pulpectomy filling material

Success rate of root canal treatments in primary teeth has been discussed in the literature. difficult to avoid the extrusion of filling materials beyond the root canals in all pulpectomy cases. Rubber dams are used on all teeth to prevent contamination of the root canal with microorganisms from the oral cavity. If the calcium hydroxide is placed in the canal too soon (before adequate healing of the periodontal ligament), however, it may stimulate replacement root resorption. 125, CH-8053 Zurich, Switzerland) may be preferable. CASE DESCRIPTION: The author presents two pulpectomy cases that were filled with Vitapex. Mature first primary molar canals are often so small that they are inaccessible even to the smallest barbed broach. 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. Root canal pluggers may be used to condense the filling material into the canals. 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. CLINICAL IMPLICATIONS: Vitapex is an excellent filling material for primary tooth pulpectomies. The canal should be filled approximately 2 weeks after the injury. 19-13). The laser technique required less time for completion of the cleaning and shaping procedures when compared with both rotary or hand instrumentation [. A pulpectomy is similar to a root canal, and is actually typically a part of the root canal process. 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. Leaky temporary filling will allow the root canals to become reinfected by bacteria in the saliva (coronal microleakage). ANDHRA PRADESH, India: The success of a pulpectomy depends on the elimination of bacteria from the root canal. 6. An x-ray film may be necessary to allow evaluation of the success in filling the canals (Fig. The root canals and pulp chamber are filled with special dental materials, and a dental filling … 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. However, many teeth do not revitalize. 35.8). The success rate with calcium hydroxide varied between 86.7 and 100% [10, 11]. The CaOH stimulated the formation of a cementoid barrier against which gutta-percha could subsequently be condensed. 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. (FIG. It is also "spun-down" into the canals using a lentulo spiral * running counter-clockwise on a slow speed handpiece. 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. Robert J. Adams, in Laboratory Animal Medicine (Second Edition), 2002. 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. 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. David T. Brown, Mathew T. Kattadiyil, in McDonald and Avery's Dentistry for the Child and Adolescent (Tenth Edition), 2016. 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. Further condensation may be carried out if required. evaluated clinically and radiographically a mixture of zinc oxide eugenol and aloe vera as an obturating mate- rial for Pulpectomy in a total of 15 primary molars for a period of 9 months.The incidence of pain present preoperatively reduced to 86.67% postoperatively. BACKGROUND: The pulpectomy is an underutilized treatment modality for severely infected primary teeth. This way the dentist removes all of the infected tissue and the tooth can be saved and not extracted. 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. Vitapex ZOE tends to resorb at a slower rate than the roots of the primary teeth [, ZOE extruded beyond the apices set into a hard cement that resists resorption (, The antimicrobial action of calcium hydroxide is associated with its ionic dissociation. Definition. 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). Pulpectomies, on the other hand, refer to the total removal of the pulpal tissue. In A Consumer's Guide to Dentistry (Second Edition), 2002. Similarly, longer-than-normal retention of a second primary molar may be desired when the succedaneous second premolar is congenitally missing (Fig. 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. This practice helps avoid irreparable damage in the form of root fracture in case the restored tooth is once again subjected to trauma. In the strictest sense, complete removal of the the pulp from the pulp chamber and canals is a pulpectomy. The tooth is then filled with material that can be reabsorbed by the body. Steps in pulpectomy. The pulp should be extirpated when the first signs of degeneration appear. Radiographic lesions present preoperatively should resolve within 6 months, as evidenced by bone deposition and a decrease or disappearance or at least no change in pretreatment radiolucent areas. A thick mix of ZOE (Zinc Oxide BP, Eugenol BP, Associated Dental Products Ltd, Purton, England) without setting accelerators may be pushed into the root canals using a suitable root canal plugger. Multiple visits over a period of 9 to 18 months were required, however, and the outcome was a shortened root with thin walls (Fig. An ideal pulpotomy dressing material should be biocompatible, capable of hard tissue formation, have disinfectant properties and lack of cytotoxity. Although this technique is more costly and time-consuming, it does give the investigator an opportunity to easily convert troublesome temporary caps to more durable crowns at a later date. A post obturation radiograph is … The pulpectomy completed by obturating with a cream past of ZOE introduced into the canal first using a file. Copyright © 2020 Elsevier B.V. or its licensors or contributors. It is challenging to select the appropriate filling materials for primary teeth. Pulpotomy using formocresol and electrosurgery has also been described (Shulman et al., 1987). Some have advocated a more permanent technique involving the placement of a permanent pulp cap (Reynolds and Hall, 1979). In addition, there should be no radiographic evidence of a thickened periodontal ligament or of radicular disease. 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. In a dog study where Vitapex was purposefully extruded beyond the apical foramen into the mandibular canal, radio- Because replantation should be done as soon as possible after the injury, the dentist should not take time to extirpate the pulp before replantation. If the supporting bone is also compromised, the likelihood of successful endodontic therapy is lower. The main advantages of KRI paste over zinc oxide–eugenol paste are that KRI paste resorbs in synchrony with primary roots and is less irritating to surrounding tissues if a root is inadvertently overfilled. Contraindications for RCT in primary teeth are discussed lengthily in the literature [, Lateral and accessory canals exist in most primary molars and are more prevalent in mandibular molars compared with maxillary ones [, A RCT in a primary second molar with a poor prognosis is sometimes indicated, even if that tooth is maintained only until the first permanent molar has erupted, and then the primary molar is extracted and replaced with a space maintainer [. A mixture of calcium hydroxide and zinc oxide as a root canal filling material for primary teeth: a preliminary study. Vitapex (New Dental Chemical Products Co. Ltd., Tokyo, Japan)/ Diapex: 30 % calcium hydroxide, 40.4 % iodoform, and 22.4 % silicone oil. Subsequently, when root formation is completed, a pulpectomy is performed, followed by placement of the definitive restoration or crown, if needed. 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. In primary teeth with irreversible pulpal changes, ZOE pulpectomies yielded similar outcomes as Vitapex and more favorable than Sealapex, a calcium hydroxide cement (SybronEndo, Orange, CA), although there was no agreement with regard to filling materials’ resorption . The primary components of KRI paste are zinc oxide and iodoform. Zinc oxide eugenol and aloe vera. Root canal treatment should be initiated 7 to 10 days after replantation. from Columbia South America): tri-iodmethane and iodine dibutilorthocresol (40.6 %), zinc oxide (56.5 %), calcium hydroxide (1.07 %), and barium sulfate (1.63 %) with a liquid consisting of eugenol and paramonochlorophenol, Without setting accelerators may be pushed into the root canals using a suitable root canal plugger, Introduced into the root canal using disposable tips or a spiral lentulo mounted on a slow-speed handpiece, Introduced into the root canal using a spiral lentulo. Slight difference if we are talking treatment or treatment defined by treatment codes. Materials used in pulpotomy dressing usually affect the success rate of pulpotomy. The success of pulpectomy in primary teeth depends on selecting the ideal root canal filling material. The morphology of the root canals in primary teeth makes endodontic treatment difficult and often impractical. Apexification using apical barrier technique. The partial pulpectomy technique, which may be completed in one appointment, involves the removal of the coronal pulp as described for the pulpotomy technique. Diagram illustrates the level at which the canine tooth should be cut in relation to adjacent teeth. Pulpectomy should not be confused with pulpotomy, ... the root canal and the pulp chamber are filled with an inert and non-absorbable material. Vitapex is also ideal for the treatment of infected root canals and for vital pulpotomies in deciduous teeth. 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. (1979) is excellent. 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. Dean, in McDonald and Avery Dentistry for the Child and Adolescent (Ninth Edition), 2011. This resorption causes the position of the apical foramen to change continually [. Pulpectomy and endodontic therapy are not common procedures in pediatric dentistry because of their occasional failure versus the success of pulpotomy procedures. James E. Jones, ... Ghaeth H. Yassen, in McDonald and Avery's Dentistry for the Child and Adolescent (Tenth Edition), 2016. Pulpotomy is a minimally invasive procedure performed in children on a primary tooth with extensive caries but without evidence of root pathology. Advantages: The tooth is maintained in service. Instead of separate holes in the rubber dam for each tooth, a slit is made so that the rubber can be placed over all teeth in the splinted segment. Zinc oxide eugenol or zinc oxide eugenol/iodoform combined with Ca(OH) 2 appears to be the materials of choice if primary teeth are not nearing exfoliation. No pathologic root resorption, furcation/apical radiolucency [, Radiographically, success is defined either as when the radiolucency observed at the baseline did not increase [. Cautious manipulation is important, however, to prevent breaking the file or overinstrumenting the canal and apical tissues. Andreasen suggested that 2 weeks after replantation is the ideal time to fill the canal with calcium hydroxide. If the canal cannot be properly cleansed of necrotic material, sterilized, and adequately filled, endodontic therapy is more likely to fail. The main advantages of KRI paste compared with zinc oxide–eugenol paste are that KRI paste resorbs in synchrony with primary roots and is less irritating to surrounding tissues if a root is inadvertently overfilled. In addition, the rubber dam helps prevent the swallowing or aspiration of foreign objects during treatment. - It decreases tooth pain. 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. It is challenging to select the appropriate filling materials for primary teeth. Pulpectomy: immediate root canal filling with calcium hydroxide. A Hedström file will be helpful in the removal of remnants of the pulp tissue. In cases in which an adjacent tooth is still unerupted, calcium hydroxide treatment is recommended until eruption of the adjacent tooth.55 It is believed that eruption may stimulate or accelerate the resorptive process in a nearby replanted root. Six clinical trials selected for inclusion were independently reviewed by two researchers. 13-16). ZINC OXIDE EUGENOL PASTE • It is the most commonly used root canal filling material for primary teeth. Rubber dam isolation is always desirable when pulp therapy is performed. Other techniques have employed epinephrine flushes or electrocautery to stop the bleeding and dry the root canal. — Pulpectomy for primary teeth can be carried out in a single visit, if the patient is not complaining of acute symptoms or there is no pus discharge from the canals . Restorations that do not use a post should be used whenever possible to replace missing tooth structure and serve as a retentive foundation. In the absence of rapidly progressing (inflammatory) root resorption, treatment is to obturate the canal with gutta-percha. Lasers are an effective alternative for treating pulps, with the additional benefit of providing pulp therapy without introducing chemicals into children's systems. The variations included lateral branching, connecting fibrils, apical ramifications, and partial fusion of the canals. 2001;19:107-109. The excess thin paste may be removed with paper points and Hedström files. More recently, the surgical techniques of pulpectomy and pulpotomy have been popularized as alternatives to canine tooth extraction. 6). The aqueous, viscous, or oily vehicle used in the formulation of the root canal filling paste impacts the speed of ionic dissociation. Dean, in McDonald and Avery's Dentistry for the Child and Adolescent (Tenth Edition), 2016. 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. ... this is a common result of this procedure and is due to the staining of the filling materials and the cement used. 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. 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. It’s usually performed on baby teeth. 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). 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. 13-13 and 13-14). This procedure involves anesthetizing the animal, in this case a nonhuman primate, and placing it on a surgery table in dorsal recumbency. Paper points are used to dry the canal and check for the presence of blood (Tomson et al., 1979). Pulpectomy is a dental procedure where the whole dental pulp is removed, both the coronal and radicular part. Under local anesthesia and rubber dam isolation, caries is removed and access to the pulp chamber is gained. The treatment should permit resorption of the roots of the primary tooth and filling material and allow normal eruption of the succedaneous tooth. 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. 13-15). Special effort should be made to treat and retain the second primary molar, even if it has a necrotic pulp. ... Parirokh M. Sealing ability of a novel endodontic cement as a root-end filling material. However, they are a source of infection and should be treated or removed. 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. Metapex (Meta Biomed Co., Ltd. Cheongju City, Korea): calcium hydroxide with iodoform, Kri paste(Pharmachemie AG, Switzerland): iodoform (80.8 %), camphor, parachlorophenol, menthol, Maisto’s paste: zinc oxide and iodoform, with parachlorophenol camphor, lanolin, and thymol, Endoflas (Sanlor & cfa. 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