Pulpotomy

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A healthy tooth has a space inside it called the "pulp space" which is filled with soft tissues - nerves, blood vessels and pink connective tissue. If a tooth gets a large cavity, the bacteria in the decay can damage the pulp, which is often what causes toothache.

With adult teeth, damage to the pulp usually means you have to clean out all the space - including any remaining pulp - and fill it in. This is called Root Canal or Endodontic Therapy. But baby teeth only have to survive until an adult tooth comes through to replace them. They also have a better blood supply, so sometimes the pulp tissue in the canals can be saved.

Indications

Primary teeth

Primary (Baby) teeth in children have relatively large pulp spaces and a cavity does not have to get very large before it reaches the pulp chamber.

When the soft tissue in the pulp chamber is infected (has bacteria in it) or affected (is inflamed), it can be removed by a dentist under local anaesthetic. If the soft tissue in the canals is still healthy enough, a special medicated filling can be put into the chamber in an attempt to keep the remaining pulp (in the canals) alive. The process of removing the pulp from the chamber is the actual "pulpotomy", though the word is often used for the entire process including placement of the medication.

Afterwards the tooth is restored with a regular filling or a stainless steel crown.

Permanent teeth

Pulpotomies are only done in permanent teeth (adult teeth) as a temporary alternative to proper root canal therapy. For example, if there isn't enough time, the patient is traveling or they can't afford to have more conventional treatment.

Types

Partial Pulpotomy for Carious Exposures

In some cases an adult tooth might have decay down to the pulp but the pulp is still pretty healthy. If the roots haven't finished forming yet, a partial pulpotomy might give it a chance to finish forming.

Partial Pulpotomy for Traumatic Exposures

A partial pulpotomy for traumatic exposures is also called a Cvek Pulpotomy. When a baby tooth or young permanent tooth is traumatised - say, hitting your teeth on the handlebars of a bike - it can be broken in such a way that the pulp is exposed. Again, a partial pulpotomy may help it to finish developing and be saved.

Medicaments

In primary teeth medicaments such as formocresol, Ferric sulphate, and Calcium hydroxide can be used in pulpotomy although the clinical and radiographic success rate of ferric sulphate is higher than the other materials.

Alternative pulpotomy techniques

Electro-surgery pulpotomy

It is known as non chemical devitalization. Its mechanism of action is the cauterization of the pulp tissue. It carburizes heat denaturated pulp and bacterial contamination.

Laser pulpotomy

This technique overcomes histological effect of electro surgery. It creates superficial zone of coagulation necrosis that remain compatible with underlying tissue& isolate pulp from vigorous effects of the sub-base.

Objectives

1. Maintenance of radicular portion vitality.

2. Clinical and radiographic evaluation should show no complications such as, pain, swelling, internal resorption or abnormal canal calcification.

3. Neither breakdown of the supporting tissue, nor trauma to succedaneous teeth should be detected.

See also

Dentistry portal

• Pulpectomy
• Root canal therapy

References

• American Academy of Pediatric Dentistry website
• [1]
• [2]