Pulp Therapy in Pediatric Dentistry

1
Pulp Therapy in Pediatric Dentistry

• Dr. Jeff Johnson
• Division of Pediatric Dentistry
• Department of Oral Health Science
• University of Kentucky

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

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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

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

• Non-Vital Pulp Treatment (Primary Teeth)
• Choices
• Pulpectomy (most are partial due to anatomy)
• Extraction

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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

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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

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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.

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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.

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

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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)

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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)

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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

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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
• 15-30 30
• 40 27
• 50 25
• 70-80 22
• 90-100 18

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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
  33-37.
• 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.