Transcript Females with the Fragile X Premutation

Pulpotomy Access Technique
Cynthia Christensen, DDS, MS
Department of Pediatric Dentistry
Pulp Therapy for Primary Teeth
Michael Kanellis, DDS, MS
Department of Pediatric Dentistry
Pulpotomy
• Pulpotomy is the extirpation of vital
inflamed pulp from the coronal chamber
followed by medicament placement over
radicular pulp stumps to fix
(mummification) or stimulate repair of the
remaining vital radicular pulp.
Pulpotomy
• Rationale: The radicular pulp tissue is
healthy, and can either heal after the
surgical amputation of the coronal pulp, or
be fixed/mummified.
• Signs or symptoms of inflammation
extending beyond the coronal pulp is a
contraindication for a pulpotomy
Pulpotomy - Indications
• When the pulp is exposed (either
through carious exposure or through
trauma)
• When it is desirable to maintain tooth
(primarily for space, function, guidance
of permanent teeth)
• When there are no contraindications to
pulpal therapy
Pulpotomy Procedure
1.
2.
3.
4.
Rubber Dam Isolation
Remove caries
Open pulp chamber and de-roof
Amputate pulp with round bur in slow
speed running in reverse
5. Control hemorrhage with dry cotton pellet
6. Place Endo Bleach or FMC?????
7. Place Glass Ionomer over floor?????
Although the Medicaments
and Materials May Change…
The Access Opening Technique
Will Remain the Same
Pulpotomy Access Technique
•Remove caries
•Pulp exposed
•Primary Pulp
Chambers
Short vertical
dimension
Thin floor
Therefore: Perforation of Floor is
Much Greater Risk in Primary
Molars
What happened here?
Pre
Post
Radiographic Appearance
Perforation
Proper Appearance
11/17/03
•Access Opening
Must Be LARGE
•Root orafices
splayed to
accommodate
succedaneous
tooth.
•Access Opening
Must Be LARGE
•Convenience
Form to Amputate
Radicular Orafice
Edontontic Department Will
Teach You to Do A Conservative
Access Opening
Edontontic Department Will
Teach You to Do A Conservative
Access Opening
That is correct for Permanent
Teeth!!
PRIMARY TEETH ARE
DIFFERENT
Why Not Do an Access That
Conserves Tooth Structure?
• Has nothing to do with SSC Restoration
Retention
– Cervical Bulge Intact
• Convenience Form Needed
– Not using flexible files
•Place cotton
pellet and
pressure to control
initial hemhorrage
•Remove cotton
pellet
•Irrigate with
NaOH?
•Place GI?
•Place stainless
steel crown
Rubber dam isolation
Remove caries
Deep caries with pulp
exposure
Open pulp chamber and “de-roof”
Amputate pulp with slow speed in
reverse.
Control Hemorrhage with Cotton Pellet
Remove cotton pellet: Residual Bleeding
Why???
Tissue Tags Remain: Not Amputated at
Canal Orafices
Let’s Try A Larger Access Opening
Caries removal with pulp exposure
Outline of access opening
Access opening complete and pulp
chamber tissue amputated
Placement of cotton pellet
Hemostasis Acheived
Place Medicaments and Liner
Restore with SSC
Mandibular First Primary Molar
Thank You!