How to do a pri-mary Tooth pulpotomy
Good local anaesthesia is paramount to achieving a pulpotomy. Compliance in children is hard enough without performing a procedure on them that is painful! Generally, all primary molars are able to achieve adequate anesthesia with a buccal infiltration of Articaine. However, on Occasions, you may need to place a block for a lower E.
Reduce the occlusal surface by around 1.5 2 mm with a (diamond) football bur (starting with this step will make caries removal and pulpal access quicker and easier).
Caries removal prior to pulpal access is required to reduce the bacterial load that the pulp may be exposed to and to ensure that the tooth is restorable. Then gain a small access to the pulpal chamber through the pulpal roof using a flat fissure bur..
Once you have gained some access, transition to a non-end cutting bur (we use an Endo-Z bur). Extend the opening over the entire pulpal roof to make sure you gain access to the whole pulp chamber. A common mistake is to not fully remove the roof, which leads to incomplete pulp removal from the chamber. Remain far from the floor of the pulp chamber with the high speed bu as it is very thin in primary teeth and easy to perforate. Use a spoon excavator to remove the remaining pulp in the chamber. On occasion, you may also need to use a large slow speed bur under irrigation to remove the remaining coronal pulp. Take great care around the floor of the chamber.
Removal of tags
This is a crucial step and one of several reasons many Paediatric Dentists do not like Ferric Sulphate (FS). The best indication of a healthy pulp is haemostasis within 5 minutes. Failure to achieve this means the tooth is indicated for extraction. If you use FS, you will achieve haemostasis immediately which can give you a false positive. We place a wet cotton pellet into the chamber and leave it for 3- 5 minutes (until haemostasis is achieved). We follow this with a hydrogen peroxide soaked pellet to assist with decontamination
We use wet gauze to pack the MTA into the chamber. The MTA ideally should extend slightly into the canal opening and be very wel condensed
We fill the the remaining bulk of the chamber with GIC, we use Fuji ll LC as we can cure it quickly.