Mostrando entradas con la etiqueta Endodontics. Mostrar todas las entradas
Mostrando entradas con la etiqueta Endodontics. Mostrar todas las entradas


An update on primary teeth pulpotomy medicaments


Vital pulpotomy is the clinical treatment of choice for primary teeth with exposed pulp.

Pulpotomy can be defined as the surgical removal or amputation of the coronal pulp of the vital tooth.

This step is generally followed by the placement of a particular medicament over the intact stump to fix, mummify or stimulate repair of the remaining radicular pulp.

There have been three common medicaments used fot pulpotomy in primary teeth: formocresol, calcium hydroxide and glutaraldehyde; however, other medicaments have been investigated for pulpotomy procedures, including electrosurgery and laser, ferric sulfate freeze-dried bone, bone morphogenetic protein, osteogenic protein-1, the novel anti-inflammatory agent tetrandrine, collagen, feracrylum, glass ionomer, mineral trioxide aggregate (MTA), lyophilized freezefdried platelet-derived enamel matrix derivate, sodium hypochlorite, Portland cement, nanohydroxyapatite, calcium-enriched mixture, calcium phosphate cement, and Allium sativum oil.

Read Also: ENDODONTIC treatment for children

The clinical successes of these medicaments have a differed from each other in biological compatibility, healing capabilities, mutagenicity, cytotoxicity, histological responde and carcinogenic potential.

Therefore, the aim of this study was to review the history and the scientific literature published on pulpotomy medicaments and to present the findings of these studies.

Yousef H Al-Dlaigan


ENDODONTIC treatment for children


Root canal treatment for children has particular difficulties and considerations. It must be planned in light of the remaining teeth, and the need for balancing or compensating extraction borne in mind.

Diagnosis may be difficult, as may prolonged treatment under local anaesthesia and rubber dam.

Vital pulpotomy techniques with formocresol and/or calcium hydroxide must be carefully executed in line with the UK National Guidelines.

The treatment of the avulsed tooth has been the subject of much research, and practitioners should ensure that they are up-to-date with current treatment modalities.

Although the basic aims of endodontic therapy in children are the same as those in adults, ie the removal of infection and chronic inflammation and thus the relief of associated pain, there are particular difficulties and considerations.

The pulpal tissue of primary teeth may become involved far earlier in the advancing carious lesion than in permanent teeth.

Read Also: PULPECTOMY procedures in primary molar teeth

Exposure may also occur far more frequently during cavity preparation due to the enamel and dentine being thinner than in the permanent tooth, and the pulp chamber, with its extended pulp horns, being relatively larger.

Primary molar root canals are irregular and ribbon-like in shape. Periradicular lesions associated with infected primary molars are usually inter-radicular rather than periapical in site due to the presence of accessory canals in the thin floor of the pulp chamber.

As well as the problems associated with the primary dentition, endodontic treatment of permanent teeth in children may also present difficulties due to the incomplete root development and associated open apices.


°British Dental Journal
°Endodontic treatment for children
°P Carrotte


Guideline on Pulp Therapy for Primary and Immature Permanent Teeth

Pulp Therapy

The American Academy of Pediatric Dentistry (AAPD) intends this guideline to aid in the diagnosis of pulp health versus pathosis and to set forth the indications, objectives, and therapeutic interventions for pulp therapy in primary and immature permanent teeth.

The primary objective of pulp therapy is to maintain the integrity and health of the teeth and their supporting tissues.

It is a treatment objective to maintain the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes.

Especially in young permanent teeth with immature roots, the pulp is integral to continue apexogenesis. Long term retention of a permanent tooth requires a root with a favorable crown/ root ratio and dentinal walls that are thick enough to withstand normal function.

Read Also: ENDODONTIC treatment for children

Therefore, pulp preservation is a primary goal for treatment of the young permanent dentition.

A tooth without a vital pulp, however, can remain clinically functional.




What you Need to Know About a Pulpectomy


Pulpectomy is a procedure to remove all the pulp from the crown and roots of a tooth.

Pulp is the soft inner material that contains connective tissue, blood vessels, and nerves.

Pulpectomy is usually performed in children to save a severely infected baby (primary) tooth, and is sometimes called a “baby root canal.” In permanent teeth, pulpectomy is the first part of the root canal procedure.

Pulpectomy vs. root canal

A pulpectomy is complete removal of pulp from the crown and roots. The tooth is then filled with material that can be reabsorbed by the body. It’s usually performed on baby teeth.

Read Also: ORAL REHABILITATION : Stainless steel crown prep on a primary molar

A root canal starts with a pulpectomy, but the tooth gets a permanent filling or crown. It’s usually performed on permanent teeth.

Pulpectomy can be performed in one visit with these basic steps:

° X-rays are taken to look for signs of infection in surrounding areas and to get a look at the shape of the root canals

° A local anesthetic is used to numb the area

° A hole is drilled into the tooth...


° Image : Healthline


PEDIATRIC DENTISTRY : Pulp therapy and primary tooth pulpotomy

Pulp therapy for vital primary teeth has evolved over the past 20 years with the introduction of new pulp therapy medicaments and the return of old techniques.

Formocresol, ferric sulfate, and mineral trioxide aggregate are the most popular pulpotomy agents, while indirect pulp therapy (IPT) or indirect pulp capping has made a comeback as an alternative to pulpotomy for asymptomatic, caries-involved primary teeth.

Accurate diagnosis of pulpal status is of paramount importance for the successful outcome of both pulpotomy and IPT.

After diagnosis, maintenance of a biological seal to prevent microleakage is the most important aspect of both techniques to ensure long-term success.

Carefully planned follow-up must involve assessment of both clinical and radiographic parameters every six months for signs of failure.

Read Also: What Are The Normal Ages For Teeth Falling Out?

The American Academy of Pediatric Dentistry has assigned a workgroup to perform a systematic review and meta-analysis to determine if one form of primary tooth pulp therapy is better than another.

Pulp therapy for the vital primary tooth has evolved over the past 20 years with the introduction of new pulp therapy medicaments and the return of old techniques.

The pulpotomy is still the most widely used treatment for the primary tooth where caries has closely approximated the pulp so that complete removal would expose the pulp.

Youtube / Dr. Rafi Romano


Vital Pulp Therapy in Primary Teeth: An Update

Vital Pulp Therapy

Dental caries, the most common chronic childhood disease, creates unique problems in the primary dentition.

Untreated caries causes children to lose time from school and parents to lose time from work, and children with toothaches are at a greater risk of having lower grades.

The goal of pulp therapy in primary teeth is to maintain the primary tooth until it exfoliates in order to maintain the integrity of the dental arch.

Primary teeth also guide the eruption of the permanent tooth. Pulp therapy for a primary tooth helps avoid an abscess, and maintains the tooth for function, aesthetics, speech, mastication, and overall health.

There are now many options to treat primary teeth with deep caries approximating the pulp. These include: indirect pulp treatment (IPT), direct pulp cap (DPC), and pulpotomy. IPT is a procedure in which deep caries close to the pulp is left in place and covered with a biocompatible material to avoid a pulp exposure in asymptomatic teeth or a pulp with reversible pulpitis.

Read Also: EMERGENCY : Managing Patients With Primary Incisor Root Fracture

The DPC is indicated when there has been a pinpoint mechanical or traumatic exposure to a normal pulp and caries was not the cause of the pulp exposure.

A pulpotomy is a procedure in which the coronal pulp is removed, and the radicular pulp is treated after caries removal has created a pulp exposure in a healthy pulp or a pulp with reversible inflammation.


° Vital Pulp Therapy in Primary Teeth: An Update - Lance Kisby, DMD


Management of Endodontic Emergencies: Pulpotomy Versus Pulpectomy

Emergency Pediatric Dentistry

Recent studies report a 60-82% incidence of endodontic emergencies among all dental emergencies.

Within this group, 20-42% of patients seek care for teeth with symptomatic irreversible pulpitis (SIP).

Additionally, about 60% of SIP patients also complain of symptomatic apical periodontitis (SAP).

While pain due to a severely inflamed pulp is characterized by dull, throbbing and lingering pain sensations, it can be spontaneous or in response to an external stimulus, such as hot, cold or chewing.

This makes SIP the bulk of the emergency cases seen in dental clinics.

Read Also: PULPECTOMY procedures in primary molar teeth

The goal of management of endodontic emergencies is to quickly and effectively manage pain and infections thereby also minimizing the development of persistent pain and the formation of periapical pathology.

Dental Professional Community by the American Association of Endodontists (AAE)


PULPECTOMY procedures in primary molar teeth


Premature loss of primary molars can cause a number of undesirable consequences including loss of arch length, insufficient space for erupting premolars and mesial tipping of the permanent molars.

Pulpectomy of primary molar teeth is considered as a reasonable treatment approach to ensure either normal shedding or a long-term survival in instances of retention.

Despite being a more conservative treatment option than extraction, efficient pulpectomy of bizarre and tortuous root canals encased in roots programmed for physiologic resorption that show close proximity to developing permanent tooth buds presents a critical endodontic challenge.

This article aims to provide an overview of this treatment approach, including partial and total pulpectomy, in primary molar teeth.

In addition, the recommended guidelines that should be followed, and the current updates that have been developed, while commencing total pulpectomy in primary molars are discussed.


The main objective of pulp therapy in the primary dentition is to retain every primary tooth as a fully functional component in the dental arch to allow for proper mastication, phonation, swallowing, preservation of the space required for eruption of permanent teeth and prevention of detrimental psychological effects due to tooth loss.

Read Also: EMERGENCY : Managing Patients With Primary Incisor Root Fracture

To fulfill this major goal, vital pulp therapy through pulpotomy, which refers to surgical removal of the entire coronal inflamed pulp leaving the vital radicular pulp intact within the canals, is the most widely accepted technique for treating primary teeth with irreversible inflammation affecting the pulp chamber.

However, in cases of irreversibly inflamed and necrotic radicular canals, a successful pulpotomy cannot be achieved, and a partial or total pulpectomy is indicated.


° Hany Mohamed Aly Ahmed


ENDODONTICS : Is Root Canal Treatment recommended for children?


Root canal treatments are recommended in children because you have to save the tooth or even primary needs to be saved till it falls off by itself because this gives you a proper smile or occlusion will not be hindered.

If the tooth is removed without doing the root canal treatment the smile or occlusion could hinder when permanent tooth erupts.

So it's always recommended appropriate to the age of the patient.

The primary teeth can be saved if the roots are existing, this should be told to your dentist when he sees an x-ray condition of the tooth.

So the children can also have root canal treatment without any fear in mind.

Parents need not worry about root canal treatment for kids. So it is always recommended to save a tooth.

Read Also: PERIODONTICS : Gingivitis in Children and Adolescents

Youtube / Doctors' Circle - Ask Doctors. Free Video Answers


A Review on Vital Pulp Therapy in Primary Teeth


Maintaining deciduous teeth in function until their natural exfoliation is absolutely necessary.

Vital pulp therapy (VPT) is a way of saving deciduous teeth. The most important factors in success of VPT are the early diagnosis of pulp and periradicular status, preservation of the pulp vitality and proper vascularization of the pulp.

Development of new biomaterials with suitable biocompatibility and seal has changed the attitudes towards preserving the reversible pulp in cariously exposed teeth.

Before exposure and irreversible involvement of the pulp, indirect pulp capping (IPC) is the treatment of choice, but after the spread of inflammation within the pulp chamber and establishment of irreversible pulpitis, removal of inflamed pulp tissue is recommended.

In this review, new concepts in preservation of the healthy pulp tissue in deciduous teeth and induction of the reparative dentin formation with new biomaterials instead of devitalization and the consequent destruction of vital tissues are discussed.

Read Also: Dental do's and don’ts during pregnancy

Introduction : Premature loss of primary teeth can lead to malocclusion besides functional and esthetic problems. Therefore, preserving the vitality of deciduous teeth until their natural exfoliation time is critical for maintaining the arch integrity.

The pulp in primary dentition is histologically similar to permanent teeth and may be affected by caries, restorative procedure and trauma. Depending on severity of injury; the reaction of pulp is different.


° Iman Parisay / Jamileh Ghoddusi / Maryam Forghani


Pulpotomy medicaments used in deciduous dentition


The aim of this paper was to review the history and the scientific literature published on pulpotomy medicaments and to present the findings of these studies.

The review showed that pulpotomy of primary teeth has been treated with many different techniques and medicaments, that some of these approaches are controversial and that their results have presented variables of success rates in term of clinical, radiographic and histologic observation.

It is important that all clinicians, particulary for pediatric dentits, be up to date with the recent trend in this area of dental treatment for children.

Read Also: Guideline on Pulp Therapy for Primary and Immature Permanent Teeth

Introduction : Vital pulpotomy is the clinical treatment of choice for a primary teeth with exposed pulp.

Pulpotomy can be defines as the surgical removal or amputation of the coronal pulp of the vital tooth.


Souce :
Authors : Yousef H Al-Dlaigan


Treatment of the Immature Tooth with a Non–Vital Pulp and Apical Periodontitis


The immature root with a necrotic pulp and apical periodontitis presents multiple challenges to successful treatment.

1. The infected root canal space cannot be disinfected with the standard root canal protocol with the aggressive use of endodontic files.

2. Once the microbial phase of the treatment is complete, filling the root canal is difficult because the open apex provides no barrier for stopping the root filling material before impinging on the periodontal tissues.

3. Even when the challenges described earlier are overcome, the roots of these teeth are thin with a higher susceptibility to fracture.

These problems are overcome by using a disinfection protocol that does not include root canal instrumentation, stimulating the formation of a hard tissue barrier or providing an artificial apical barrier to allow for optimal filling of the canal, and reinforcing the weakened root against fracture during and after an apical stop is provided.

Read Also: ORTHODONTIC : Dental disorders are linked to mouth breathing


Disinfection of the Canal

Because in most cases nonvital teeth are infected, the first phase of treatment is to disinfect the root canal system to ensure periapical healing.


° Martin Trope, DMD


Endodontic Management of the Pregnant Patient


Managing the pregnant patient during root canal therapy requires special considerations.

In this video, Dr. Nasseh interviews Dr. Ian Grayson, post doctoral Fellow at Harvard School of Dental Medicine Post Doctoral Endodontic program regarding such spacial considerations.

Is it safe to have a root canal when being pregnant?

Yes, since this procedure is often not elective.

But elective procedures are best postponed during the first and third trimester.

Read Also: Pulpotomy medicaments used in deciduous dentition

Youtube / Real World Endo


ENDODONTIC considerations in pediatric dentistry: a clinical perspective

The deciduous tooth often presents post-carious pulpal implications that require endodontic treatment.

The deciduous tooth goes through different stages during which it witnesses changes of anatomical and physiological nature: the root undergoes resorption and the pulp’s reactive potential is diminished or even lost.

The tooth has also to be considered within the physiopathological context of the child. The age, general health, and the compliance of the young patient (and sometimes that of the parents) are also factors to be considered before undertaking any treatment procedure.

The aim of pulp therapy in the primary dentition is to retain the primary tooth as a fully functional part of the dentition, allowing at the same time for mastication, phonation, swallowing, and the preservation of the space required for the eruption of the permanent tooth.

Read Also : DENTAL ANESTHESIA : Children's Dental Injection Technique

Furthermore, maintaining esthetics will avoid psychological problems related to the loss of teeth. Clinically, the choice of pulp therapy is based on semeiology despite the assessment difficulties and imprecision of pulp tests related to deciduous dentition.

The choice between pulpotomy and pulpectomy is generally based on the severity of the symptoms clinically and/or radiographically. When indicated, pulpotomy of the deciduous tooth is relatively an easy procedure with generally good clinical results.

Pulpectomy on the other hand is a heavier treatment for the child and is more complicated due to anatomical complexities that are not found in the permanent tooth.

Hani F. Ounsi / Dina Debaybo / Ziad Salameh / Anis Chebaro / Hassan Bassam