Nonvital pulp treatment for primary teeth diagnosed with irreversible pulpitis or necrotic pulp
Pulpectomy
Pulpectomy is a root canal procedure for pulp tissue that is irreversibly infected or necrotic due to caries or trauma. The root canals are debrided and shaped with hand or rotary files. Since instrumentation and irrigation with an inert solution alone cannot adequately reduce the microbial population in a root canal system, disinfection with irrigants such as 1% sodium hypochlorite and/or chlorhexidine is an important step in assuring optimal bacterial decontamination of the canals. Because it is a potent tissue irritant, sodium hypochlorite must not be extruded beyond the apex. After the canals are dried, a resorbable material such as nonreinforced zinc/oxideeugenol, iodoform-based paste (KRI), or a combination paste of iodoform and calcium hydroxide (Vitapex®, Endoflax®) is used to fill the canals. The tooth then is restored with a restoration that seals the tooth from microleakage.
• Indications: A pulpectomy is indicated in a primary tooth with irreversible pulpitis or necrosis or a tooth treatment planned for pulpotomy in which the radicular pulp exhibits clinical signs of irreversible pulpitis (eg, excessive hemorrhage that is not controlled with a damp cotton pellet applied for several minutes) or pulp necrosis (eg, suppration, purulence). The roots should exhibit minimal or no resorption.
• Objectives: Following treatment, the radiographic infectious process should resolve in 6 months, as evidenced by bone deposition in the pretreatment radiolucent areas, and pretreatment clinical signs and symptoms should resolve within a few weeks. There should be radiographic evidence of successful filling without gross overextension or underfilling. The treatment should permit resorption of the primary tooth root and filling material to permit normal eruption of the succedaneous tooth. There should be no pathologic root resorption or furcation/apical radiolucency.
drsnehamaheshwari