Pulpectomy VS Pulpotomy // Pulpectomy vs. Pulpotomy as Alternative Emergency Treatments

 

Pulpotomy vs Pulpectomy

this is an overall overview of pulpotomy and pulpectomy By; Dr. Muneeb Ali Hassan , Date: 10-5-2024

You know what is the main difference between Pulpotomy and Pulpectomy? Here we are discuss about both terms in detail. Before going to these terms we should know about the PULP ( is the soft tissue that lies in the center of the pulp chamber that contains the blood vessels and nerves and provide nutrients/ nourishments to the soft and surrounding tissues). Pulp is responsible for the stimulation like hot/cold response in the form of pain. If the pulp is necrosed teeth vitality is lost and teeth become dead. So pulp is an important part of our teeth.  

Both Pulpectomy & Pulpotomy  are dental procedures under pediatric dentistry that treats the pulp tissues of the damaged permanent tooth. Both procedures are essential in dentistry but have different procedures. We will discuss its procedure in this article.

difference between Pulpotomy and Pulpectomy

What is Pulpotomy?

                     In this procedure Coronal Portion of the Pulp is removed with the aim to preserve the Redicular part of the pulp and to relief the Pain. As the Pulpotomy leaves the roots of a tooth intact and able to grow, it is used primarily in children with baby (primary teeth), which have an immature root formation.

• ·       Coronal Part= this lies in the crown portion.
• ·       Redicular Part= this lies in the Root.

pulpotomy

Main Objectives:

• ·      To preserve the redicular portion of the root and
• ·        to relief the pain.

Indications:

1. ·       If the primary teeth are cariously exposed, when its retention is most advantages/preferred than extraction.
2. ·       If the tooth is vital and has healthy periodontium.
3. ·       In the case of Pain if present not spontaneous after the removal of stimulus.
4. ·       Restorable tooth.

 Contraindications

• ·       In the case of internal resorption.
• ·       If inter-radicular bone loss case is present/occur.
• ·       If the caries penetrate to the floor of pulp chamber.
• ·       If the tooth is near to the Natural exfoliation.
• ·       In Irreversible pulpitis cases.
• ·       If any sensitivity to Heat or cold.
• ·       In Tender to Percussion ( TTP ) cases.

Techniques to do Pulpotomy:

Pulpotomy is further divided into the

• ·       One step and
• ·       Two Step Techniques

A.    Devitalization ( Single Siting ).

       In this we use Formocresol

  It contains 19% of the Formaldehyde; 35% of the Cresol; 15% of the glyecrine (veichle ).

How to do One Step Pulpotomy;

·       First give LA to target area.

·       Then Give Rubber Dam isolation.

·       Then remove all caries.

·       And then remove the dentinal roof of the Pulp chamber.

·       Remove all the CORONAL Part of the pulp by using slow speed No.06 and No.8 Round bur or with sharp Spoon Excavator.

·       After this now achieve a heamostasis by using the cotton pellets under pressure.

·     Then applied  diluted Cresol Oil ( formocresol ) to the pulp with the help of cotton pellets for 3 to 5 minutes. Apply pressure on pellets.

·       Pulp chamber will be dried by using the new cotton pellets.

·       Now Place a thick paste of ZOE ( Zinc Oxide Eugenol ) in contact with pulp stumps.

·       And at last placed a stainless steel crown or bonded composite. As shown in figures 1.1.

B.     Devitalization ( Two Siting ).

                 It involves the use of Paraformaldehyde to fix the entire Coronal and Radicular Pulp tissues.

The medicaments that are used in this techniques have a devitalizing, mummifying and bactericidal actions.

Indications;

        If following conditions are present then we do Two Sitting Pulpotomy;

• ·       If profuse bleeding is indicated
• ·       If any difficulty in bleeding control.
• ·       In the case of spontaneous pain.
• ·       Slight Purulence ( پیپ )discharge.
• ·       If Thickened PDL.

Contraindications

• ·       Non restorable tooth
• ·       Necrotic Pulp/tooth
• ·       If it is near to exfoliate.

First Appointment for 2 sitting step;

• In the 1^st step/sitting we do
• ·       Rubber dam isolation on targeted teeth.
• ·       Then prepare a cavity and remove the caries.
• ·       On the excavation of the deep caries pulp exposure is encountered and ensure that the exposed site is free from any type of the debris.
• ·       Cotton pellet socked with formaldehyde is placed in the exposure sites and seal it for at least 1 to 2 weeks.

2^nd Second  Appointment for 2 sitting step;

In the 2nd step/sitting we do

• ·       Now do Pulpotomy with the help of LA.
• ·       Here remove the roof of pulp chamber and then cleaned it with normal saline water and dried it with cotton pellet.
• ·       Then filled the pulp chamber with antiseptics paste and the tooth is restored.

Note:  There Are some medicament that placed above the vital pulp i.e. formocresol ( cresol oil ), calcium hydroxide ( CaOH2 or mineral trioxide aggregate (MTA).

What is Pulpectomy?

In this procedure Redicular Portion of the Pulp is removed. Pulpectomy, on the other hand, is similar to a root canal. In pulpectomy dentists remove the entire pulp from crown to root.

pulpectomy and its types

Procedure;

In pulpectomy we do following steps;

• ·       Use/ Apply LA
• ·       Access to the pulp by using burs
• ·       Then whole pulp is removed from root
• ·       Then cleaned the tooth, disinfected and filled with prescribed material.
• ·       Then covered it with a crown
• ·       Use antibiotics to reduce infection risk.

Indication;

Tooth indicated for pulpectomy should have one or more of the following criteria:

• ·       If the pt. has a History of spontaneous pain.
• ·       If any Evidence of radicular pathologic lesion is present with or without caries involvement.
• ·       If pt. has Alveolar swelling.
• ·       Pus discharge from canal(s).
• ·       If continuous bleeding even after the amputation of the coronal pulp tissue during pulpotomy.
• ·       No pulp tissue remaining when the pulp chamber is entered.
• ·       In the presence of sinus tract.
• ·       In the presence of inter radicular or periapical radiolucency

Contra-indication;

Followings are the contraindications of the pulpectomy;

• ·       Un-restorable tooth.
• ·       If teeth with pathological lesion extended to the tooth germ of the successor tooth.
• ·       If teeth have evidence of extensive internal or external pathological root resorption.
• ·       Patient with systemic disease such as congenital or rheumatic heart disease, leukemia and children on long term corticosteroid therapy or those who are immunocompromised.

Types of pulpectomy:

its types depends upon the region / area

1. Partial Pulpectomy;

               in this the infected crown portions along with some part of the root pulp is removed. 

2. Complete Pulpectomy;

              in this type complete pulp is removed