What is a pulpotomy?

What is a pulpotomy

Pulpotomy is a procedure to keep decayed or injured teeth vital and is done on the baby or newly erupted permanent teeth. It is a painful procedure and takes 20-30 mins. 

The pulpotomy saves the innermost vital portion of the tooth, known as the pulp, so the tooth remains alive. The pulp lies in the core of the tooth, where reparative cells, nerves, and blood vessels are present. 

A pulp cavity is divided into two parts; coronal and root pulp. The coronal pulp lies in the crown portion of the tooth above the gums and the root pulp fills the root canals of the tooth. 

When does your child need pulpotomy?

Pulpotomy is a vital pulp procedure carried out to save the vitality of the baby tooth or newly erupted tooth.

It is attempted in deep cavities where there is a risk of pulp exposure upon removal of tooth decay. These cavities don’t show the signs of bacterial invasion into the pulp, but the pulp undergoes reversible reversible damage due to influx of bacterial products from the advancing cavity.

The symptoms indicating the pulp is reversibly damaged and can be saved are:

  • Episodes of mild pain in the tooth
  • Pain triggered on eating sweet foods
  • Black discoloration or cavity in the tooth

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Can you get a pulpotomy in permanent teeth?

Yes, it can be done in the newly erupted permanent teeth with open apex. When the tooth erupts, its terminal end is open. The root begins to taper and continues to increase in length after eruption and terminates at a small hole where nerves and blood vessles enter the tooth. On average, root completion takes 2-3 years.

Fall injuries are common among children with an injury or fracture to the front permanent tooth/teeth. If the injury involves enamel or dentin, the tooth is restored with a filling. However, if the pulp gets exposed, it can be saved with pulpotomy if intercepted within 24 hours. 

Pulpotomy allows root to grow and increase in length and pulp preservation is a prerequisite for root completion.

Pulpotomy shows limited success in permanent teeth with complete root formation because of limited pulp regenerative capacity and reduced vascular (blood) supply. 

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Is pulpotomy necessary in baby teeth?

Yes, a pulpotomy is necessary for the baby teeth because of the following reasons: 

  • To prevent the progression of infection in the root canals 
  • To save the developing permanent tooth from the spreading infection.
  • The baby teeth maintain the space for permanent teeth. Early loss of baby molars allow the 6 year molar (first molar) to move forward and occupy the space, leading to crowding in the permanent teeth.
  • The pulpotomy dressing stimulates dentin formation over the pulp in deep baby teeth cavities.

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What steps are involved in the pulpotomy procedure? 

The following steps are involved in the pulpotomy procedure:

X-ray of the tooth

The dentist will take an x-ray of the infected or injured tooth to see the spread of the infection. The x-ray confirms the extent of disease spread in the tooth and helps in diagnosis and treatment planning. 

Anesthesia given to the tooth

Depending on child’s cooperation, one of the following method is used to anesthetize the child’s tooth;

  • Anesthetic spray to numb the site of injection followed by a local anesthetic injection. 
  • Nitrous oxide inhalation is also used to sedate young children with a mask followed by a local anesthetic injection.

Rubber dam placement and Removal of tooth decay 

A sheet of rubber dam is placed to isolate the tooth from salivary contamination and accidental ingestion of the instrument. Next, the decay is removed with a high-speed dental drill.

Placement of pulp dressing or medicament  

Once all the decay has been removed, the infected pulp is amputated with a slow-speed dental drill. A cotton pellet is placed on the remaining pulp for two minutes to control the bleeding. If the bleeding stops, it indicates that the remaining pulp is healthy. 

A medicament is then applied to the pulp stump, and the pulp space/chamber is filled with a biocompatible base, zinc oxide eugenol base.

Filling the tooth 

If the tooth is expected to be retained in the mouth for two years, the removed enamel and dentin are replaced with a white or silver fillings to seal the tooth.

Placement of a silver crown 

Finally, a silver cap is placed on the restored tooth to protect it untill it exfoliates.

Click the link for full article on, Why do kids get silver caps on baby teeth?

What happens to the pulp after pulpotomy?

Pulpotomy saves the pulp in one of the following ways:

What are different dressings used during pulpotomy?

Any of these dressings can be used to preserve pulp. The most widely used medicament is formacresol, and the procedure is named formacresol pulpotomy.

Other materials used are 

Formecresol pulpotomy 

Formecresol is the most widely used material in pulpotomy. It is composed of equal parts of formalin and cresol. It is a very concentrated solution and is used in 1:5 dilution. 

This medicament mummifies coronal pulp leaving the root pulp vital. 

During formacresol pulpotomy, after the removal of tooth decay, a sterile cotton pellet is dipped in the diluted formacresol solution, and dabbed on the sterilized gauze to express the excess solution. The cotton pellet is finally applied to the pulp for 4-5 mins. 

What are modern methods of pulpotomy  

Cevk pulpotomy 

It is a partial pulpotomy where 2mm of the pulp tissue is removed, leaving the healthy pulp where the dressing is placed. The cevk pulpotomy saves cell rich superficial layer of the pulp that is more capable of repair.

Laser pulpotomy 

Laser pulpotomy is the latest technology to preserve the pulp. It efficiently stops bleeding, maintains the pulp vitality without vibration and odor, and shows better long-term results than the widely used formacresol pulpotomy. 

Electrosurgery pulpotomy 

The pulp amputation and bleeding are stopped by passing the high-frequency electric current through the pulp. The technique carbonizes, and heat denatures the pulp and bacteria. The electric current penetrates just a few cell layers deep into the pulp, so it doesn’t harm the root pulp. This procedure relatively quick and takes less time to complete. 

Pulpotomy vs. pulpectomy

In pulpotomy, the pulp shows reversible changes due to inflammation from the bacterial products entering the pulp from advancing cavity. The pulp heals if the superficial inflammed pulp is removed or the source of infection is removed. 

In a pulpectomy, the spread of bacteria in the pulp irreversibly damages the pulp and requires complete pulp removal.  

Conclusion 

Pulpotomy is a pulp therapy to keep decayed or injured teeth vital. It is done on the baby or newly erupted permanent teeth. 

In a pulpotomy, the decayed and inflamed pulp is removed, a soothing medication is placed, and the tooth is covered with a crown. 

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