PULPOTOMY PROCEDURES IN

PRIMARY DENTITION

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 index

A. Definition
B. Classification
C. Technique
D. Formocresol pulpotomy
E. Ca(OH)2 pulpotomy
F. Other procedures
G. Summary
H. References

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 DEFINITION
A pulpotomy is defined as the surgical removal
of the entire coronal pulp pre-sumed to be
partially or totally inflamed and quite possibly
infected, leaving intact the vital radicular pulp
within the canals.

The aim is to relieve pain due to pulpalgia and

leave the vital pulp in roots for its completion ,
if incomplete (apexogenesis )

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 classification
Pulpotomy

Partial pulpotomy complete pulpotomy

calcium hydroxide
formocresol
pulpotomy
pulpotomy
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 CLASSIFICATION

Non vital pulpotomy Vital pulpotomy

Beechwood cresol Devitalization

Formocresol Preservation
Regeneration

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 Vital pulpotomy technique
Devitalization Single sitting –
Formocresol
Preservation Electrosurgery
1. Glutaraldehyde Laser
2. Ferric sulphate Two stage –
Gysi triopaste
Easlick’s formaldehyde
Regeneration Paraform devitalising pastePreservation
1. Bone morphogenetic
protein
2. Dentin chips

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Formocresol pulpotomy
Formocresol was introduced in 1904 by
Buckley, who contended that equal parts of
formalin and tricresol would react chemically
with the intermediate and end products of pulp
inflammation to form a “new, colorless, and non-
infective compound of a harmless nature.”

Buckley’s formula
formocresol, consists of tricresol, 19% aqueous
formaldehyde, glycerine, and water.

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 indications
1. Carious / mechanical exposure in vital
asymptomatic tooth
2. Tooth free of radicular pulpitis
3. Presence of atleast 2/3rd root length
4. Absence of abscess or fistula.
5. Absence of inter radicular bone loss
6. Absence of internal root resorption
7. Permanent posterior teeth for the expedient
treatment of pulpalgia. (it relieves pain in
emergency as formocresol fixes the contiguous
pulp left in the root canal.)

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 Contraindications
Local : -
Spontaneous pain / pain at night
Pathologic mobility
Swelling or fistula
Internal resorption
Less than 2/3rd root remaining
Periapical inter radicular radiolucency
Pus / serous exudate at exposure site
Uncontrolled haemorrhage from amputed pulp
Excesive pulp calcification

Medical : -
Cardiac condition
Immunocompromised children
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 TECHNIQUE
The formocresol pulpotomy technique was first advocated by
SWEET [1930]
He used a multiple sitting technique, which has been
subsequently modified to either a single or two stage technique.
FORMULA :- 19% Formaldehyde
35% cresol
15% Glycerin & Water
To prepare 1.5%concentration of this formula, first
mix 3 parts of glycerin with 1 part of distilled water ,
then add 4 parts of this preparation to 1 part buckley’s
formocresol , and throughly mix again.

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 Mechanism of action
Formocresol causes coagulation necrosis in
tissues in immediate vicinity of the application
with fixation of tissue cells and micro
organism.

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 One-Appointment
Pulpotomy.
Indications :-
only on those restorable teeth in which it has
been determined that inflammation is confined to the
coronal portion of the pulp.

Contraindications :-

• Teeth with a history of spontaneous pain

• Profuse haemorrhage
• Pathologic or internal root resorption
• Inter radicular bone loss
• Presence of fistulas or pus in the chamber
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 PROCEDURE
Anesthetize the tooth and tissue.

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Isolate the tooth with rubber dam

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 Remove caries & determine
site of pulp exposure

Remove roof of pulp chamber

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Remove coronal pulp with a large
excavator or a large round bur

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Apply formocresol on the pledge of cotton wool
for 4 minute

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 Remove formocresol pledget
after 4 min. & check that
haemorrhage has stopped

Fill pulp chamber with cement

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Restore the tooth with stainless steel crown

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 Take a post operative photograph

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 Two-Appointment
Pulpotomy.
Indications

(1) Evidence of sluggish or profuse bleeding at the

amputation site
(2) Difficult-to-control bleeding
(3) Slight purulence in the chamber but none at
the amputation site
(4) Thickening of the periodontal ligament
(5) A history of spontaneous pain without other
contraindications.

Contraindications.

(1) Nonrestorable
(2) Soon To Be Exfoliated
(3) Necrotic.

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 Procedure

1. The steps are the same as for the one-appointment procedure

2. A cotton pellet moistened with diluted formocresol is sealed
into the chamber for 5 to 7 days with a durable temporary
cement.
3. At the second visit, the temporary filling and cotton pellet
are removed and the chamber is irrigated with hydrogen
peroxide.
4. A ZOE cement base is placed.
5. The tooth is restored with a stainless steel
crown.

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 Partial pulpotomy (pulp
curretage )

It is removal of coronal pulp tissue up to the

level of healthy pulp. This process is also known
as partial pulpotomy.
INDICATIONS : --
when zones of inflammation has extended
more than 2 mm. in an apical direction but has not
reached root pulp.
Eg. A traumatic exposure (a few days post
injury in a large young pulp)
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 TECHNIQUE
1. Area is anaesthetised and isolated
2. A 2 mm. deep cavity is prepared into pulp using sterile
diamond bur and copius water coolent
3. Excess blood is removed by saline & small cotton pelletes
4. Calcium hydroxide is placed onto cavity
5. Sealed with ZOE reinforced IRM restoration.

IT IS RARELY SUCESSFUL AND HENCE HAS

NO CLINICAL SIGNIFICANT.

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REASONS FOR FAILURE
Pulp is highly vascular so, even with slightest
infection in any corner of pulp , the whole of
it gets infected very quickly.

Its practically impossible to remove one part

of coronal pulp without disturbing the other
parts of it in pulp chamber.

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 DEVITALIZATION
PULPOTOMY
It is two stage procedure involving the use
of paraformaldehyde to fix the entire coronal
& radicular pulp tissue.

The medicament used have a devitalizing,

mummifying, & bactericidal action.

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 TECHNIQUE
First appointment :-
Same as formocresol pulpotomy but place
the paraformaldehyde paste in cotton pellete
over the exposure & seal the tooth for 1 to 2
weeks.
Formaldehyde gas liberates from the
paraformaldehyde permeates through the coronal
and radicular pulp, fixing the tissue.
Second appointment :-
pulpotomy is carried out with the help of
local anaesthesia

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 ELECROSURGICAL
PULPOTOMY
Given by mack & dean (1933 )
It is a non chemical devitalizaton
technique.
Electrocautery carbonizes and heat
denatures the pulp & bacterial
contamination
After amputation of coronal pulp,the
pulp stumps are cauterized through this
method
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 Laser pulpotomy

Jeng-fen liu et al in 1999 studied the

effect on Nd:YAG laser for pulpotomy
in primary teeth

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 Glutaraldehyde
by kopel (1979 )

Advantages over formocresol

1. Superior fixative property
2. Self limiting penetration
3. Low antigenicity
4. Low toxicity
5. Elimination of cresol

2-5 % concentration
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 Ferric sulphate

It forms a metal protein clot at the

surface of the pulp stump and this act
as a barrier to irritating components
of the sub-base

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 references
• Restorative technique for paediatric dentistry - Ms DUGGAL,
MEJ CURZON, SA FAYLE, KJ TOUMBA, AJ ROBERTSON

• Endodontic – Fifth Edition - JOHN I. INGLE, LEIF K.

BAKLAND

• Text Book Of Pedodontics - SHOBHA TANDON

• Clinical Pedodontics - FINN

• INTERNET ( www.google.com)

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