Pulpotomy, Pulp Capping and Apicectomy

What is a Pulpotomy? 

Pulpotomies are carried out in children, instead of a Root Filling that is carried out in adults.  Sometimes children’s decidious teeth can cause pain due to the nerve beginning to die off or due to pulp exposure.  

This procedure is also carried out on children’s newly erupted permanent teeth for the same reasons but as the apex is still wide open an RCT is not needed as no pressure can build up as the blood can move freely around the pulp, and nerve death can be avoided so just removing the infected part of the pulp will suffice and then the pulp can recover due to this good rich blood flow.

 
The procedure is similar to that of a root filling as the tooth needs to be accessed in the same way.  The child will normally require an anaesthetic, which can be upsetting for the child as this may be the first treatment that they have received at the dentist.  Lots of topical anaesthetic and lots of praise will hopefully help them through the injection.   Once numb, the dentist will then drill through the crown of the tooth with a fast hand piece and access the pulp.  The pulp will then be removed generally using an excavator and then the entrance of the root canals will be dried with sterile cotton wool and dressed usually with calcium hydroxide – this stimulates the development of secondary dentine, and temporised with a dressing such as Chemfil Glass Ionomer.
 

This procedure can usually be carried out in one visit so lots of patient encouragement and praise is needed to make it  relaxed, calm and not scary.  We find drilling to the count of ten is calming as the child knows when the drilling will end; therefore the child will begin to trust you and the dentist.

 

What do I need?

 
In surgery you will need the following:
 
Mirror
Probe
Tweezers
Spoon Excavator
Ball Ended Burnisher
Flat Plastic
Wards Carver
Hand Pieces – Slow and Fast
Burs and Gates Gliddens
Saliva ejector
Aspiration tip
 
For the Procedure you will need:
 
Calcium hydroxide (Hypo-Cal)

Temporary Filling Material. (Chemfil)

 

What is Pulp Capping?

 
Pulp Capping is carried out quite often as an emergency procedure when the vital pulp is exposed possibly due to caries or during a filling procedure.  Generally a pulpotomy or an RCT will be required but due to the length of time these procedures take, this temporary measure will hopefully help protect the tooth and hopefully prevent pain.  The exposed pulp will be dressed with Calcium Hydroxide or ‘Ledermix’ and temporised with a temporary filling material until the full procedure can be carried out.
  
 

What is an Apicetomy?

 
An Apicetomy is carried out to remove the infected apex of the tooth and the infected surrounding areas as to save the tooth when for example a Root Filling has failed due to possible failure to completely seal the canals or it has become impossible to access due to fused canals or a broken hand instrument.  An Apicetomy can also be carried out on a tooth that has a post crown present as you cannot access the canals due to the post.
 

To carry out this procedure the area will have to be anaesthetised and the dentist will make an incision into the gum and will then lift that flap of gum with a periosteal elevator.  The dentist will then cut into the bone with a fast hand piece and appropriate burs to expose the infected apex and area.  The dentist will then cut off the infected apex use a Curette to scrape away the infected areas.  If the tooth is presenting a failed RCT, the dentist will check the removed root end to see if the filling has failed.  If so, some more filling will be inserted into the end.  This filling is usually a Glass Ionomer Cement mixture (GIC) or a Zinc Oxide and Eugenol mixture (ZOE) and is called a Retrograde Root Filling.  Once placed the dentist will rinse the area and suture the gum back into position.  The patient will return usually in 7 days to have these sutures removed.  Hopefully the patient will no longer be presenting pain or tenderness.

 
 What do I need?
 
Mirror
Probe
Tweezers
Wards Carver
Flat Plastic
Spoon Excavator
Syringe
Scalpel - Disposable
Periosteal Elevator
Curette
Scissors
Dissecting forceps
Needle holder
Aspiration tip
Saliva ejector
 

For the procedure you will need:

 
Sterilised gauze
Required mixture of GIC or ZOE
Sutures
 

Rebecca RDN

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