the coronal pulp as for the
pulpotomy technique. The pulp filaments from the root canals are removed with a fine barbed
broach, there will be considerable hemorrhage at this point .
A Hedstrom file will be helpful in the removal of remnants of the pulp tissue.
Use an endodontic file to remove the pulpal tissue
The file removes tissue only as it is withdrawn and penetrates readily with a minimum of resistance .
Care should be taken to avoid penetrating the apex of the tooth .
After the pulp tissue has been removed from the canals, a syringe is used to irrigate them with
3%hydrogen peroxide followed by sodium hypochlorite .
The canals should then be dried with sterile paper points .
Dry the canals with cotton pellets and, if possible, paper points
Hemorrhage should control and the canals should dry .
Thin mix of zinc oxide-eugenol paste may be prepared, and paper points covered with the material
are used to coat the root canal walls.
Obturate the canals with a ZOE mixture
Small files may be used to file the paste into the walls. The excess thin paste may be removed with
paper points and Hedstrom files .
Apply constant pressure to the ZOE mixture

B- Complete Pulpectomy :
1) It is unwise to maintain untreated infected primary teeth in the mouth .
2) They may be opened for drainage and often remain asymptomatic for an indefinite period of time .
Open the tooth with a No. 4 bur.
3) They are a source of infection and should be treated or removed .
4) Specially second primary molar even if it has a necrotic pulp . Effort should be made to treat and
retain the too .
5) The rubber dam is applied, and the roof of the pulp chamber should be removed to gain access to the
root canals .
6) The contents of the pulp chamber and all debris from the occlusal third of the canals should be
removed, with care taken to avoid forcing any of the infected contents through the apical foramen .
Use an endodontic file to remove the pulp tissue
7) A moistened pellet of camphorated monochlorophenol (CMCP) or l:5 , concentration of Buckley's
formocresol, with excess moisture blotted, should be placed in the pulp chamber, Irrigate the tooth ,
Dry the canal with paper points
8) The chamber may be sealed with zinc oxide-eugenol. Condense a thick mix of paste in the root canal
9) At the second appointment, several days later, the tooth should be isolated with a rubber dam and the
treatment pellet removed . If the tooth has remained asymptomatic during the interval, the remaining
contents of the canals should be removed. The apex of each root should be penetrated slightly with
the smallest file .
10) A treatment pellet should again be placed in the pulp chamber and the seal completed with zinc
oxide-eugenol .
11) After another interval of a few days the treatment pellet should be removed. If the tooth has remained
asymptomatic, the canals may be prepared and filled as described for the partial pulpectomy. If the
tooth has been painful and there is evidence of moisture in the canals when the treatment pellet is
removed, the canals should again be mechanically cleansed and the treatment repeated.