The canals are completely filled with ZOE. 19-13). The use of calcium hydroxide as a root-canal–filling material was described previously in the discussion of apexification. 35.8). Although zinc oxide–eugenol paste has been viewed as the traditional root canal filling material for primary teeth, results from multiple studies23-28 suggest that KRI paste (Pharmachemie AG, Zürich, Switzerland) may be preferable. This way the dentist removes all of the infected tissue and the tooth can be saved and not extracted. An x-ray film may be necessary to allow the success in filling the canals to be evaluated (Fig. Lasers provide a safe, effective, nonchemical alternative for pulpotomies.59,60 With more than 6 years of results on more than 5000 laser pulpotomies showing excellent results, the author can confirm the safety and effectiveness of this technique on children without using chemicals or electrosurgery (Figure 12-25). CASE DESCRIPTION: The author presents two pulpectomy cases that were filled with Vitapex. It is particularly important that the teeth in the mouths of accident-prone adolescents or in whom athletic trauma has previously occurred be restored without a post, if possible. Mature first primary molar canals are often so small that they are inaccessible even to the smallest barbed broach. The calcium hydroxide material used to fill the root canal should be replaced every 3 to 6 months until a decision is made to fill the canal with gutta-percha. A pulpectomy is defined as a root canal procedure for pulp tissue that is irreversibly infected or necrotic as a result of caries or traumatic injury. (. The objective of both pulpectomy and pulpotomy is to maintain a tooth both functionally and painlessly without pathology until the primary tooth normally exfoliates upon eruption of the underlying permanent tooth, or until the tooth is adequately developed for definitive root canal therapy. 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 (Fig. Other techniques have employed epinephrine flushes or electrocautery to stop the bleeding and dry the root canal. Physiologic root maturation cannot occur without the presence of vital pulp tissue, apical papilla stem cells, odontoblasts, and the Hertwig epithelial root sheath.24 Traditional treatment for these cases was an apexification procedure wherein CaOH was carried to the root apex to contact vital tissues directly. The excess thin paste may be removed with paper points and Hedström files. The aim of this systematic review was to determine whether there is a root canal filling for deciduous teeth equally or more effective than zinc oxide-eugenol cement (ZOE). The inflamed or necrotic pulp is removed and access preparation is refined to make sure that entrance to all of the canals is possible and clearly visible. If the supporting bone is also compromised, the likelihood of successful endodontic therapy is lower. Root canal instrumentation may be facilitated with the judicious use of this mechanical technique, especially in canals that are difficult to negotiate with hand instruments. It’s usually performed on baby teeth. The tooth should be restored with full coverage. Researchers have now experimented with a new mixture consisting of propolis, which is a natural product with proven antibacterial and anti-inflammatory properties, and zinc oxide powder as a filling material in primary teeth. Pulpotomy using formocresol and electrosurgery has also been described (Shulman et al., 1987). Figure 35.7. A temporary filling material is applied between the visits. Vitapex is also ideal for the treatment of infected root canals and for vital pulpotomies in deciduous teeth. In many cases of severe decay, trauma, or infection, a pulpectomy is necessary to save a tooth. 30 or 35 (Fig. Filling the treated tooth with reabsorbable material As compared to the pulpectomy procedure, a root canal treatment generally requires more than one visit to the dentist. BACKGROUND: The pulpectomy is an underutilized treatment modality for severely infected primary teeth. The calcium hydroxide material used to fill the root canal should be replaced every 3 to 6 months until a decision is made to fill the canal with gutta-percha. The root, however, remains fragile and at increased risk of future trauma because no further dentinal wall apposition can occur. The primary components of Vitapex are calcium hydroxide and iodoform. The root canals are irrigated with either 0.2 % up to 2 % chlorhexidine solution or with 1 % up to 5 % sodium hypochlorite (limited to one percent sodium hypochlorite according to the AAPD guidelines) (Fig. Mechanical removal of remnants from the canal is performed using a series of 21 mm long K-type endodontic files (Unitek Corp., Monrovia, CA) up to file No. Paper points are used to dry the canal and check for the presence of blood (Tomson et al., 1979). The primary components of KRI paste are zinc oxide and iodoform. An undistorted radiograph before performing root canal treatment is essential to assess canal morphology (Fig. Another popular root canal filling material for primary teeth is Vitapex (Dia Dent Group International, Inc., Vancouver, British Columbia, Canada), a product that has received many favorable anecdotal reports about its successful use in infected primary teeth. Objective To evaluate the success rate of pulpectomy of primary molars using four different root canal filling materials: ZOP as a new paste, Endoflas, Metapex, and ZOE. This procedure involves anesthetizing the animal, in this case a nonhuman primate, and placing it on a surgery table in dorsal recumbency. These findings explain the complications often encountered in root canal therapy. Further condensation may be carried out if required. When hemorrhage is controlled and the canals remain dry, a thin mix of filling paste may be prepared. preferred root canal filling material. 125, CH-8053 Zurich, Switzerland) may be preferable. Primary molar roots are usually curved to allow for the development of the succedaneous tooth. 13-13 and 13-14). Each canine tooth is cut off level with adjacent teeth, using tapering crosscut bars or Damascus separating disks (William Dixon, Inc., Carlstadt, New Jersey) attached to a dental drill. 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. This resorption causes the position of the apical foramen to change continually [. The file removes tissue only as it is withdrawn and penetrates readily with a minimum of resistance. Conclusions: The mixture of ZOE, iodoform and calcium hydroxide can be considered an effective root canal filling material in pulp involved primary teeth and had no adverse effect on tooth replacement. It is also indicated when root maturation is complete and the permanent restoration requires a post buildup. Pulpectomy in deciduous teeth is a common procedure in dental practice, seeking to preserve function of the pulpally involved tooth. Vitapex may be at least as effective as KRI paste, and Nurko and García-Godoy26,29 have published some reports of studies in humans. Another popular root canal filling material for primary teeth is Vitapex (Dia Dent Group International, Inc., Vancouver, British Columbia, Canada), a product that has received many favorable reports about its successful use in infected primary teeth. The canal should be filled approximately 2 weeks after the injury. The pulp filaments from the root canals are removed with a fine barbed broach; considerable hemorrhage will occur at this point. The treatment should permit resorption of the roots of the primary tooth and filling material and allow normal eruption of the succedaneous tooth. Similarly, longer-than-normal retention of a second primary molar may be desired when the succedaneous second premolar is congenitally missing (Fig. The purpose of the present retrospective study was to assess the success rates of root canal treatment of In this technique, the gum flap is repositioned over the remaining tooth, with retention of nerve function and minimization of subsequent problems such as tooth root abscesses and devitalization of the tooth. Cost: Cost of this procedure plus the crown (cap) (p. 146) required for strength may equal or exceed the cost of tooth removal and placement of a space maintainer. Care should be taken to avoid penetrating the apex of the tooth. The optimum duration of the calcium hydroxide treatment is unknown, but generally calcium hydroxide should be kept in the canal for at least 6 months or until root end closure (apical plug) occurs beyond 1 year. A post obturation radiograph is … Although zinc oxide–eugenol paste is viewed as the traditional root canal filling material for primary teeth, multiple studies18–23 suggest that KRI paste (Pharmachemie AG, Drusberstr. Special effort should be made to treat and retain the second primary molar, even if it has a necrotic pulp. A thick mix of the treatment paste should then be prepared, rolled into a point, and carried into the canal. 13-16). Many dentists prefer to use root canal instruments placed in a special handpiece for root canal débridement. Pulpectomy : Definition, Indication and Contra-indication. The pulpectomy completed by obturating with a cream past of ZOE introduced into the canal first using a file. The materials used for obturation in this study included zinc oxide propolis (ZOP) as a new paste, Endoflas, Metapex, and zinc oxide eugenol (ZOE). However, Moskovitz et al. In the strictest sense, complete removal of the the pulp from the pulp chamber and canals is a pulpectomy. Aminabadi and colleagues have demonstrated that while primary second molars are more accessible than first molars, all of them are negotiable.20 In addition, other studies have investigated ultrasonic instrumentation21 and root apex locators22 in the root canal treatment of primary teeth. Many dentists prefer to use root canal instruments placed in a special rotary handpiece and nickel titanium files for root canal debridement. 35.7).25 In addition, long-term CaOH therapy has been shown to weaken the tooth root and increase the likelihood of root fractures.26. The resulting space is then filled with special, medicated, dental materials, which while fill not allowing further maturation restore the tooth to its normal function. Root canal instrumentation may be facilitated with the judicious use of this mechanical technique, especially in canals that are difficult to negotiate with hand instruments. The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp (nerve) tissues to heal and regenerate plus the availability of advanced endodontic materials. A pulpectomy is complete removal of pulp from the crown and roots. Pulpotomy is a minimally invasive procedure performed in children on a primary tooth with extensive caries but without evidence of root pathology. The pulp should be extirpated when the first signs of degeneration appear. Hibbard and Ireland studied the primary root canal morphology by removing the pulp from extracted teeth, forcing acrylic resin into the pulp canals, and dissolving the covering of tooth structure in 10% nitric acid.19 It was apparent that, initially, only one root canal was present in each of the mandibular and maxillary molar roots. 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. The tooth should be restored with full coverage. Endodontic procedures for the treatment of primary teeth are indicated if the canals are accessible and if there is evidence of essentially normal supporting bone. 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. If small endodontic instruments are used without rubber dam protection, they should be secured with a length of dental floss to facilitate retrieval in the unlikely event that they are dropped in the patient’s mouth. The laser technique required less time for completion of the cleaning and shaping procedures when compared with both rotary or hand instrumentation [. Cautious manipulation is important, however, to prevent breaking the file or overinstrumentation of the canal and apical tissues. Risks: Occasionally the procedure fails in children, requiring removal of the tooth. An alternative to the CaOH apexification technique for managing devitalized immature incisors is the apical barrier technique using MTA.27 The material is condensed into the apical area and allowed to set. 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. Subsequently, when root formation is completed, a pulpectomy is performed, followed by placement of the definitive restoration or crown, if needed. Pulpotomies refer to the opening of the root canal and the partial removal of the pulpal tissue. Multiple visits over a period of 9 to 18 months were required, however, and the outcome was a shortened root with thin walls (Fig. The use of gutta-percha or silver points as a root canal filling material in primary teeth is contraindicated as these would not resorbe and Even though trauma may result in restoration dislodgement or perhaps even fracture of the tooth, the tooth will have survived at least one more traumatic experience. Andreasen suggested that 2 weeks after replantation is the ideal time to fill the canal with calcium hydroxide. Vitapex may be at least as effective as KRI paste, and Nurko and Garcí-Godoy21,24 have published some human reports. Lawrence Kotlow DDS, in Principles and Practice of Laser Dentistry, 2011, Primary teeth that have exposed pulp tissue resulting from caries, mechanical removal of carious tissue, or preventive procedures on severely abraded teeth require a pulpotomy or pulpectomy.52,53 In a pulpotomy, as defined by the American Academy of Pediatric Dentistry, the coronal pulp is amputated and the remaining vital radicular pulp tissue surface is treated with a medicament (e.g., formocresol, ferric sulfate)54 or with electrocautery to preserve the pulp's health. Though overall treatment time is greatly reduced, the shortened root and thin walls continue to place the tooth at risk for subsequent cervical root fracture. The root canals are first irrigated with either 0.2 % up to 2 % chlorhexidine solution or with 1 % up to 5 % sodium hypochlorite and then with normal saline, The use of sodium hypochlorite in the primary dentition should be performed cautiously since it is a potent tissue irritant and must not be extruded beyond the apex [, Sodium hypochlorite accident in a pediatric patient. [30] pulpectomy in primary teeth: a 18-months clinical randomized controlled trial Xiaoxian Chen1, Xinggang Liu2* and Jie Zhong1 Abstract Background: To avoid untoward changes when primary teeth are replaced by permanent teeth, resorption of the material used in primary teeth root canal filling should occur at the same rate as root resorption. An apexification procedure allowed this immature permanent tooth to be obturated successfully with gutta-percha (GP). In root canal treatment, the dentist will first perform the pulpectomy procedure in which the entire root canal system is cleaned, shaped, filled, and sealed. Following extraction of the pulpal tissue, the root canal is filled with a root canal paste. Thick paste such as ZOE is inserted and condensed with root canal pluggers, while thinner pastes like iodoform and calcium hydroxide-based materials are inserted with a spiral lentulo mounted on a slow-speed engine (Fig. A pulpectomy involves complete pulp tissue removal from the crown and root and is indicated when no vital tissue remains. James E. Jones, ... Ghaeth H. Yassen, in McDonald and Avery's Dentistry for the Child and Adolescent (Tenth Edition), 2016. After a dentist or endodontist removes the damaged pulp from the tooth, the area inside the tooth is disinfected and then filled with an inert material. More recently, the surgical techniques of pulpectomy and pulpotomy have been popularized as alternatives to canine tooth extraction. RCT is considered successful if clinically pretreatment clinical signs and symptoms resolve within a few weeks and the tooth is painless, presenting healthy surrounding soft tissues and no increased mobility. The primary components of Vitapex are calcium hydroxide and iodoform. Apexification using apical barrier technique. As aqueous vehicles favor a high degree of solubility, they will cause a depletion of the paste from the root canals, In vitro studies found that Metapex demonstrated minimal inhibition of 23 strains of bacteria isolated from infected root canals of primary molars and three nonstandard bacterial strains using agar diffusion assay [, Maisto’s paste, introduced in 1967, includes both zinc oxide and iodoform, with parachlorophenol camphor, lanolin, and thymol. Excess alloy is removed, and the tooth is sculptured smooth (Tomson et al., 1979) (Fig. Zinc oxide eugenol and aloe vera. However, Trope suggests that the pulp contents be removed at the emergency visit and a tetracycline-corticosteroid combination (Ledermix; Sigma Pharmaceuticals Pty Lid., Croydon, Victoria, Australia) be placed in the root canal.48 He believes that this combination decreases the inflammatory response after replantation to allow for more favorable healing than in those teeth that do not receive the medicament. One of the greatest challenges facing the clinician is the treatment of a nonvital immature permanent tooth with an open apex. 19-14). In a dog study where Vitapex was purposefully extruded beyond the apical foramen into the mandibular canal, radio- No pathologic root resorption, furcation/apical radiolucency [, Radiographically, success is defined either as when the radiolucency observed at the baseline did not increase [. Pulpectomy The procedure requires the removal of all tissue within the pulpal area, as well as in the root canals. A silver alloy amalgam (Caulk Company, Milford, Delaware, or White Dental Products International, Philadelphia) filling is used to permanently seal the filled root canal. ANDHRA PRADESH, India: The success of a pulpectomy depends on the elimination of bacteria from the root canal. 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