انت هنا الان : شبكة جامعة بابل > موقع الكلية > نظام التعليم الالكتروني > مشاهدة المحاضرة

Vital pulp therapy (partial pulpectomy)

الكلية كلية طب الاسنان     القسم التقويم والاطفال وطب الاسنان الوقائي     المرحلة 5
أستاذ المادة حسن فليح فرحان السلطاني       6/2/2011 8:54:30 PM

Lec. 10                                               Pediatric dentistry                                      د.حسن الوطيفي  


4- PARTIAL PULPECTOMY
Indication:
1- A partial pulpectomy may be performed on primary teeth when coronal pulp tissue and the tissue entering the pulp canals are vital but show clinical evidence of hyperemia.
2- The tooth may or may not have a history of painful pulpitis, but the contents of the root canals should not show evidence of necrosis (suppuration).
3- In addition, there should be no radiographic evidence of a thickened periodontal ligament or of radicular disease.
If any of these conditions is present, a complete pulpectomy or an extraction should be performed.

Procedure:
1- The partial pulpectomy technique, which may be completed in one appointment, involves the removal of the coronal pulp as described for the pulpotomy technique.
2- The pulp filaments from the root canals are removed with a fine barbed broach; considerable hemorrhage will occur at this point. A Hedstrom file will be helpful in the removal of remnants of the pulp tissue. The file removes tissue only as it is withdrawn and penetrates readily with a minimum of resistance. Care should be taken to avoid penetrating the apex of the tooth.
3- Cautious manipulation is important, however, to prevent breaking the file or over instrumenting the canal and apical tissues.
4- After the pulp tissue has been removed from the canals, a syringe is used to irrigate them with 3% hydrogen peroxide followed by sodium hypochlorite.
5-  The canals should then be dried with sterile paper points.
6- When hemorrhaging is controlled and the canals remain dry, a thin mix of unreinforced zinc oxide-eugenol paste may be prepared (without setting accelerators), and paper points covered with the material are used to coat the root canal walls. Small Kerr files may be used to file the paste into the walls. The excess thin paste may be removed with paper points and Hedstrom files.
7-  A thick mix of the treatment paste should then be prepared, rolled into a point, and carried into the canal. Root canal pluggers may be used to condense the filling material into the canals.
8- An x-ray film may be necessary to allow evaluation of the success in filling the canals.
9- The tooth should be restored with full coverage.

Capping materials:
1-  Zinc oxide-eugenol paste
2- KRI paste (zinc oxide and iodoform).
3- Vitapex (calcium hydroxide and iodoform).

B: NONVITAL PULP THERAPY TECHNIQUE (COMPLETE PULPECTOMY)

It is unwise to maintain untreated infected primary teeth in the mouth. They may be opened for drainage and often remain asymptomatic for an indefinite period. However, they are a source of infection and should be treated or removed.
The morphology of the root canals in primary teeth makes endodontic treatment difficult and often impractical. Mature first primary molar canals are often so small that they are inaccessible even to the smallest barbed broach. If the canal cannot be properly cleansed of necrotic material, sterilized, and adequately filled, endodontic therapy is more likely to fail. Endodontic procedures for the treatment of primary teeth with necrotic pulps are indicated if the canals are accessible and if there is evidence of essentially normal supporting bone. If the supporting bone is also compromised, the likelihood of successful endodontic therapy is lower. If the second primary molar is lost before the eruption of the first permanent molar, the dentist is confronted with the difficult problem of preventing the first permanent molar from drifting mesially during its eruption. Special effort should be made to treat and retain the second primary molar even if it has a necrotic pulp. Similarly, longer than normal retention of a second primary molar may be desired when the succedaneous second premolar is congenitally missing

Indication:  non vital primary teeth with necrotic pulp or periapical abscess.
Procedure:
1. The rubber dam should be applied, and the roof of the pulp chamber should be removed to gain access to the root canals as described previously in the pulpotomy technique.
2. The contents of the pulp chamber and all debris from the occlusal third of the canals should be removed, with care taken to avoid forcing any of the infected contents through the apical foramen.
3. A pellet moistened with camphorated monochlorophenol (CMCP) or a 1:5 concentration of Buckley s formocresol, with excess moisture blotted, and should be placed in the pulp chamber. The chamber may be sealed with zinc oxide–eugenol.
4. At the second appointment, several days later, the tooth should be isolated with a rubber dam and the treatment pellet removed. If the tooth has remained asymptomatic during the interval, the remaining contents of the canals should be removed using the technique described for the partial pulpectomy.
5. The apex of each root should be penetrated slightly with the smallest file. (The dentist should experiment with dissociated primary molars to develop a feel for the instrument as it just penetrates the apex.)
6. A treatment pellet should again be placed in the pulp chamber and the seal completed with zinc oxide- eugenol.
7. After another few days the treatment pellet should be removed. If the tooth has remained asymptomatic, the canals may be prepared and filled as described for the partial pulpectomy.
8.  However, if the tooth has been painful and there is evidence of moisture in the canals when the treatment pellet is removed, the canals should again be mechanically cleansed and the treatment repeated.
9. Currently, pulpectomies in primary teeth are commonly completed in a single appointment. If the tooth has painful necrosis with purulence in the canals, however, completing the pulpectomy procedure over two or three visits should improve the likelihood of success.



المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .